2012년 제63차 대한내과학회 추계학술대회 □
노년내과 심포지엄-흔한 노인질환의 최근진료지침
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노인 피부 가려움증의 감별진단
건국대학교 의학전문대학원 피부과학교실
최 용 범
DEFINITION OF PRURITUS
An unpleasant sensation that may lead to intensive scratching
CLASSIFICATION OF ITCH PROPOSED BY INTER- NATIONAL FORUM FOR THE STUDY OF ITCH (IFSI)
Group 1- usually associated with dermatologic disease.
Group II and III-may suffer from systemic, neurologic, or psychogenic pruritus.
PRURITIC SKIN DISEASES OCCURING IN THE ELDERLY
1. Xerosis
2. Inflammatory disease
Dermatitis, drug reactions, urticaria, neurodermatitis 3. Erythematous papulosquamous disease
Seborrheic dermatitis, psoriasis, lichen planus.
4. Autoimmune blistering disease
Bullous pemphigoid, pemphigus vulgaris..
5. Autoimmune connective tissue disease
Dermatomyositis, systemic sclerosis, Sjogren syndrome 6. Skin infection and infestation
Tineas, Scabies, pediculosis, insect bites and arthropod reactions.
7. Cutaneous lymphomas
Mycosis fungoides and its variants, Sezary syndrome
SYSTEMIC DISESEASE ACCOMPANIED BY GENERALIZED PRURITUS
1. Liver disease
Primary biliary cirrhosis, primary sclerosing cholangitis, extrahepatic chholestasis, hepatitis B and C
2. Kidney disease
Chronic kidney insufficiency 3. Hematologic disease
Anemia, Polycythemia vera, Leukemias, Hodgkin`s disease
4. Endocrine disorder
Hyperthyroidism, hypothyroidism, hyperparathyroidism, Diabetes
5. Neurologic diseae Neuropathic pruritus
6. Brain injury/tumor(frequently unilateral pruritus) 7. Carcinoid syndrome
8. Infectious disease HIV, Infestations
LABORATORY EVALUATION 1. CBC with differential count 2. Serum iron level
3. Serum urea and creatinine 4. Liver function test
－ 2012년 제63차 대한내과학회 추계학술대회 －
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6. Thyroid function test 7. Stool examination for parasite 8. KOH smear for scabies
AGING AND FUNCTIONAL CHANGES IN THE SKIN 1. A decline in barrier function, physical protection, sensory
perception, wound healing, temperature regulation, vitamin D production, sweat and sebaceous secretions, and immunologic responsiveness to infection.
2. A decline in absorption of topically applied medication.
3. Flattening of the dermal-epidermal junction resulting in the skin of the elderly more prone to tear and blister.
4. A decrease in the production of epidermal keratin and decrease in the number of melanocytes
5. A decrease in the production of vitamin D 6. Up to 20% decrease in dermal thickness
7. loses up to 50% of the mast cells and decline in the cutaneous blood flow
8. Collagen atrophy and impairment of its synthesis and elastin breakdown.
9. A reduction in the amount and distribution of subcutaneous fat
10. graying of hair and reduction of hair growth
11. reduced eccrine, apocrine and sebaceous gland activity
COMMON SKIN DISORDERS ASSOCIATED WITH PRURITUS IN THE ELDERLY
Seborrheic Dermatitis
affects the scalp, face (eyebrows, eyelids, and skin between the nose and upper lip), the central part of the body (trunk)
and other areas where sebaceous glands are found in abundance.
becomes itchy, red, flaky and causes dandruff when the scalp is affected.
it may be due to: an inflammatory reaction to Malassezia furfur (a fungal infection), environmental, genetic, hormonal and immunologic causes.
Temporary hair loss may occur when the scalp is affected
treated by using shampoos or topical lotions or creams that contain sulfur, selenium sulfide, climbazole, pyrithione, salicylic acid, tar, ketoconazole or a combination of two or more of these.
In severe cases topical corticosteroids.
no permanent cure, but serious complications are rare and symptoms are usually manageable
Xerosis cutis
rough, dry skin with fine scaling and occasional appearance of fine cracks
as a result of a decrease in the amounts of oily secretions (sebum) from the sebaceous glands, allowing water loss from the skin.
can be aggravated by environmental factors such as low humidity, frequent bathing and the use of harsh soaps
MANAGEMENT OF UREMIC PRURITUS
REFERENCES
1. Yosipovitch G, et al. Pathophysiology and clinical aspects of pruritus. Fitzpatrick`s Dermatology in General Medicine. 8th edition;1146-1158.
2. Reich A, Ständer S, Szepietowski JC. Prutitus in elderly Clin Dermatol. 2011;29(1):15-23.
3. Farage MA, Miller KW, Berardesca E, Maibach HI. Clinical implications of aging skin: cutaneous disorders in the elderly. Am J Clin Dermatol. 2009;10(2):73-86.
