Scratching
Pruritus (or purigo) is an itchy type of dermatosis, the main element of the rash of which will be a small nodule with fluid contained in it. A pronounced form of itching can lead to severe scratching of places where rashes are observed, as well as to the further appearance of excoriations of a deep nature. The most important distinguishing feature of pruritus from all other similar skin diseases is the special location of the rash. As a rule, the rash is located on the areas of the bends of the limbs, while without the involvement of flexor surfaces. It is possible to diagnose pruritus with the help of a dermatological examination, as well as by examining the organs of the gastrointestinal tract, while eliminating the possibility of the occurrence and development of any other types of skin diseases. Treatment of pruritus consists primarily in diet, physiotherapy, the use of antihistamines or sedatives, as well as regular intake of vitamins.
The content of the article:
Causes of pruritus
Symptoms of pruritus
Diagnosis of pruritus
Treatment of pruritus
Scratching
In modern dermatology, there are three types of clinical pruritus: pruritus in children, pruritus in adults, nodular pruritus. A child’s type of pruritus usually develops in the first year of a child’s life, but it happens that it also occurs in children whose age reaches 5 years. As for adult pruritus, people of older age categories suffer from it. A knotty appearance of pruritus is usually observed in women after 50 years.
Causes of pruritus
The main reason for the occurrence and further development of pruritus is the sensabilization of the body, which leads to the developing processes of various inflammations of an allergic nature. The main agents that sensitize the body are considered to be various foods. If we talk about infants, then most often they do not tolerate cow protein or even mother’s milk, for older children, mushrooms, eggs, chocolate, citrus fruits and even fish can become the main cause of allergic inflammation. For adults, food sensitizers are honey, alcohol, coffee, smoked meats, spices.
Of great importance in the occurrence and further development of pruritus in children is observed in a possible tendency to allergic processes, which can manifest themselves both in the form of diathesis and in the form of fermentopathy of the digestive tract. The factor that precedes the occurrence and development of pruritus not only in children, but also in adults, is autointoxication and autosensitization of the body, which occurs clearly from the intestinal cavity in the case of dysbiosis, dyskinesia and helminthic invasion. The main provoking factors of pruritus in adults are various neuropsychiatric disorders (including sleep disorders and neurasthenia), as well as diseases such as diabetes mellitus, lymphogranulomatosis, cirrhosis of the liver, tumor of internal organs, hepatitis or cholecystitis.
Some researchers believe that the occurrence of pruritus can be explained by insect bites (primarily fleas and ticks). This theory is explained by the fact that pruritus is most often found in open countryside.
Symptoms of pruritus
Depending on the type of pruritus, we can talk about different symptoms.
Children’s scratching
The children’s type of pruritus usually begins with the characteristic appearance of rashes on the skin, which may look like nodules, no more than 5 mm in size. After some time, small bubbles may appear on the surface of such rashes. If such bubbles burst, then in their place point erosions are formed, which are covered with a special kind of crusts — these are serous crusts. It should also be said that in addition to the rash located on the skin of the face and trunk, such rashes can be concentrated on the surface of the extensor limbs. Interestingly, the location of papulovesicles can be both on the skin of the palms and the skin of the feet. Their size can reach about 5-6 mm, they may have a base of edematous appearance and a special inflammatory rim. The main distinguishing feature of pruritus will be a very strong itching characteristic only for it. If you comb the places affected by pruritus, then a large amount of excoriation may appear.
In addition to the main symptoms, children may experience various neuropsychiatric disorders, for example, poor sleep, previously uncharacteristic moodiness, increased irritability, tearfulness. Such symptoms can be explained both by the pruritus itself, accompanied by severe itching and general auto-intoxication of the body, and by the labile state of the innate nervous system.
Very often, for patients suffering from pruritus, it is characteristic that the symptoms may disappear after, for example, milk is excluded from the diet. However, there are also cases when there is a transformation of children’s scratching into pruriginous eczema or atopic dermatitis. The main sign of such a change may be the appearance of dermographism of the white type or a reduced type of abdominal reflex, as well as the possible disappearance of the plantar. Children suffering from pruritus may have characteristic dry skin, enlarged femoral (or inguinal) lymph nodes, or anhidrosis.
Itching in adults
If we talk about pruritus, which is characteristic of adults, then it should be said that it manifests itself in the form of nodular rashes on the abdomen, buttocks, back and in the places of the bends of the arms and legs. In adults, pruritus is also accompanied by severe itching. It is also characteristic of adult pruritus that the person remains unaffected during the course of this disease. Another characteristic symptom of adult pruritus is dense papules in the form of hemispheres or cones, which are brown or red in color, the size of which is no more than 5 mm. In addition, the patient may have papules, which are characterized by a bright red color and very severe itching. Excoriations may be marked on the body, which are usually covered with a hemorrhagic crust.
The course of pruritus can be acute and chronic. With a chronic course, in addition to skin symptoms, a neurotic syndrome may be observed, which includes sleep disturbance, the presence of emotional lability and severe irritability.
Nodal scratching
The third type of pruritus — nodular pruritus — has a chronic long-term course. Rashes are dense papules in the form of hemispheres, the size of which can be from 5 to 15 mm. In the event of such a pruritus, the rash can be both on the bends of the limbs, and on the legs or trunk.
Diagnosis of pruritus
Both a dermatologist and a general practitioner can diagnose pruritus. Usually, it is enough for a dermatologist to conduct a general examination or dermatoscopy to make a final diagnosis. In case of suspicion of pruritus and a secondary infection attached to it, scraping is usually carried out in order to detect the cause and its causative agent. Bakposev also helps to determine sensitivity to a particular antibacterial drug. If pruritus has arisen against the background of one of the types of disorders associated with the gastrointestinal tract or against the background of diseases of the endocrine system, then you can not do without consulting an endocrinologist or gastroenterologist. In addition to bakposev, fecal analysis is also carried out in order to detect helminths, as well as analysis for dysbiosis. If necessary, a patient suffering from pruritus may be prescribed an ultrasound of the liver or pancreas, as well as liver tests or a special type of examination of pancreatic enzymes.
It is very important when diagnosing pruritus to exclude the occurrence of any dermatological disease, which may be similar to pruritus due to a similar clinical picture. In general, it is possible to distinguish pruritus from any other dermatological diseases by its location. The rash of pruritus can be easily distinguished from the usual atopic dermatitis, toxidermia, and even more so scabies.
In the case of atopic dermatitis, rashes will be localized, as a rule, on the flexor surfaces. In the case of scabies, a dermatoscopy will help to detect typical moves for her, while a positive result of her research will confirm the diagnosis. It should also be said that for toxidermy, the relationship between rashes and taking medications will be characteristic.
Treatment of pruritus
The main thing in the treatment of pruritus is to follow a diet. Newborn babies are advised to give 10 drops of expressed milk 15 minutes before receiving breast milk. The latter is necessary to reduce the level of sensitization of the body. Also, the diet should include cottage cheese, kefir or carrot juice. If we talk about pregnant or nursing women, then they also need to follow a diet, reducing the amount of fish, citrus fruits, pickles or eggs consumed.
Older children, as well as adults who are sick with pruritus, are recommended to eat sour-milk products (including cottage cheese, fermented baked milk and kefir), as well as beef, but only in boiled form, fruits and vegetables (especially cabbage, peas, carrots and spinach).
In the case of helminthic invasion in the human body, it is necessary to carry out deworming. It is also very desirable to sanitize the foci of this infection, which may include otitis media, tonsillitis, sinusitis, carious teeth, dysbiosis and treatment of diseases of the gastrointestinal tract.
For the treatment of pruritus, digestive enzymes such as mezim or festal are used, as well as vitamins of group B, vitamin C or A. The use of antihistamines such as fencarol or desloratadine, suprastin or loratadine, as well as preparations containing calcium is also desirable in the treatment of pruritus. A beneficial effect is provided by the reception of special therapeutic baths, which are made with bran or decoction of oak bark, chamomile or turn. An additional remedy for the treatment of pruritus will be the use of ointments or creams containing glucocorticoids. In more severe cases, small doses of glucocorticosteroids are prescribed, using them orally.
If we talk about the use of physiotherapeutic methods, then for the treatment of pruritus, suberythemic doses of UFOs are used, as well as phonophoresis, microwave therapy (extending to the adrenal region), electrophoresis and DDT, applicable to the area of cervical sympathetic nodes.
