Medication-related pruritis in older adults with long-term conditions

Pruritus or itch, defined as the desire to itch, is a common feature of inflammatory skin disease. It has many causative factors, such as, eczema or psoriasis, allergic reaction with the release of histamine, iron deficiency, imbalanced thyroxine levels, renal disorders or failure, and as a complication of diabetes. For some individuals, this condition may be so bad that their general health deteriorates because they can no longer sleep without disturbance due to the itch. This then leads to a diminished quality of life (Peters, 2019). Patients on anticoagulant therapy may have bruised or excoriated skin from the mechanical action of the scratching on thinner skin. The appearance of their skin is quite dramatic and the skin is sore, both of which can be upsetting for the patient. The mechanical reaction of the epidermis to repeated trauma from scratching can also lead to lichenification, or thickening of the skin. With lichenification, the skin lines become more raised from the surface and the skin becomes drier. Inflammatory cells remain active and this leads perpetuates the itch scratch cycle (National Institute for Health and Care Excellence, 2019). A quarter of patients with chronic kidney disease suffer from pruritus, and despite topical leave-on treatment, their skin condition only improves after a renal transplant (Healy and Sahota, 2007).