Abstract

Generalized Pruritus (GP) is chronic itch that occurs without any associated diagnosable skin diseases or primary skin lesions. Uremic pruritus (UP), also known as Chronic Kidney Disease-associated pruritus (CKD-aP), is the most common cause of GP and is a debilitating symptom in patients with end-stage renal disease. Topical therapy is often inadequate; thus, providing additional therapeutic options becomes essential for the successful primary care physician. Phototherapy is a proven method for the management of many pruritic disorders, including uremic pruritus (UP). Objective: This review aims to give an update on the use of phototherapy for managing UP to establish it within the spectrum of therapeutic options. The pathogenesis of UP and the mechanism of action of phototherapy in treating UP were also reviewed. Methods: A thorough literature search of the PubMed database was conducted to identify studies that examined a variety of phototherapy methods in UP. Results: UP causes a microinflammatory state with changes in cutaneous nociceptive endings. A circulating substance responsible for pruritus is annihilated through the apoptotic actions of phototherapy. BB-UVB is the preferred modality to decrease UP. Conclusion: Phototherapy is a safe and beneficial option when other measures fail to control UP.

Highlights

  • Generalized Pruritus (GP) is chronic itch that occurs without any associated diagnosable skin diseases or primary skin lesions

  • A study conducted by Seckin compared Uremic pruritus (UP) to idiopathic pruritus (IP) [28]. 68% of those with IP showed greater than 50% improvement with a 61% remission rate on a 6 month average follow-up. 60% in the UP group showed greater than 50% improvement with 66.7% recurrence on follow-up

  • Remission after a single course of Narrowband UVB (NB-UVB) therapy is not prolonged, 54.2% in the UP group and 67.9% in the IP group had a change in visual analog score (VAS)

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Summary

Introduction

GP is chronic itch that occurs without any associated diagnosable skin diseases or primary skin lesions. It can be secondary to neurologic disorders, chronic renal failure, cholestasis, systemic infections, malignancies, and endocrine disorders. A judicious history, thorough physical examination, and suitable laboratory investigation must be performed to elucidate the cause. Systemic disease has been implicated in up to 20% of patients with GP [1]. Special emphasis should be placed on drug exposure, travel history, environmental irritants, lifestyle, extra-cutaneous symptoms, and prior hospitalizations. Initial laboratory tests may include complete blood count, liver and renal function tests, serum glucose, iron, ferritin, thyroid function tests, erythrocyte sedimentation rate, protein electrophoresis, and urinalysis. Generalization can be caused by a lowering of itch threshold on other body parts through a combination of neurologic and/or psychological mechanisms

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