Study Finds Pruritus Common in Elderly Patients

SAN DIEGO – Nearly half of elderly patients admitted to a geriatric ward reported having symptoms of pruritus, results from a single-center study found.

"Pruritus is a common complaint among the elderly," Dr. Yee Leng Teoh and colleagues wrote in an abstract presented during a poster session at the annual meeting of the American Academy of Dermatology. "It may have a significant impact on quality of life, but may be underestimated and poorly addressed."

In a study of 194 patients admitted to the geriatric ward of Changi General Hospital, Singapore, between March and May of 2010, Dr. Teoh and associates used a structured questionnaire including the Dermatology Life Quality Index (DLQI) to assess the prevalence and severity of itch and its impact on quality of life. They reviewed the patients’ hospital records regarding comorbid conditions, prior skin disease, medication use, and social background.

The mean age of the patients was 85 years, and their mean DLQI score was 6.7. Nearly half (49%) reported having a problem with itch for a mean of 15.3 months. Negative impacts on quality of life included disruption of sleep (reported by 35% of respondents) and disruption of mental concentration (reported by 31% of respondents).

More than half of patients (61%) said they had informed a physician about the problem, yet 26% believed that it was not sufficiently addressed. Twenty patients (10%) were diagnosed with a specific dermatologic condition, most commonly eczema and dermatophyte infection.

Of the participants who had informed their physician about the problem, 58% were treated with topical agents, 4% with oral antihistamines, and 33% with topical agents and oral antihistamines; 5% did not receive any treatment.

Study participants with a history of cerebrovascular accidents or transient ischemic attacks were 3.5 times more likely to have itch, compared with those who did not have this history. And patients with diabetes were 2.2 times more likely to have itch, compared with those who did not have the condition.

This may be because "sympathetic dysfunction caused hypohidrosis and resulted in xerosis," they hypothesized. "Another possible explanation is that patients with diabetic polyneuropathy, usually as a result of poor diabetic control, have damaged sensory C fibers, which can cause pruritus."

The study also found that elderly patients being treated with laxatives were 2.1 times less likely to have itch, compared with patients not taking laxatives. "We postulate that laxatives may facilitate the clearing of bile acids, resulting in a reduced incidence of itch," Dr. Teoh and associates wrote. "Lactulose can inhibit formation of deoxycholic acid from primary bile acids. This effect is thought to be mediated through the acidification of the proximal bowel, leading to reduction in 7 alpha-dehydroxylase, which converts primary to secondary bile acids."

The researchers reported having no relevant financial disclosures.

SAN DIEGO – Nearly half of elderly patients admitted to a geriatric ward reported having symptoms of pruritus, results from a single-center study found.

"Pruritus is a common complaint among the elderly," Dr. Yee Leng Teoh and colleagues wrote in an abstract presented during a poster session at the annual meeting of the American Academy of Dermatology. "It may have a significant impact on quality of life, but may be underestimated and poorly addressed."

In a study of 194 patients admitted to the geriatric ward of Changi General Hospital, Singapore, between March and May of 2010, Dr. Teoh and associates used a structured questionnaire including the Dermatology Life Quality Index (DLQI) to assess the prevalence and severity of itch and its impact on quality of life. They reviewed the patients’ hospital records regarding comorbid conditions, prior skin disease, medication use, and social background.

The mean age of the patients was 85 years, and their mean DLQI score was 6.7. Nearly half (49%) reported having a problem with itch for a mean of 15.3 months. Negative impacts on quality of life included disruption of sleep (reported by 35% of respondents) and disruption of mental concentration (reported by 31% of respondents).

More than half of patients (61%) said they had informed a physician about the problem, yet 26% believed that it was not sufficiently addressed. Twenty patients (10%) were diagnosed with a specific dermatologic condition, most commonly eczema and dermatophyte infection.

Of the participants who had informed their physician about the problem, 58% were treated with topical agents, 4% with oral antihistamines, and 33% with topical agents and oral antihistamines; 5% did not receive any treatment.

Study participants with a history of cerebrovascular accidents or transient ischemic attacks were 3.5 times more likely to have itch, compared with those who did not have this history. And patients with diabetes were 2.2 times more likely to have itch, compared with those who did not have the condition.

This may be because "sympathetic dysfunction caused hypohidrosis and resulted in xerosis," they hypothesized. "Another possible explanation is that patients with diabetic polyneuropathy, usually as a result of poor diabetic control, have damaged sensory C fibers, which can cause pruritus."

The study also found that elderly patients being treated with laxatives were 2.1 times less likely to have itch, compared with patients not taking laxatives. "We postulate that laxatives may facilitate the clearing of bile acids, resulting in a reduced incidence of itch," Dr. Teoh and associates wrote. "Lactulose can inhibit formation of deoxycholic acid from primary bile acids. This effect is thought to be mediated through the acidification of the proximal bowel, leading to reduction in 7 alpha-dehydroxylase, which converts primary to secondary bile acids."

The researchers reported having no relevant financial disclosures.

SAN DIEGO – Nearly half of elderly patients admitted to a geriatric ward reported having symptoms of pruritus, results from a single-center study found.

"Pruritus is a common complaint among the elderly," Dr. Yee Leng Teoh and colleagues wrote in an abstract presented during a poster session at the annual meeting of the American Academy of Dermatology. "It may have a significant impact on quality of life, but may be underestimated and poorly addressed."

In a study of 194 patients admitted to the geriatric ward of Changi General Hospital, Singapore, between March and May of 2010, Dr. Teoh and associates used a structured questionnaire including the Dermatology Life Quality Index (DLQI) to assess the prevalence and severity of itch and its impact on quality of life. They reviewed the patients’ hospital records regarding comorbid conditions, prior skin disease, medication use, and social background.

The mean age of the patients was 85 years, and their mean DLQI score was 6.7. Nearly half (49%) reported having a problem with itch for a mean of 15.3 months. Negative impacts on quality of life included disruption of sleep (reported by 35% of respondents) and disruption of mental concentration (reported by 31% of respondents).

More than half of patients (61%) said they had informed a physician about the problem, yet 26% believed that it was not sufficiently addressed. Twenty patients (10%) were diagnosed with a specific dermatologic condition, most commonly eczema and dermatophyte infection.

Of the participants who had informed their physician about the problem, 58% were treated with topical agents, 4% with oral antihistamines, and 33% with topical agents and oral antihistamines; 5% did not receive any treatment.

Study participants with a history of cerebrovascular accidents or transient ischemic attacks were 3.5 times more likely to have itch, compared with those who did not have this history. And patients with diabetes were 2.2 times more likely to have itch, compared with those who did not have the condition.

This may be because "sympathetic dysfunction caused hypohidrosis and resulted in xerosis," they hypothesized. "Another possible explanation is that patients with diabetic polyneuropathy, usually as a result of poor diabetic control, have damaged sensory C fibers, which can cause pruritus."

The study also found that elderly patients being treated with laxatives were 2.1 times less likely to have itch, compared with patients not taking laxatives. "We postulate that laxatives may facilitate the clearing of bile acids, resulting in a reduced incidence of itch," Dr. Teoh and associates wrote. "Lactulose can inhibit formation of deoxycholic acid from primary bile acids. This effect is thought to be mediated through the acidification of the proximal bowel, leading to reduction in 7 alpha-dehydroxylase, which converts primary to secondary bile acids."

The researchers reported having no relevant financial disclosures.