managing the patient with chronic itch · inflammatory (eczema/ psoriasis/ lp) ! urticaria !...
TRANSCRIPT
![Page 1: Managing the Patient with Chronic Itch · Inflammatory (Eczema/ Psoriasis/ LP) ! Urticaria ! Scabies ! Tinea ! Bullous Pemphigoid ! Dermatitis Herpetiformis ! Cutaneous Lymphoma Differential](https://reader033.vdocuments.net/reader033/viewer/2022053110/607f0d4760ed4d61022b7d82/html5/thumbnails/1.jpg)
Managing the Patient with Chronic Itch Dr Nicky Jackson
![Page 2: Managing the Patient with Chronic Itch · Inflammatory (Eczema/ Psoriasis/ LP) ! Urticaria ! Scabies ! Tinea ! Bullous Pemphigoid ! Dermatitis Herpetiformis ! Cutaneous Lymphoma Differential](https://reader033.vdocuments.net/reader033/viewer/2022053110/607f0d4760ed4d61022b7d82/html5/thumbnails/2.jpg)
Differential Diagnosis
� Rash or No Rash
![Page 3: Managing the Patient with Chronic Itch · Inflammatory (Eczema/ Psoriasis/ LP) ! Urticaria ! Scabies ! Tinea ! Bullous Pemphigoid ! Dermatitis Herpetiformis ! Cutaneous Lymphoma Differential](https://reader033.vdocuments.net/reader033/viewer/2022053110/607f0d4760ed4d61022b7d82/html5/thumbnails/3.jpg)
Differential Diagnosis- Rash
� Nodular Prurigo � Inflammatory (Eczema/ Psoriasis/ LP) � Urticaria � Scabies � Tinea � Bullous Pemphigoid � Dermatitis Herpetiformis � Cutaneous Lymphoma
![Page 4: Managing the Patient with Chronic Itch · Inflammatory (Eczema/ Psoriasis/ LP) ! Urticaria ! Scabies ! Tinea ! Bullous Pemphigoid ! Dermatitis Herpetiformis ! Cutaneous Lymphoma Differential](https://reader033.vdocuments.net/reader033/viewer/2022053110/607f0d4760ed4d61022b7d82/html5/thumbnails/4.jpg)
Differential Diagnosis – No Rash
� Systemic disease (Thyroid, low Fe, uraemia, polycythaemia, malignancy)
� Psychogenic
� Dementia senile pruritis
![Page 5: Managing the Patient with Chronic Itch · Inflammatory (Eczema/ Psoriasis/ LP) ! Urticaria ! Scabies ! Tinea ! Bullous Pemphigoid ! Dermatitis Herpetiformis ! Cutaneous Lymphoma Differential](https://reader033.vdocuments.net/reader033/viewer/2022053110/607f0d4760ed4d61022b7d82/html5/thumbnails/5.jpg)
Prurigo
![Page 6: Managing the Patient with Chronic Itch · Inflammatory (Eczema/ Psoriasis/ LP) ! Urticaria ! Scabies ! Tinea ! Bullous Pemphigoid ! Dermatitis Herpetiformis ! Cutaneous Lymphoma Differential](https://reader033.vdocuments.net/reader033/viewer/2022053110/607f0d4760ed4d61022b7d82/html5/thumbnails/6.jpg)
Prurigo � Very common � Insect bites can precipitate � Very strong urge to itch � Topical steroids/ emollients/ soap substitutes � Sedative antihistamines eg hydroxyzine � Occlusive bandages/ dressings � Refer ? Biopsy (exclude DH BP) � UVA/ UVB (thalidamide)
![Page 7: Managing the Patient with Chronic Itch · Inflammatory (Eczema/ Psoriasis/ LP) ! Urticaria ! Scabies ! Tinea ! Bullous Pemphigoid ! Dermatitis Herpetiformis ! Cutaneous Lymphoma Differential](https://reader033.vdocuments.net/reader033/viewer/2022053110/607f0d4760ed4d61022b7d82/html5/thumbnails/7.jpg)
Inflammatory Skin Conditions
![Page 8: Managing the Patient with Chronic Itch · Inflammatory (Eczema/ Psoriasis/ LP) ! Urticaria ! Scabies ! Tinea ! Bullous Pemphigoid ! Dermatitis Herpetiformis ! Cutaneous Lymphoma Differential](https://reader033.vdocuments.net/reader033/viewer/2022053110/607f0d4760ed4d61022b7d82/html5/thumbnails/8.jpg)
Inflammatory Skin Conditions � Diagnose History/ Examination (Eczema,
Psoriasis, Lichen Planus)
� Patch Testing
� Xerosis very common in elderly
� (New presentation eczema from Sub Saharan Africa HIV)
![Page 9: Managing the Patient with Chronic Itch · Inflammatory (Eczema/ Psoriasis/ LP) ! Urticaria ! Scabies ! Tinea ! Bullous Pemphigoid ! Dermatitis Herpetiformis ! Cutaneous Lymphoma Differential](https://reader033.vdocuments.net/reader033/viewer/2022053110/607f0d4760ed4d61022b7d82/html5/thumbnails/9.jpg)
Urticaria
� Chronic > 6 weeks (CIU) � Physical urticarias , dermographism,
delayed pressure cholinergic (cold/ heat rare)
� Urticarial vasculitis lesions > 48hrs (biopsy 1 case per cons clinic/ year)
![Page 10: Managing the Patient with Chronic Itch · Inflammatory (Eczema/ Psoriasis/ LP) ! Urticaria ! Scabies ! Tinea ! Bullous Pemphigoid ! Dermatitis Herpetiformis ! Cutaneous Lymphoma Differential](https://reader033.vdocuments.net/reader033/viewer/2022053110/607f0d4760ed4d61022b7d82/html5/thumbnails/10.jpg)
Scabies
� Burrows hands/ feet (dermatoscope) � Family contacts � Itch worse at night � If lots of itch but not much to see
consider scabies � Average 10-12 mites � Noweigan Crusted Scabies
![Page 11: Managing the Patient with Chronic Itch · Inflammatory (Eczema/ Psoriasis/ LP) ! Urticaria ! Scabies ! Tinea ! Bullous Pemphigoid ! Dermatitis Herpetiformis ! Cutaneous Lymphoma Differential](https://reader033.vdocuments.net/reader033/viewer/2022053110/607f0d4760ed4d61022b7d82/html5/thumbnails/11.jpg)
Cutaneous lymphoma
� Suspicion � Refer needs biopsy
![Page 12: Managing the Patient with Chronic Itch · Inflammatory (Eczema/ Psoriasis/ LP) ! Urticaria ! Scabies ! Tinea ! Bullous Pemphigoid ! Dermatitis Herpetiformis ! Cutaneous Lymphoma Differential](https://reader033.vdocuments.net/reader033/viewer/2022053110/607f0d4760ed4d61022b7d82/html5/thumbnails/12.jpg)
Immunobullous Disorders
� Pemphigoid (indirect/ direct immunofluoresence) IgG dermal/ epidermal junction
� Dermatitis Herpetiformis
� Direct / indirect IMF- IgA sub epidermal. Positive coeliac serology, villous atrophy
![Page 13: Managing the Patient with Chronic Itch · Inflammatory (Eczema/ Psoriasis/ LP) ! Urticaria ! Scabies ! Tinea ! Bullous Pemphigoid ! Dermatitis Herpetiformis ! Cutaneous Lymphoma Differential](https://reader033.vdocuments.net/reader033/viewer/2022053110/607f0d4760ed4d61022b7d82/html5/thumbnails/13.jpg)
Bullous Pemphigoid
![Page 14: Managing the Patient with Chronic Itch · Inflammatory (Eczema/ Psoriasis/ LP) ! Urticaria ! Scabies ! Tinea ! Bullous Pemphigoid ! Dermatitis Herpetiformis ! Cutaneous Lymphoma Differential](https://reader033.vdocuments.net/reader033/viewer/2022053110/607f0d4760ed4d61022b7d82/html5/thumbnails/14.jpg)
Dermatitis Herpetiformis
![Page 15: Managing the Patient with Chronic Itch · Inflammatory (Eczema/ Psoriasis/ LP) ! Urticaria ! Scabies ! Tinea ! Bullous Pemphigoid ! Dermatitis Herpetiformis ! Cutaneous Lymphoma Differential](https://reader033.vdocuments.net/reader033/viewer/2022053110/607f0d4760ed4d61022b7d82/html5/thumbnails/15.jpg)
Tinea
� Very common � Send scrapings/ clippings � Consider if unilateral itchy rash
![Page 16: Managing the Patient with Chronic Itch · Inflammatory (Eczema/ Psoriasis/ LP) ! Urticaria ! Scabies ! Tinea ! Bullous Pemphigoid ! Dermatitis Herpetiformis ! Cutaneous Lymphoma Differential](https://reader033.vdocuments.net/reader033/viewer/2022053110/607f0d4760ed4d61022b7d82/html5/thumbnails/16.jpg)
No Rash – Pruritis Screen
� Tests 1st Line- TFTs Lfts U/Es FBC Ferritin Gluc CRP
� 2nd line- CXR serum electrophoresis autoantibodies Stool sample (parasites) HIV biopsy
![Page 17: Managing the Patient with Chronic Itch · Inflammatory (Eczema/ Psoriasis/ LP) ! Urticaria ! Scabies ! Tinea ! Bullous Pemphigoid ! Dermatitis Herpetiformis ! Cutaneous Lymphoma Differential](https://reader033.vdocuments.net/reader033/viewer/2022053110/607f0d4760ed4d61022b7d82/html5/thumbnails/17.jpg)
Medication
� Common – need to stop 6 weeks � Statins � ACE – change to sartan � Opioids � Aspirin � Amiodarone � Allopurinol
![Page 18: Managing the Patient with Chronic Itch · Inflammatory (Eczema/ Psoriasis/ LP) ! Urticaria ! Scabies ! Tinea ! Bullous Pemphigoid ! Dermatitis Herpetiformis ! Cutaneous Lymphoma Differential](https://reader033.vdocuments.net/reader033/viewer/2022053110/607f0d4760ed4d61022b7d82/html5/thumbnails/18.jpg)
Types of Itch
� Sudden onset - unlikely to be systemic � Hands/ feet – hepatobiliary � Aquagenic – Polycythaemia, asteototic
eczema � 30-40 yr Female raised crp and itch –
Primary Biliary Cirrhosis � Chronic itch, wt loss, night sweats
consider malignancy
![Page 19: Managing the Patient with Chronic Itch · Inflammatory (Eczema/ Psoriasis/ LP) ! Urticaria ! Scabies ! Tinea ! Bullous Pemphigoid ! Dermatitis Herpetiformis ! Cutaneous Lymphoma Differential](https://reader033.vdocuments.net/reader033/viewer/2022053110/607f0d4760ed4d61022b7d82/html5/thumbnails/19.jpg)
Management � Emollients including dermacool � Soap substitutes � Keep nails short and filed � Encourage rub with palms/ not scratch with
fingernails � Pruritis Screen � Medication review, trial stopping 6 weeks � Mild/ moderate steroids � Sedating antihistamines eg hydroxyzine � Refer UVB