Pruritus in the elderly. Pathophysiological, clinical, laboratory and therapeutic approach.

Generalized pruritus is a common symptom in elderly, patients, with severe impact on the quality of life. The diagnosis of senile idiopathic pruritus is made after the exclusion of a systemic disease such as chronic renal disease, hepatobilliary disease with cholestasis, thyroid dysfunctions, drug-induced hypersensitivity reactions, visceral or hematological neoplasia, and primitive dermatological distinct conditions. The pathophysiological mechanisms are still unclear. A critical role is considered to be played by changes related to skin aging, cutaneous nerve supply and other nervous system components. The clinical approach requires a thorough assessment of general health status. In primary skin conditions, a biopsy and direct immunofluorescence (DIF) are required, while in pruritus associated with a systemic disorder, the assessment of hematological, biochemical and immunological parameters and imaging are necessary. The treatment of a patient with chronic pruritus is often palliative and individualized, with emollients, sedating and non-sedating antihistamines, tricyclic antidepressants, gabapentinum, and narrow-band UVB phototherapy. Pruritus associated with systemic disease may be alleviated by etiologic treatment.