Senile pruritus is a type of idiopathic pruritus that develops in elderly people. Among the main causes of the problem are excessive dryness of the skin, chronic dermatoses, somatic diseases. Pathology is manifested by constant subjectively unpleasant sensations and the need for mechanical irritation of the skin for their relief. Comprehensive diagnosis requires dermatoscopy, a standard set of blood and urine tests, methods of instrumental visualization of internal organs. Treatment consists of intensive moisturizing of the skin, the use of local and systemic antipruritic agents, physiotherapy and psychotherapy techniques.
L29.8 Another itch
Senile pruritus is a common condition that worries more than 50% of people over 70 years old. Men get sick more often than women. Senile pruritus is a serious physical and psychological problem for patients, reduces the quality of life and causes persistent emotional disorders. Specialists in the field of practical dermatology face the difficult task of effectively relieving symptoms and eliminating their root cause, which is not always possible, despite the improvement of clinical protocols.
Skin pruritus in elderly patients refers to idiopathic diseases, its exact etiological factors have not yet been established. Most experts agree that both age-related changes in the structure of the skin and systemic disorders of the body, which are typical for elderly patients, play a role in the development of the problem. The main causes of senile pruritus include:
- Dry skin. In old age, histological rearrangements of the epidermis and dermis occur, the amount of hyaluronic acid decreases, the skin loses turgor and elasticity. Physiological changes cause severe dryness, which, in the absence of adequate cosmetic care, causes pruritus.
- Skin diseases. Unpleasant sensations develop against the background of eczema, fungal infections, scabies and other dermatoses, which can occur with scant objective signs. Often, diseases are not diagnosed in time due to the late access of elderly people to a doctor.
- Metabolic disorders. The main causes of the formation of senile pruritus include atherosclerosis, iron deficiency anemia, decreased glucose tolerance and the development of type 2 diabetes mellitus. Occasionally, the problem is associated with hypothyroidism, insufficiency of adrenal function.
- Diseases of internal organs. Typical causes of pruritus in elderly people are cholestasis, chronic renal failure, functional and organic diseases of the gastrointestinal tract. An unpleasant symptom may be one of the first signs of oncopathology of the abdominal organs, the central nervous system.
Pruritus is considered one of the options for the perception of irritation by a skin analyzer. It occurs by the same mechanisms as the feelings of touch, pain reactions. Sensations are caused by mechanical, thermal, chemical and electrical influences on peripheral nerve fibers of type C, which make up about 5% of nerves and are characterized by slow conduction of impulses. Mediators contribute to the appearance of the symptom: histamine, substance P, interleukins and prostaglandins.
Unlike pain, which provokes an unconditional “avoidance” reflex, processing processes are activated with pruritus. Impulses arising in the cerebral cortex stimulate a person to scratch, rub, knead itchy areas in order to get instant satisfaction. Such actions cause strong tactile and painful impulses that suppress weak pruritus signals and relieve the condition for a short time.
It is assumed that age-related transformations of the structure of nerve fibers play a role in the development of senile pruritus. In the senile period, the perception of pain is disrupted, the central mechanisms of pruritus inhibition change, so this symptom is more persistent and painful than in young people. A 20% reduction in skin thickness is also involved in the pathophysiology of itchy dermatosis.
Initially, there is an unpleasant subjective feeling, which is accompanied by a constant desire to comb the skin to get rid of it. For senile age, generalized pruritus is typical, which mainly begins in the back and trunk, gradually spreading throughout the body with the capture of the scalp. Many patients complain that the symptoms get worse when they take off their clothes at night.
In the idiopathic form of pruritus, there are no inflammatory elements and rashes on the skin. Gradually, crusts and excoriations form against the background of combs, the skin thickens, becomes covered with cracks and peeling. With deep and repeated damage, bloody crusts are observed in certain areas of the body. Due to the habit of scratching itchy skin, the nails on the hands of patients become smooth and polished.
Senile pruritus significantly affects the general condition and quality of life of the elderly. Long-term symptoms cause insomnia, supplemented by agitation and irritability of patients. In severe cases of uncontrolled generalized pruritus, depressive states occur, accompanied by suicidal thoughts and individual attempts to implement them.
Wounds that form at the site of deep skin scratches become the entrance gate for secondary infection. Against the background of a physiological decrease in immunity in old age, there is a high risk of pyoderma, skin mycoses. In adverse cases, infectious agents spread deep into the soft tissues, causing phlegmons, long-term non-healing ulcers.
Senile pruritus is considered as an exception diagnosis, therefore, an examination by a dermatologist and other specialized specialists is required for its formulation. Diagnosis begins with a detailed clarification of the patient’s complaints, the prescription of symptoms and possible provoking factors. Then an external examination of the skin of the body is carried out to identify possible primary signs of dermatosis. The full examination program includes the following methods:
- Dermatological diagnostics. All patients are examined by dermatoscopy, and if mycosis is suspected, fluorescent diagnostics with a Wood lamp is shown. In case of secondary infection of the combs, a bacteriological examination of the smear or scraping of the damaged areas is required.
- Laboratory complex. To clarify the metabolic status and the presence of somatic problems, a hemogram, a biochemical blood test with liver samples and a lipidogram, urine and stool tests are performed. Be sure to determine the fasting glucose level, according to the indications, an extended hormonal profile is performed.
- Instrumental methods. Ultrasound of the abdominal cavity and pelvis, thyroid sonography, contrast radiography of the gastrointestinal tract are prescribed as screening methods to exclude diseases of the internal organs.
- Consultation of a psychiatrist. Given the high frequency of senile dementia and senile psychoses, in the absence of other causes of skin symptoms, a psychiatric examination is recommended. If necessary, a neurologist is connected to the diagnosis, brain CT and other neuroimaging methods are performed.
Patients are prescribed complex symptomatic therapy, which is determined by the duration and severity of clinical manifestations. A significant role in the correction of subjective symptoms is played by non-drug measures, such as water procedures with the use of gentle cosmetics, wearing light clothing made of natural fabrics, maintaining comfortable humidity and temperature in the apartment.
The triggering factor of senile pruritus is xerosis, so measures for deep hydration and nutrition of the skin come to the fore. For daily care, emollients are recommended that combine emollient, regenerating, antioxidant and moisturizing components. Recommended lines of pharmacy and professional cosmetics created for the care of dry and sensitive skin. In addition to them, a medical correction is prescribed:
- Local therapy. Creams and balms with local anesthetics, calcineurin inhibitors are used for local application to the areas of the greatest intensity of pruritus. Antipruritic hormonal ointments show a good effect on dry skin in old age.
- Antihistamines. Medications are indicated for the rapid relief of itchy sensations. They act on the pathogenetic mechanisms of the appearance of senile pruritus, provide a good symptomatic effect. In addition, hyposensitizing agents, stabilizers of mast cell membranes are prescribed.
- Sedatives. Light anxiolytics, selective serotonin reuptake inhibitors are used to normalize the psychoemotional background, eliminate the pathological cycle of “pruritus–combing”.
To enhance the effect of drug treatment, physiotherapy procedures are used: acupuncture, reflex laser therapy and magnetotherapy, percutaneous nerve stimulation. According to the indications, individual psychotherapy is prescribed, aimed at correcting psychoemotional disorders, taking into account the peculiarities of the psychology of senile age. If other types of therapy are ineffective, the possibility of using hypnosis is considered.
Prognosis and prevention
Although senile pruritus does not belong to threatening diseases, painful symptoms significantly complicate the patient’s life. Comprehensive therapy programs show good effectiveness for reducing or completely eliminating subjective signs, but often after treatment, unpleasant sensations return. Prevention of the problem includes proper care of senile skin, early detection and correction of somatic disorders without polypragmasia.