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Pruritus

Pruritus is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Unpleasant sensation that provokes a desire to scratch
  • Mediated by unmyelinated C fibers in upper portion of dermis:
    • Transmitted to dorsal horn of spinal cord
    • Via spinothalamic tract to cerebral cortex
  • Peripheral mediators (e.g., histamine and peptides such as substance P that release histamine) stimulate C fibers and induce itching
  • Prostaglandins (PGE2, PGH2) lower threshold to pruritus
  • Opiates cause pruritus by acting on central receptors
  • No single pharmacologic agent effectively treats all causes of pruritus
  • “Itch–scratch–itch” cycle:
    • Itching triggers scratching
    • Scratching damages skin and stimulates nerve endings, thereby producing even greater itching

Etiology

4 categories in proposed itch classification:
  • Pruritoceptive: Generated in the skin from localized irritation or inflammation
  • Neurogenic: Generated in the CNS due to circulating pruritogens
  • Neuropathic: Due to CNS or PNS lesions
  • Psychogenic

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Citation

Rosen, Peter, et al., editors. "Pruritus." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307147/all/Pruritus.
Pruritus. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307147/all/Pruritus. Accessed April 24, 2019.
Pruritus. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307147/all/Pruritus
Pruritus [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 24]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307147/all/Pruritus.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Pruritus ID - 307147 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307147/all/Pruritus PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -