PRURITUS & NeurocutaneusDeseases.ppt

8/10/2019 PRURITUS & NeurocutaneusDeseases.ppt

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PRURITUS &Neurocutaneus Dermatoses

The most popular DIseases of the Skin


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ITCH = sensation exclusive to Skin

Neuro

genic

Psycho

genic

Neuro

pathic

Prurito

ceptive

ITCHCENTRAL

Severe

Atopic /Cholestasis

AfferentPathway

HerpesZoster

Parasito phobia

NerveEnding: Dryness- Inflammation -Skin damage


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PATHOGENESIS of ITCH

STIMULI of Itch

To Release:

SEROTONINSubstansi P

11 amino peptideHISTAMINE

CAPSAICINAnti H1 receptor


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Aggravating Factors of ITCH

TIME

STRESS

HEATLOCATION

Ear canal

Eyelids

Nostril

AnoGenital


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PATTERN of ITCHING

The Pleasure of Scratch until Pain

Severe Persistent & Recurrence (DisNum)

Paroxyxmal & Awakening (Anal Itch)At special Time :

1. Bedtime NeuroDermatitis, Scabies

2. Bathing ColdUrtikr, ContactDis,PolyctVr3. Sweating DermatoMycosis

4. SunExposed Fotocontact Dermatitis


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Pruritus in Dermatophytosis


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Pruritusin Candidosis


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VERY SEVERE ITCH

DERMATITIS:Atopic- Numular- NeuroD`is

EOSINOFILIC Folikulitis

PRURIGO Nodularis

BASIC OF ITCH TREATMENT

1. Keep COOL : Losio +Menthol/Camphora, Wet cool dressing2. Avoid Hot Bath, Heavy Soap , Much Sweat

3. Use Moisturizers and wear soft clothes

4. Use Lidocain combined with Low-Moderate Steroid topical

5. Oral AntiH1 receptor : sedatif & Non sedatif


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INTERNAL DISEASES + ITCH

INTERNAL

DISEASES

LIVERMETA

BOLICRENAL

HEMATO

POETIC

NEURO

PSIKITARIC

Obstructif

JAUNDICE

D M

THYROID

Hyper/hypo

CHRONIC

RenalFailure

UREMIC

AnemiaPoycytemia

Leukemia

Lymphoma

Parasit DelusionNeurotic

Excoriation

D`is Artefacta

Multi Sclerosis

H I V = AIDS


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INTERNAL DISEASES

RENAL

TYROID

LYMPHOMADIABETES mell

BILLIARY

ITCHING20-50% of cases

Central Mech Peptide

Th/ Naloxone,Naltrexone

Sugar bloodCandida inf

15-50% generalized Severe

Caused by Xerosis, Anemia

Th/ antiH1 + Hemodialisa

Gabapentin+ UVB+cholestyrm

Generalized Idiopathic

Complet Blood count(CBC)

Hypo : Xerosis Itch

Hyper: Sweating

Dermatomycosis Inf


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UREMIC PRURITUS

Histamin

Anemia < Fe

Hipervit A

Neuropathy

Prurigo Nodul

NeuroD`is

XEROSIS

15-50 %

Of Cases

Severe

Generalized

THERAPY : Gabapentin 3x/w + Cholestyramine 2x 5 gr/d

Hemodialisis + capsaicin topical


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BILLIARY PRURITUS

Dark Urine

Steatorrhoe

Osteoporos

Scleroderma

ICTERUS

Severe Itch

20-50 %

0f Cases

Central Mech

Opioid Peptide

THERAPY : Naltrexone 50 mg/d

Cholestyramine 3dd 4gr + Methotrexate


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POLYCYTEMIA & LYMPHOMA

Severe Itch + severe Burning

10-20 % of Cases

Unknown Mechanism Hodgskin itch >> Leukemia

Severe generalized itch Indication

of Physical and Lab examination:CBC + Renal, Liver, Tyroid,Hepatitis, HIVPanels,Urinalysis, Stool, SerumProtein, Chest XRay.

Therapy : Low dose Aspirin + PUVA+ nbUVB


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Pruritic Dermatoses

Winter Itch

Pruritus Ani

Pruritus Scroti Pruritus Vulva

Aquagenic Pruritus

Scalp Pruritus

Drug Induced Pruritus

Chronic Pruritus of Unkonwn cause


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INTERNAL DISEASES

RENAL

TYROID

LYMPHOMADIABETES mell

BILLIARY

ITCHING20-50% of cases

Central Mech Peptide

Th/ Naloxone,Naltrexone

Sugar bloodCandida inf

15-50% generalized Severe

Caused by Xerosis, Anemia

Th/ antiH1 + Hemodialisa

Gabapentin+ UVB+cholestyrm

Generalized Idiopathic

Complet Blood count(CBC)

Hypo : Xerosis Itch

Hyper: Sweating

Dermatomycosis Inf


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PruriticDermatosis


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WINTER ITCH

Asteatotic Eczema = Eczema Craquele Xerosis of Arms + Lower legs Spare the Face, scalp , axilla, groin Low Humidity + Winter + Air Condition Therapy :

1. Used Less Soap

2. Bath soaking and smearing3. Apply Triamcinolone Ointment soon


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Winter Itching Ichtyosis


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PRURITUS ANI

Cause : contact Dermatitis Fragrance, Preservatives, detergents Iritant foods : Spices, Cathartics

Leakage of Mucus Physical changes : Fissure, Vegetation Infection: Fungi, Viral, Bacterial,Worm Seborrhoic d`is, Psoriasis.

Malignancy : Paget diseases


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Pruritus peri anal


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PRURITUS VULVA

54 %UNSPECIFIED

Dermatitis

10 %Candidosis

5 %

Psoriasis

9 %Dystetic

vulvodynia

13 %Lichen Sclerosus

PRURITUS

VULVA


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Pruritusvulva


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PRURITUS SCROTI

Scrotum is immune to Dermatophytoses Faourite site to Neurodermatitis Psychogenic pruritus Lichenification

Eroded, Weepy Crusted Candida Infect. Dermatitis Contac AllergySteroid TopAddicted Scrotal syndrome : Steroid too Strong Therapy: Use Tranquilizer antibiotics Oral

Topical : Use Low Steroid & Emolien.


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PRURITUS SCROTI

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PRURITUS & NeurocutaneusDeseases.ppt