Pruritus is a skin disease associated with conditions pertaining to autoimmune disorders and other advanced complications like liver cirrhosis. Pruritus cases vary from mild to complex as the symptoms associated with the condition generally aggravate with age. Untreated pruritus can be a big hindrance to an individual's normal life as it interferes with sleep patterns leading to irritability and stress. In some cases the causative agent for this disease is the Hepatitis C virus which accounts in 20% of the population.
Pruritus occurs mostly in the wrist and ankles as a scratch. The intensity of the itch facilitates other factors such as eczema, impetigo and induced urticaria. The immune response releases histamines causing allergic reactions. The association of pruritus with allergic reactions is identified by the presence of serotonin. The serotonin release caused because of pruritus occurs in case of preexisting medical conditions such as polycythemia, lymphoma and cholestasis.
The identification and diagnosis of pruritus is closely associated with the evaluation of dermatological condition of the patient. Progressive pruritus is noticed with contact dermatitis, urticaria, scabies, pediculous infections of the genital region, folliculitis and xerotic eczema.The factors associated with the respective causes along with pruritus are fomites, dust, bites, chemicals and photosensitivity. Atopic dermatitis induces aggressive form of pruritus. The intense forms of atopic dermatitis associated pruritus usually occur in pregnant women, infants and veterans. Systemic causes of pruritus involve preexisting conditions such as Hodgkin's lymphoma, HIV, scleroderma, multiple myeloma, chronic renal failure and many other conditions.
Pruritus diagnosis involves meticulous procedures in examining the exact history of the patient to rule out other forms of allergic reactions. The information pertaining to the patient history includes several factors such as travel zones, food and occupation. Differentiation of non-septic and septic forms is done to identify systemic involvement of the disease. Secondary infections and malignancies associated have to be identified. Specific sites are identified on the skin reaction to respective drug therapy is carefully monitored.
Avoid stress which delays the healing process. Topical creams are prescribed for allergic forms of pruritus. Skin cleansing is an important step. It is predominantly done to prevent secondary infections and conditions such as psoriasis. Patients who have history of sunburn and sensitivity to extreme temperatures need to relieve the stress upon immune system that reacts immediately to such conditions. Hydration of the skin helps in the restoration of the skin cells to facilitate the process of healing. Change of diet and lifestyle is prescribed to patients who are sensitive foods such as nuts, seafood etc. Patients with a history of contact dermatitis are advised to use skin safe deodorants, shampoos and bubble bath solutions. Oral antihistamines are recommended to ease the immune system's reactivity. Hot water bath and tight clothing are to be avoided in case of pruritus as it may aggravate the condition. Topical creams containing corticosteroids are recommended during the onset of a pruritic reaction. In case of secondary infections associated with pruritus, antibiotics are given.
Vulvitis or vulvovaginitis is a condition where the vulval opening becomes inflamed. It can occur due to poor hygiene, UTI, allergy or vaginitis and mycotic infections. Symptoms of vulvitis include burning, itching, redness and swelling in the vulva and vaginal opening. Acute vulvitis is characterized by edema of the vulva and pruritis. There is acute pain and burning. On the other hand, chronic vulvitis has lesser symptoms. It can be causes by allergies, fungal or bacterial infection, low estrogen levels or genital warts. Cold compress can give relief from acute vulvitis. Cortisone ointments can reduce the itching. Avoid tight clothes and materials like nylon and polyester. Oral antihistamines can give relief. Corticosteroids are prescribed for inflammation and pruritus.
Vulvar vestibulitis is another similar condition that is characterized by urinary frequency, Dyspareunia and rawness and burning. Women suffer vestibular redness and itching. Severe pain is felt during exercising and intercourse. On the other hand, vaginismus is painful sexual intercourse. This mostly happens due to inadequate sexual arousal. Usually women suffering vaginismus are offered sexual therapy and suggested Kegels exercises.
Bibliography / Reference
Collection of Pages - Last revised Date: March 18, 2019