Original Research Article DOI: 10.18231/2454-6712.2016.0001 Journal of Preventive Medicine and Holistic Health, July-December 2016;2(2):30-32 30 Clinical profile of pruritus in elderly- a study from sub-Himalayan area Shruti Barnwal 1,* , Ravi Kant 2 , BK Bastia 3 1 Assistant Professor, Dept. of Dermatology, Doon Medical College, Dehradun, 2 Associate Professor, Dept. of Medicine, 3 Additional Professor, Dept. of Forensic Medicine, AIIMS, Rishikesh *Corresponding Author: Email: drshruti2006@gmail.com Abstract Pruritus is a very common clinical entity in geriatric population .It poses not only a diagnostic clue but therapeutic challenge as well. The clinical examination of the skin hardly provides any clue to the etiology of the Pruritus. Detail history and a thorough examination is mandatory to reach a diagnosis. In geriatric population, often only secondary lesions like excoriation, lichenification and eczematous may be mistaken as primary lesions. Xerosis is sometimes coincidental only. This is important to search for Systemic causes if the cause of Pruritus remains unidentified. If the cause is not identified even after thorough work up, the diagnosis of Willan's itch merits consideration. It probably arises due to age-related changes of the skin and cutaneous nerves. Introduction Amongst the dermatological conditions in geriatric population, pruritus qualifies as the most common skin disorder. (1) Pruritus is defined as an unpleasant cutaneous sensation that leads to a desire to scratch. (2) Itching that lasts less than 6 weeks is usually a protective phenomenon whereas an itch that remains for more than 6 weeks is mostly a nuisance. (3) A decline in the normal physiological functions of skin is partly responsible for the Pruritus. (4) It is because of this reason that the prevalence of pruritus increases with increasing age. In one of the studies regarding medical conditions, pruritus was considered as the most common medical condition. It was cited by almost two- third population as most frequent complaint and almost 83% of the octo-generians sufferd from pruritus. (5,6) In another study conducted in Norway, itching was the predominant skin complaint in subjects ranging from 30 to 76 years of age. (7) While studying the quality of life with pruritus, it was found that a sizeable portion of the sudy subjects were depressed. (8) Pathophysiologically, pruritus is mainly mediated by unmylinated C-fibres. (9,10,11) These itch fibres enters the spinal cord via the dorsal horn and ascends the lateral spinothalamic tract. These neurons are tonically inhibited by conventional nociceptive spinal cord neurons. Tonic inhibition is released with administration of centrally acting opioids, thereby causing itch. This mechanism explains the antipruritic, effect of naloxone, an opiod antagonist. (11) These fibres enters the somatosensory cortex after passing through the internal capsule. The very perception of itch stimulates the adjoining motor cortex, initiating the urge to scratch. (1) Schmelz et al., recently reported the existence of ‘active itch fibers’ through microneurographic recordings in a chronic pruritus patient. (13) Study Design We conducted a retrospective study in the Dermatology outpatients department at Doon Medical College, Dehradun, between June 2015 to June 2016. The study population comprised of 110 subjects. They were subjected to detailed history that not only comprised of the onset and course of Pruritus but appearance of skin lesions, systemic diseases, allergies drug intake, contact with pets and family history. Both primary and secondary scratch lesions like linear one round excoriations and ulcerations, lichenification, hyper-or hypo-pigmentation etc. were included. Skin biopsy was done to those lesions which were difficult to classify on the clinical grounds. Laboratory investigations viz. hemoglobin, serum liver function test, iron, ferritin, creatinine, uric acid, thyroid profile, stool for ova and parasites, Age-appropriate cancer screening, radiological investigations like chest x-ray and ultrasound abdomen to look for the lymph nodes were done when required. The patients were classified into two categories- those with primary dermatological disease and the other category having systemic disorder as the cause of pruritus. Data analysis was done by appropriate statistics.