Akhiani M, Daneshpajooh M, Jomhori P,
Volume 59, Issue 4 (8-2001)
Abstract
Pruritus is an unpleasant sensation that provokes the desire to scratch. It has long been recognized as a presenting or concomitant symptom of many systemic diseases. Indeed, generalized pruritus is reported to be associated with underlying diseases in 10-50 percent of cases. This study was conducted to investigate the underlying diseases in pruritic patients without primary skin lesion. Seventy-five patients with at least one-month history of pruritus with no primary skin lesions, presenting to dermatological clinics of Razi Hospital, from April 97 until December 99 were evaluated. The work up procedure consisted of medical history, physical examination, laboratory findings (CBC, ESR, blood chemistry, thyroid function tests, urinalysis, stool exam), chest X-ray and in selected cases, additional specific tests. Fifty-four patients were female, and 21 male the mean age was 45.7y±16.41, and the mean duration of pruritus, 21.8m±21. In 43 patients (75.4 percent), no abnormal finding was detected. Five patients (6.66 percent) had atopy. In the remaining 27 patients (36 percent), the following abnormalities were found: Iron deficiency in 6 patients (8 percent), diabetes mellitus in 6 patients (8 percent), hyperthyroidism in 4 patients (5.33 percent), hypothyroidism in 2 patients (2.66 percent), lymphoma in 3 patients (4 percent), chronic hepatitis, hypocalcaemia, cholelithiasis, psychosis and chronic renal failure each in one patient (1.3 percent). Evaluation of patients with pruritus may be a valuable tool for early detection of underlying systemic diseases.
H Kalili, S. Dashti, P.ahmad Poor, M. Haji Babaei, F. Abdollahi ,
Volume 64, Issue 4 (7-2006)
Abstract
Background: Pruritus is one of the most common problems in patients suffering chronic renal failure. Twenty five - 35% of predialysis patients and 60-80% of patients during dialysis complain pruritus. The exact pathophysiology of pruritus is unknown however, some possible interactive factors include: histamine release from mast cells and basophiles, uremic skin, cutaneous mast cells proliferation, adipose cells atrophy, electrolyte imbalance, and accumulation of bile acids. Since histamine is the main proposed mediator in pruritus, the goal of this study was to evaluate the role of antihistamines in controling of pruritus of patients with chronic renal failure. This study was done as a before - after study during one year period in dialysis department of Imam Khomeini hospital.
Methods: Thirty patients complied with inclusion criteria were entered in the study. Treatment strategy was: 2 weeks treatment with hydroxyzine 25 mg TDS, followed by one week wash-out period, then 2 weeks ketotifen therapy 1mg BID and finally two weeks treatment with chlorpheniramine 4mg BD following one week washout period after ketotifen therapy. Pruritus severity before and after each treatment period was evaluated with Pruritus Severity Score (PSS) chart.
Results: The mean PSS reduction by hydroxyzine, ketotifen and chlorpheniramine, were 33%, 4.5% and 20%, respectively.
Conclusion: PSS improvement with hydroxyzine and chlorpheniramine was statistically significant (p<0.001). However, ketotifen induced pruritus reduction was not considerably significant.
Arman Taheri , Mohammad Hosseini , Hossein Chaychi Nakhjir ,
Volume 76, Issue 9 (12-2018)
Abstract
Background: Adding morphine as adjuvant intrathecal drug for cesarean section is a gold standard for post-operative analgesia according to literature, but because of frequent incidence of nausea, vomiting and pruritus, it has limited popularity. Various mechanisms have been demonstrated for the opioid-induced pruritus, with a variety of medications with different mechanisms of actions for prevention and treatment. The aim of this study was to determine the effect of intramuscular promethazine on intrathecal morphine-induced pruritus after cesarean delivery.
Methods: In a retrospective descriptive-analytical study, recorded data of two thousand American Society of Anesthesiologists (ASA) I or II women undergoing elective cesarean delivery at the Bahman Hospital of Tehran, Iran, during the period of 2008 to 2013 were reviewed. Participants were divided into two groups of one thousand for each theme; the initial group underwent spinal anesthesia by employing intrathecal morphine as part of a standard anaesthetic regimen without prophylactic administration of promethazine, the subsequent group received 25 mg intramuscular promethazine after intrathecal drug administration. The incidence and severity of pruritus (absent, mild, moderate or severe) and intensity of pain using numeric rating scale (NRS) and also the incidence of nausea and vomiting were examined as main variables. All data were analyzed using SPSS software, version 22 (IBM SPSS, Armonk, NY, USA) and P values of less than 0.05 were considered as statistically significant.
Results: The incidence of nausea (P=0.025) and vomiting (P=0.046) was different in two groups; with statistical significance. The mean score of pain according to numeric rating scale (NRS) was similar in both groups (P=0.46). The frequency of pruritus was statistically similar in both groups, (P=0.302); but the severity of itching showed statistically significant difference between two groups (P<0.001).
Conclusion: The severity of pruritus was significantly reduced by intramuscular administration of 25 mg promethazine, shortly after spinal morphine administration but it was shown to be ineffective to reduce the incidence of pruritus. Also, the incidence of post-operative nausea and vomiting (PONV) was less by intramuscular promethazine application.
Mohsen Soleimani , Rahimeh Nabavi , Nadia Karimi , Abbasali Ebrahimian ,
Volume 78, Issue 3 (6-2020)
Abstract
Background: Uremic pruritus is one of the important problems in patients undergoing hemodialysis. Causing the mechanism of uremic pruritus in hemodialysis patients is complex and multifactorial. Almost 60 percent of hemodialysis patients suffer from uremic pruritus. Oral hydroxyzine is a common treatment for uremic pruritus of this patients. This study aimed to survey effect of hydroxyzine on uremic pruritus of hemodialysis patients.
Methods: This quasi-experimental study (pre and post design) performed on 40 patients with eligible criteria. All of the hemodialysis patients who suffer from pruritus received a tablet of hydroxyzine 25 mg daily for 6 weeks. In this time, drugs and the plan of hemodialysis were constant. Pruritus score of patients, evaluated with 5-D pruritus scale that had 8 items with 5-score Likert scale and evaluate duration, direction, disability, and distribution of pruritus. Severity scores of pruritus before and after treatment with tablet of hydroxyzine were compared. This study was conducted on hemodialysis patients in the Soodeh Center of Hemodialysis in the south of Tehran, Iran, from September 2016 to February 2017.
Results: The findings of this study showed that most of the patients in this study were male (55%) with mean age of 55.97±11.59 years. The most cause of chronic renal failure in these patients was diabetes (37.5%). This study showed that 32.5% of the hemodialysis patients had moderate to severe uremic pruritus. The mean score of pruritus before the treatment with hydroxyzine was 16.73±3.4 and the most effect of this drug was in the social activity item (2.47±0.6). After treatment with hydroxyzine, the mean score of pruritus in the patients was 9.65±2.15 that was decreased significantly (P<0.001). The findings showed that there was no significant relationship between decrease of pruritus and characteristics of patients.
Conclusion: This study showed that uremic pruritus is still a challenge in hemodialysis patients. According to this study use of hydroxyzine, regardless of uremic pruritus mechanism, could be decreased uremic pruritus of hemodialysis patients.
