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Chronic Itching in the Elderly

1. Itch Management in the Elderly: Download Itch Management in the Elderly

Leslie TA1. Curr Probl Dermatol. 2016, 50, 192–201 

Abstract

Itch is a common symptom in the elderly population over 65 years old, and is often a chronic condition lasting more than 6 weeks. As in all age groups, but especially in the elderly, there can be a significant effect on the general health status and quality of life, with impaired daily activities and lack of sleep, which can also lead in some cases to depression or anxiety. The cause of chronic itch in the elderly is often multifactorial due to physiological changes in the aging skin, including impaired skin barrier function, and also due to decline in immunological (immunosenescence), neurological, and psychological changes associated with age. Common causes of chronic pruritus in the aging skin include xerosis (dry skin), dermatological disorders (eczema, psoriasis, lichen planus), and systemic (renal, hepatic, endocrine), neurodegenerative, and psychological diseases. Comorbidities in the elderly population lead to polypharmacy, increasing the potential risk of drug side effects, which can result in causing or exacerbating itch in the elderly patient. It is essential to obtain a detailed history, including drugs, as well as a thorough clinical examination with appropriate subsequent investigations. Management of the elderly patient with chronic pruritus should include treatment with topical therapies such as emollients as well as other agents for symptomatic relief. Systemic therapies should be directed at any underlying cutaneous or systemic diseases. Often the cause of itch in the elderly cannot be found and some systemic treatments can be used for symptomatic control of the itch, including antihistamines, gabapentin, and selective antidepressants. A holistic approach needs to be taken on an individual basis to relieve chronic pruritus, as the management of itch in the elderly can be a challenge.

 

2. Causes, pathophysiology, and treatment of pruritus in the mature patient.

Shevchenko A1, Valdes-Rodriguez R1, Yosipovitch G2. Clin Dermatol. 2018 Mar - Apr;36(2):140-151

Abstract: Download Causes of Pruritus in Elderly

Chronic itch is a common and debilitating health condition in the elderly. There are several common causes of itch in the mature population, such as skin xerosis, immunosenescence, and neuropathic changes. In addition, skin diseases, such as seborrheic dermatitis and stasis dermatitis, systemic conditions (end-stage renal disease and diabetes), or psychogenic derailments, such as depression, anxiety, and dementia, can all serve as triggers of pruritus. Polypharmacy, a common occurrence among the elderly population, may also serve as a cause of itch that may or may not be accompanied by dermatitis. Such medications as μ opioids and calcium channel blockers have been found to have a connection with pruritus in the advanced aging population. Determining the exact trigger for pruritus in the elderly may be especially challenging, because itch can be idiopathic in many cases. The role of treatments should not only take into account elimination of various underlying cutaneous, systemic, or psychogenic conditions associated with itch but also focus on the skin changes that are characteristic of the aging process. Development of such treatment options can be guided by elucidation of the mechanisms underlying the pathophysiology of itch in the geriatric population.

Sunscreen Bans

Most Sunscreens Appear to Damage Coral Reefs

NY Times, November 2, 2018

The Western Pacific nation of Palau has become the first country to ban many kinds of sunscreen, in a move to protect its coral reefs from chemicals that scientists say cause significant damage.

Under the ban, which will take effect in 2020, “reef toxic” sunscreen — defined as containing one of 10 prohibited chemicals, a list that could grow later — can be confiscated from tourists when they enter the country, and retailers who sell it can be fined up to $1,000.

Palau's ban comes after Hawaii in July banned the sale of sunscreen containing the chemicals oxybenzone and octinoxate from 2021 in an attempt to protect its reefs. In Hawaii, however, tourists will still be able to bring the banned sunscreen with them into the state or buy it there if they have a doctor's prescription.

This NY Times article is a good introduction to this area, Palau Bans Many Types of Sunscreen to Protect Its Coral Reefs.

 

 

Use and Cost of Actinic Keratosis Treatment for Medicare 2007 - 2015

See article in JAMA Dermatology

CONCLUSIONS AND RELEVANCE This study’s findings suggest that actinic keratosis imposes continuously increasing levels of treatment burden in the Medicare fee-for-service population. Reimbursement decreases have been used to control rising costs of actinic keratosis treatment. Critical research may be warranted to optimize access to actinic keratosis treatment and value for prevention of keratinocyte carcinoma.

Download Yeung JAMA AKs