pruritus
Introduction
Introduction to pruritus Pruritus is one of the most common skin diseases in the clinic, especially in the elderly. It is characterized by itching, and no primary damage, clinically can be divided into two types: limited and systemic. basic knowledge The proportion of sickness: 0.06%-0.4% Susceptible people: no special people Mode of infection: non-infectious Complications: folliculitis
Cause
Cause of pruritus
Visceral disease (20%):
Stomach, intestine, liver, kidney and other internal organs have functional or organic diseases, especially in patients with diabetes, uremia, and liver disease, often with generalized itching; some tumors such as leukemia, lymphosarcoma, He Jie Skin itching occurs in patients with King's disease, mycosis fungoides, and malignant lymphoma.
Neuropsychiatric disorders (20%):
Neuropsychiatric disorders Cerebral arteriosclerosis, spinal cord spasm, neurasthenia can also occur systemic or limited skin itching, clinically common neurosis patients have some kind of hallucinations, think that there are insects in the skin and itching, and some Develop a habit of scratching.
Endocrine disorders (15%):
Endocrine disorders Some women often have pruritus during pregnancy, usually disappearing after childbirth. Menstrual disorders or ovarian diseases often cause genital itching in the female. The skin itching in the elderly may be related to the decrease of sex hormone levels in the body. Patients with thyroid disease may have Itching.
Infection of the lesion, drug (10%):
In addition to the above, infections of the lesion, drugs, diet (alcoholism), food allergies and infections by parasites or fungi can cause systemic or limited itching.
Temperature change (15%):
Changes in temperature often cause itching of the skin. Winter pruritus and summer pruritus patients are extremely sensitive to changes in temperature. They are too hot, and sudden onset of heat or cold may cause itching.
Mechanical friction or stimulation of physical and chemical factors (10%):
Mechanical friction or stimulation of physical and chemical factors can cause local itching, such as some people are sensitive to wool, some alkaline too strong soap, wearing chemical fiber wool and so on.
Disinfectant (5%):
In addition, disinfectants, insecticides, deodorants, dyes and other irritants can cause local itching.
Prevention
Pruritus prevention
(1) Try to find out the cause of the disease and treat the primary disease.
(B) avoid hot water scalding, avoid irritating drugs.
(3) Try to avoid contact with allergic or sensitive substances and reduce the environment in which the temperature difference changes drastically.
Complication
Pruritic complications Complications folliculitis
Systemic pruritus due to scratching a wide strip or spotted scratches, blood stasis, pigmentation, and eventually skin hypertrophy can be secondary infections such as folliculitis, bloated and so on.
Symptom
Symptoms of pruritus Common symptoms Light and heavy night itching Itching Itchy skin Itching of the thighs inside the erythema groin itch Skin itching scratches hands and feet itchy
According to the scope of itching, the disease is divided into systemic or limited.
1. systemic pruritus (pruritus universalis)
The patient has a feeling of itching throughout the body, but it is not itchy at the same time. It often moves from one place to another. The degree of itching is not the same. Some people feel itchy but still tolerable. Some patients can still bear it. I feel that the whole body is itchy, I need to use iron brush to brush the skin or hot water to wash, until the skin is bleeding and feel pain and burning, the itching is temporarily relieved, often itching in the evening, the patient is insomnia due to itching or can not sleep, due to Intense itching, constant scratching, scratches, bloody, or strip-like scratches, sometimes eczema-like changes, mossy changes or pigmentation, scratched skin is also susceptible to infection and edema or folliculitis.
Old-age pruritus occurs in the elderly and tends to be the most itchy in the trunk; winter pruritus occurs in the cold season, induced by the cold, the patient often begins to feel the anterior medial side of the thigh, the calf and other parts of the genital genital itching, the more the more Itchy, and the more itching, the more it catches until local bleeding.
2. Limited pruritus is more common in the anus, female genitals and scrotum.
(1) Anal pruritus is the most common localized pruritus, more common in middle-aged men, often confined to the anus, sometimes spreading forward to the scrotum, backward to the sides of the gluteal sulcus, women can also develop disease, children suffering from sputum Insect disease can also cause anal pruritus, the skin around the anus is usually grayish white or pale white, the anus is wrinkled and fat, and the radiation is cleft due to scratching; sometimes secondary infection occurs; after a long time, the skin around the anus is thickened. Pigmentation can also occur, and pigmentation can also occur.
(2) Female pruritus mainly occurs in the labia majora and labia minora. Yin sputum and clitoris can also occur. Because itching is often scratched, the skin of the vulva is thick, grayish white, and the clitoris and vaginal mucosa are red and swollen.
(3) pruritus pruritus pruritus occurs in the scrotum, but can also affect the penis or anus, due to constant scratching, scrotal skin hypertrophy, and pigment changes, or moss-like changes, some patients can see erosion, exudation and scarring and eczema Kind of change.
Examine
Pruritus examination
The exact medical history helps to understand the patient's disease process. Carefully and comprehensively examine the skin and its appendages to assess primary and secondary damage, distribution, dryness of the skin, and skin signs of systemic disease.
Full physical examination includes lymph nodes, liver and spleen. Laboratory tests for patients with unexplained generalized pruritus may be required, including erythrocyte sedimentation, whole blood cell analysis, liver and kidney function, blood glucose, thyroid and parathyroid function tests, serum iron and ferritin, viral hepatitis screening, HIV Detection, serum protein electrophoresis, serum IgE levels, skin immunofluorescence, chest X-ray, abdominal B-ultrasound, urine routine, urine pregnancy-free test, check eggs and occult blood, skin scraping inspection aphids. It has been reported that 3% to 47% of patients with generalized pruritus who cannot be explained by skin diseases have visceral cancer. Studies have also shown that there is no significant increase in the incidence of malignant tumors in patients with idiopathic pruritus and therefore does not support comprehensive cancer screening.
Diagnosis
Diagnosis of pruritus
diagnosis
The diagnosis of this disease is based on systemic or localized itching without primary skin damage, only secondary rash, the general diagnosis is not difficult.
Differential diagnosis
Need to be identified with the following diseases.
1. Although hemorrhoids have severe itchy skin at night, there are papules, blister tunnels and scrotum, penis, and nodules of the labia majora. There are often family history, and aphids can be found locally.
2. Scrotal eczema is sometimes difficult to identify, carefully question the history, there may be acute eczema process, visible papules, blister exudation and scarring, mossy is not obvious.
