Itching Pruritus and Homoeopathy

Itching Pruritus and Homeopathy

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Definition

Pruritus, or itch, is defined as an unpleasant sensation that provokes the desire to scratch.

CLASSIFICATION

Pruritoceptive or Dermal

Originates in diseased skin. (Psora/ Syphilis/ Sycosis)

Neurogenic

Due to molecular or neurophysiologic dysfunction in the nervous system, e.g., cholestasis, opioid-induced pruritus. (Psora)

Neuropathic

Due to nervous system pathology, e.g., multiple sclerosis, Creutzfeldt-Jakob disease. (Psora/ Syphylis)

Psychiatric

Fears e.g. parasitophobia. (Psora)

Pathophysiology

Itch originating from nerves in the skin. The only peripheral tissues from which it can be evoked are skin, mucous membranes, and cornea. Itch sensitivity is not evenly distributed; there are itch points in a spotty distribution.

Neurons

Itch and all other primary sensations are associated with activation of specialized neurons, one for each sensation. There are certain Itch-producing mediators in skin.

Histamine

It is released in response to a variety of injurious stimuli. It produces itch by way of the H 1 receptor. Histamine also causes rapid tachyphylaxis with respect to vasodilation and increased vascular permeability.

Serotonin

5-hydroxytryptamine is an amine, present in platelets, can cause itching in skin through histamine release from dermal mast cells.

Endopeptidases

Trypsin or papain cause itch. Trypsin is an important component of dermal mast cells, and is secreted upon mast cell activation.

Neuropeptides

Substance P, localized in C neuron terminals causes itching both by a direct action.

Eicosanoids

Arachidonic acid transformation products (prostaglandins, leukotrienes, and other hydroxy fatty acids) possess powerful pro-inflammatory properties and enhance itching.

Types

Renal

Pruritus is one of the most important and distressing symptom of chronic renal failure. Due to intense scratching, secondary skin lesions may develop, such as nummular eczema, prurigo nodularis, or lichenified plaques. (Psora/ Syphilis/ Sycosis)- staph

Cholestasis

Stressful constant pruritus associated with biliary obstruction starts with an acral distribution and becomes generalized due to both bile salts in the skin and elevated levels of opioid peptides. (Psora)-

Dol. Hep. myric. pic-ac. ran-b. thyr.

Endocrine disease

Obstinate itching happens in thyrotoxicosis, due to increased blood flow, and in hypothyroidism (NAT-M. GRAPH. LYC. MERC. PSOR. SEP. Alum. Calc. Con. Gel. Iod. Kali-c. Nux-v. cortico. hist.) due to excessive skin dryness (cortico. hep. sil. sulph.). It can be an expression of diabetic neuropathy (Cephd-i.) (Psora)

Hematologic disease

Pruritus is seen in polycythemia vera (cob-n. cortico. lach. phos. x-ray), worse after contact with water (bath itch) (clem. Fago. olib-sac. tub.) (Psora), and may be associated with raised blood histamine levels (med.). In Hodgkin disease it is a presenting symptom (Acon. ARS. Ars-i. Bar-c. bufo Calc. Calc-f. Cist. Con. iod. Kali-bi. lap-a. NAT-M. Phos. TUB.). It locally occurs in leukemias, cutaneous mastocytosis etc. usually due to rubbing the skin (aloe Am-m. ANAC. arn. ARS. aur. Bism. borx. Calad. Calc. cann-s. canth. Caps. Carb-an. CAUST. cham. CHEL. cina Coff. CON. Cupr. dros. guaj. Kreos. Led. m-ambo. MAG-C. mang. MERC. MEZ. mosch. mur-ac. Nat-c. OL-AN. Olnd. pall. par. Ph-ac. Phos. PLB. podo. PULS. RHUS-T. Ruta seneg. SEP. SIL. spig. SPONG. Squil. stann. STAPH. stram. STRONT-C. SULPH. TARENT. tell. Thuj. valer. zinc.). (Psora/ Sycosis/ Syphilis)

HIV infection

Pruritus is a chief symptom of HIV infection as pruritus sine materia (Itch without eruptions) (agar. ALUM. alum-sil. ARS. bar-act. bar-c. calc-sil. carc. cist. clem. cupr. Dol. fago. gal-ac. galeoc-c-h. Gels. gink-b. graph. hist. kali-s. kola lach. med. Merc. MEZ. nat-m. Oncor-t. ozone Petr. plac-s. Psor. pycnop-sa. Ros-d. rosm. sil. spong. Sulph. thyr. ulm-c.). (Psora)

Senile pruritus

This is common in the aged but no cause is found. Desiccation of the skin may be one cause. Occasionally pruritus may also be aggravated by water contact. (Psora) (alum. arg-n. ars. bar-act. bar-c. con. dol. dulc. fago. fl-ac. kreos. mag-p. merc. Mez. nat-sil. olnd. op. sul-ac. sulph. urt-u.)

Psychiatric disease

Localized pruritus is often a common manifestation of chronic anxiety, and persistent rubbing of the localized area will result in lichenification. Parasitophobia is a more serious problem which has sensations of insects crawling on skin. (Psora) (alum. am-c. ars. bov. coca-c. kali-c. mur-ac. Nux-v. phos. ran-s. sil.)

Aquagenic pruritus

This pruritus is aggravated by contact with water of any temperature. It lasts up to 1 hour, and there are no visible signs on the skin. This condition must be distinguished from “bath-itch” in polycythemia vera or water-induced senile pruritus. The causes are unknown. Since no lesions can be found, such patients are often considered as neurotic. (Psora) (clem. Fago. olib-sac. tub.)

Notalgia paresthetica

This is a common localized itch usually in the interscapular area. The sensations are itch with paresthesia. It is probably a neuropathic itch due to the entrapment of spinal nerves as they come out through the muscle fascias of the back. (Causa occasionalis/ Psora) (all-s. alum. am-m. arg-met. calc. calc-s. caust. chinin-s. choc. cortico. cortiso. cystein-l. dios. Hipp. lap-la. laur. mag-c. mag-m. mosch. positr. rat. ruta stront-c. Zinc.)

Causes

Metabolic, endocrine conditions

Hyperthyroidism

Hypothyroidism

Pregnancy

Malignant neoplasms

Hodgkin disease

Lymphoma, myeloid and lymphatic leukemia,

Multiple myeloma

Myelodysplasia

Rarely in other cancers

Drug ingestion

Aspirin, alcohol, dextran, polymyxin B, morphine, codeine, scopolamine, D-tubocurarine etc.

Drug sensitivities

Infestations

Ascariasis

Hookworm

Onchocerciasis

Pediculosis

Scabies

Renal disease

Renal failure

Hematologic disease

Iron deficiency

Paraproteinemia

Polycythemia vera

Hepatic disease

Obstructive biliary disease

Pregnancy – due to intrahepatic cholestasis

Psychogenic states

Transitory

Periods of emotional stress

Persistent

Anorexia nervosa

Delusions of parasitosis- parasitophobia

Neurotic excoriations

Psychogenic pruritus

Latent dermatoses and miscellaneous conditions

Aquagenic pruritus

Atopic dermatitis (without skin lesions)

Brachioradial pruritus

Bullous pemphigoid (without skin lesions)

Dermatitis herpetiformis (without skin lesions)

Factitious urticaria (dermographism)

Fibre glass exposure

Notalgia paresthetica

Senile pruritus

Xerosis e.g. winter itch

Treatment

Skin - itching

abrot. acon. adam. aesc. AGAR. agath-a. Agn. aids. ail. aloe Alum. alumn. Am-c. am-m. Ambr. anac. anac-oc. anag. Anan. ang. Ant-c. ant-t. Anthraci. anthraco. anthraq. Antip. ap-g. APIS apoc. Arg-met. arge-pl. arist-cl. arizon-l. arn. ARS. Ars-i. ars-s-f. arum-d. asaf. asar. Astac. aur. aur-m. aur-m-n. aur-s. bamb-a. Bar-c. bar-m. bar-ox-suc. bell. bell-p. benzol. beryl. bism. borx. both. BOV. brass-n-o. Bry. bufo buth-a. cadm-met. cadm-s. Calad. Calc. calc-f. Calc-p. calc-s. calc-sil. camph. cann-i. cann-s. canth. caps. Carb-ac. Carb-an. CARB-V. CARBN-S. carl. carneg-g. cassia-s. CAUST. cench. cham. CHEL. chin. Chinin-ar. chion. chir-fl. CHLOL. choc. chrysar. Cic. cina cinnb. Cist. Clem. cob-n. coc-c. coca-c. Cocc. cod. coff. coff-t. colch. coli. coll. coloc. com. Con. cop. corian-s. cortico. cortiso. croc. Crot-h. Crot-t. Cupr. cupr-ar. Cycl. cygn-be. cypra-eg. cyt-l. Dig. dios. Dol. dream-p. dros. Dulc. elae. elat. euph. euph-l. euphr. eupi. Fago. falco-pe. fic-m. Fl-ac. flor-p. form. gal-ac. galla-q-r. Gamb. Gels. ger-i. germ-met. glon. glycyr-g. gran. GRAPH. grin. guaj. guan. guat. haliae-lc. hell. hep. hist. hom-xyz. Hydrc. hyos. hyper. ichth. ign. ina-i. indg. iod. Ip. jug-c. Jug-r. Kali-ar. Kali-bi. kali-br. Kali-c. kali-n. kali-p. Kali-s. kali-sil. Kreos. lac-d. Lach. lap-a. lap-la. lat-h. lat-m. laur. lavand-a. Led. limest-b. loxo-lae. loxo-recl. LYC. m-ambo. m-arct. m-aust. MAG-C. mag-m. mag-s. maland. mang. mang-act. Med. medul-os-si. menis. menth. mentho. meny. MERC. merc-c. merc-i-f. MEZ. mim-p. Moni. morph. mosch. mur-ac. naphtin. Nat-ar. Nat-c. NAT-M. nat-p. Nat-s. neon nicc. nicotam. Nit-ac. Nux-v. OL-AN. Olib-sac. Olnd. Oncor-t. Op. pall. par. Petr. petr-ra. Ph-ac. Phos. physala-p. pic-ac. pieri-b. pin-con. pitu-gl. Pix plac-s. Plat. plb. plut-n. podo. polys. Positr. prim-o. prot. pseuts-m. PSOR. ptel. PULS. pulx. PYCNOP-SA. rad-br. ran-b. ran-s. rheum rhod. RHUS-T. Rhus-v. rumx. Ruta Sabad. sabin. sal-ac. sal-fr. samb. Sanguis-s. Sars. sec. sel. seneg. SEP. SIL. sphing. spig. SPONG. Squil. stann. STAPH. stram. streptoc. stront-c. strych-g. suis-em. suis-hep. sul-ac. sul-i. SULPH. symph. syzyg. Tab. tarax. TARENT. Tarent-c. tell. teucr. ther. thioc-ac. Thuj. Til. tril-p. Trios. tritic-vg. TUB. URT-U. valer. vanil. ven-m. verat. Vesp. viol-o. Viol-t. visc. x-ray xero. zinc. zinc-p.

References

Radar 10
Encyclopedia Homoeopathica
Chapter 102. Pathophysiology and Clinical Aspects of Pruritus Dermatology
Section 36. Generalized Pruritus Without Skin Lesions (Pruritus Sine Materia) Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology
Pruritus CURRENT Medical Dx & Tx > Chapter 8. Ear, Nose, & Throat Disorders > Diseases of the Ear > Diseases of the Ear Canal
Pruritus (Itching) CURRENT Medical Dx & Tx > Chapter 6. Dermatologic Disorders > Common Dermatoses
The Treatment of Pruritus Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e > Chapter 65. Dermatological Pharmacology
Pruritus Clinician's Pocket Reference > Chapter 3. Differential Diagnosis: Symptoms, Signs, and Conditions
Pruritus Dermatology > Chapter 151. The Skin and Disorders of the Alimentary Tract, the Hepatobiliary System, Kidney, and Cardiopulmonary System > General Skin Changes
Pruritus Dermatology > Chapter 104. Cutaneous Manifestations of Drug Abuse > Clinical Manifestations
Pruritus and Pruritic Eruptions of Human Immunodeficiency Virus Disease Dermatology > Chapter 198. Cutaneous Manifestations of Human Immunodeficiency Virus Disease > Cutaneous Disorders Occurring in Human Immunodeficiency Virus Disease
Pruritus Dermatology > Chapter 108. Aging of Skin > Papulosquamous Disorders
Pruritus Harrison's Online > Chapter 55. Cutaneous Drug Reactions > Clinical Presentation of Cutaneous Drug Reactions > Nonimmune Cutaneous Reactions
Excoriation Williams Hematology, 8e > Chapter 1. Initial Approach to the Patient: History and Physical Examination > Physical Examination > Skin
Pruritus CURRENT Diagnosis & Treatment: Gastroenterology, Hepatology, & Endoscopy, 2e > Chapter 51. Primary Biliary Cirrhosis > Treatment > Secondary Therapy
Pruritus Hazzard's Geriatric Medicine and Gerontology, 6e > Chapter 87. End-Stage Renal Disease > Indications for Initiation of Dialysis
Key Symptom Itching (Pruritus) DeGowin's Diagnostic Examination > Chapter 6. The Skin and Nails > Skin and Nail Symptoms
Histamine (see Chapter 32) is a potent vasodilator, bronchial smooth muscle constrictor, and... Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e > Chapter 65. Dermatological Pharmacology > Antihistamines
H1 antagonists have a place in the treatment of pruritus. Some relief may be obtained in... Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e > Chapter 32. Histamine, Bradykinin, and Their Antagonists > H1 Receptor Antagonists > Therapeutic Uses > Allergic Diseases
Itch is a distinctive sensation that can be separated on clinical and neurophysiologic... Adams and Victor's Neurology > Chapter 9. Other Somatic Sensation > Anatomic and Physiologic Considerations > Sensory Pathways > Sensory Nerves
Cholestatic diseases are often accompanied by pruritus—a source of severe discomfort in some... CURRENT Diagnosis & Treatment: Surgery, 13e > Chapter 25. Biliary Tract > Jaundice > History
Clinical Box 8–1 Ganong's Review of Medical Physiology, 24e > Chapter 8. Somatosensory Neurotransmission: Touch, Pain, and Temperature > Sense Receptors & Sense Organs > Nociceptors