The pruritus “has arrived.” What is the peculiarity of the disease and how to fight it?

How to treat pruritus in adults at home

Prurigo is a polyetiological skin disease of neuroallergic nature. Another name for the pathology is prurigo, which means “itch” in Latin. It is not for nothing that the disease is named so, since the main manifestations are a rash, which is accompanied by intense, obsessive itching.

There are children's prurigo (strophulus, childhood urticaria), adult and nodular (neurodermatitis nodosum). The last two can have an acute and chronic course. Prurigo in adults is quite rare. Statistics say that about 2% of patients who consult a dermatologist have this problem.

Causes

The main factor is sensitization of the body. The result is allergic inflammation of the skin.

Irritants:

• in infants - cow's or breast milk protein;
• for older children - eggs, baked goods, strawberries, chocolate, some types of fish, mushrooms;
• provoke pruritus in adults - honey, smoked meats, spices, spicy foods, alcohol.

Other causes of pruritus:

• disruption of the biliary tract;
• neurasthenia;
• sleep disorder;
• hereditary tendency to allergic reactions;
• helminthic infestations;
• dysbacteriosis;
• tumors of internal organs;
• cholecystitis;
• chronic hepatitis;
• lymphogranulomatosis.

Scientists drew attention to the seasonality of the disease in rural areas. Many researchers are sure: prurigo occurs from insect bites - ticks, mosquitoes, fleas.

Preventive actions

Naturally, such a dangerous and serious disease is easier to prevent. Moreover, there are some preventive measures. For example, you should carefully structure your diet, excluding allergens from it. In addition, it is worth fighting for your peace of mind as much as possible in order to eliminate stress, use insect repellents, protect your skin from the sun, treat ailments of internal organs that can cause specific diseases, and undergo regular medical examinations.

Classification

This neurodermatosis has four main types:

1. Adult (prurigo, Beignet's prurigo) is a type of dermatosis that is most common in old age. Often this disease also manifests itself in adults who suffered from diathesis or urticaria in childhood. In most cases, the appearance of a rash is provoked by food products or autointoxication of the body, which occurs due to improper functioning of the gastrointestinal tract or due to other diseases.
2. Infantile prurigo (strophulus, papular urticaria) is an allergic skin disease that most often occurs in children aged one to 5 years, but can occur earlier: during teething or as a reaction to a new product. Children with exudative diathesis, dysbacteriosis, or gastrointestinal pathologies are especially prone to pruritus. The disease manifests itself in the form of dense blisters filled with serous fluid, or a very itchy small rash with dense papules.
3. Senile (senile itching) - affects people over 70 years of age who suffer from various pathologies of the endocrine system, atherosclerosis, and metabolic disorders. With age and as a result of various diseases, most of which have already become chronic, the skin becomes dry and flaky, attacks of night itching appear, and then a rash characteristic of pruritus appears.
4. Nodular prurigo (also called Hyde's pruritus) is a rare form of dermatosis to which women with an unstable psyche or reduced immunity are predisposed. Most often, the provoking factor in the development of the disease is regular stress or severe nervous shock. The risk group also includes people suffering from endocrine pathologies, diseases of the biliary system and liver.

Pathogenesis

In the formation of a pathological process, leading importance is given to the sensitization of the body by various kinds of sensitizers (food, medicinal, insect, environmental, helminthic infestations, enzymopathies, metabolic disorders, tumors, etc.). A significant role in the development of prurigo, especially in children, is played by psycho-emotional development, the connection of which with skin diseases is clearly established.

The syndrome of vegetovisceral dysfunctions is of greatest importance in the development of allergic dermatoses, in which there are functional disorders of the gastrointestinal tract, dysbacteriosis , secondary enzyme deficiency, malabsorption/nutrition disorders, which creates a vicious circle.

Children's pruritus - symptoms

The childhood form of prurigo usually begins with the characteristic appearance of rashes on the skin, which can take the form of nodules no larger than 5 mm in size. After some time, small bubbles may appear on the surface of such rashes.

If such bubbles burst, then in their place point erosions are formed, which are covered with a special type of crusts - these are serous crusts. It should also be said that in addition to the rash located on the skin of the face and torso, such rashes can also be concentrated on the surface of the extensor limbs. Interestingly, the location of papulovesicles can be both on the skin of the palms and the skin of the feet. Their size can reach about 5-6 mm, they can have an edematous base and a special inflammatory rim. The main distinguishing feature of prurigo is the very strong itching that is unique to it. If you scratch the areas affected by scabies, a large amount of excoriation may appear.

In addition to the main symptoms, children may experience various neuropsychic disorders, for example, poor sleep, previously uncharacteristic moodiness, increased levels of irritability, and tearfulness. Such symptoms can be explained both by prurigo itself, accompanied by severe itching and general autointoxication of the body, and by congenital instability of the nervous system.

Very often, it is typical for patients suffering from pruritus that the symptoms may disappear after, for example, milk is excluded from the diet. However, there are also cases when infantile prurigo transforms into pruriginous eczema or atopic dermatitis. The main sign of such a change may be the appearance of white-type dermographism or a reduced type of abdominal reflex, as well as the possible disappearance of the plantar reflex. Children with prurigo may have characteristic dry skin, enlarged femoral (or inguinal) lymph nodes, or anhidrosis.

During pregnancy

In rare cases, prurigo occurs in pregnant women. Most likely, it is caused by changes in the endocrine, immune, nervous and digestive systems, as a result of which the condition of the skin changes. The disease is also associated with an increase in a woman’s weight during pregnancy, especially during multiple pregnancies, in which the skin of the abdominal wall is greatly stretched. Prurigo develops in the last weeks of pregnancy or after childbirth. Itchy papules appear on the skin, which merge into plaques. Prurigo rashes initially appear in the areas of abdominal stretch marks, and then spread to the buttocks and thighs. In places where the muscles are severely stretched, the connective tissue is sometimes damaged, and this leads to a more pronounced inflammatory process and aggravates the course of the disease. The rash goes away within 4-5 weeks. Prurigo does not affect the fetus, but may recur during subsequent pregnancies.

Symptoms in adults

Prurigo in adults is characterized by the presence of papules that form on the extensor surfaces of the arms and legs. Papules have a brownish-red tint. their size is about five millimeters. The shape of the formations, dense to the touch, is conical or hemispherical.

Acute itching sensations are caused by other elements of a bright red hue. When the patient scratches them, the formations transform into specific wounds covered with hemorrhagic crusts.

When pruritus develops into a chronic form, the following symptoms are observed:

• insomnia;
• irritability for no particular reason;
• emotional instability.

Senile prurigo is extremely rare and mainly affects older women. The symptoms of the disease in this case are not much different from the signs of “adult” prurigo. Patients complain of itching, provoked by the formation of dense papules of a brownish-gray hue, the diameter of which is about one centimeter.

Nodular prurigo is characterized by severe, paroxysmal itching. As the disease progresses, the itching sensation becomes stronger. Often the anomaly develops in people suffering from neurocircular dystonia or diabetes mellitus.

Clinical picture

Hyde's nodular prurigo begins with the appearance of itching in certain areas of the skin. Suffer from:

• coverings of the extensor surfaces of the limbs: on the arms - this is their back surface, on the side of the elbow, and on the legs - the front, on the other side of the kneecap. The shins and forearms suffer more;
• stomach;
• back;
• buttocks.

Symptoms of Hyde's nodular prurigo are not detected on the flexor sides of the limbs and the face.

Gradually, as one scratches previously clean skin, a person notices the appearance of a rash on the affected surfaces in the form of very dense nodules of varying sizes. They are characterized by a round, semicircular or cup-shaped shape and a diameter of 6-15 mm. They can range in size from a millet grain to a hazelnut.

At first, the loose elements do not differ in color from healthy skin, but only rise above it, creating small groups of dozens of elements. Confluence of the rash is not typical for Hyde's nodular prurigo. Their symmetrical appearance is characteristic.

The next stage in the development of Hyde nodular prurigo is a change in the color of the rash: it becomes brownish-red. The surface of individual elements also changes: some of them become covered with reddish crusts, others become flaky, and others take on a warty appearance. In addition to dense nodules, red crusts and scratch marks are visible on the skin. There may be isolated bright red spots that are even more itchy than the nodules. Between the elements of the rash, the covering tissue has a normal color and structure.

There are no rashes on the mucous membranes during the development of nodular prurigo Hyde.

Hyde nodular pruritus is characterized by itching of significant intensity, occurring in attacks. After the rash appears, it becomes stronger. This is explained by the fact that along with the development of nodules, the number of nerve endings increases - they grow to each element of the rash. Their irritation causes itching.

The course of Hyde nodular prurigo quickly becomes chronic. In the affected areas, the skin thickens, acquires a brownish tint, and becomes crusty. The pronounced intensity of itching forces a person to scratch the skin without caring about the hygiene of hands and nails. Therefore, scratches quickly become infected, and complications of Hyde’s nodular prurigo arise: abscesses of larger or smaller diameter.

Disappearing, the elements of Hyde's nodular prurigo or opened and healed ulcers turn into scars of various sizes, surrounded by brownish skin at the periphery.

Even if a secondary infection does not occur, Hyde’s nodular pruritus, with its constant and severe itching, exhausts the person’s nervous system: he becomes irritable, emotionally labile, and stops getting enough sleep.

Even after the pathology is completely cured, the habit of scratching the skin does not disappear immediately; some require treatment from a psychotherapist. This situation is especially typical for people who, even before the development of Hyde’s nodular prurigo, were prone to nervous or mental illnesses. By the way, the latter can worsen due to itching.

In pregnant women, nodular prurigo Hyde can occur in any trimester, affecting one woman out of 3 thousand pregnant women. This is due to decreased immunity, a normal condition for this period. Its manifestations do not differ from the symptoms described earlier.

Diagnostics

Pruritus is diagnosed by a dermatologist who conducts an examination and prescribes dermatoscopy of the rash. In the event of a secondary infection, a bacterial culture of the scraping is done, which reveals the pathogen, as well as sensitivity to antibacterial drugs. If pruritus occurs against the background of gastrointestinal diseases, as well as endocrine pathology, then consultation with an endocrinologist and gastroenterologist is required. An additional stool test for helminths is prescribed, as well as an analysis for dysbacteriosis.

According to indications, the doctor prescribes an ultrasound of the pancreas, liver, and liver tests. When diagnosing prurigo, it is important to exclude dermatological diseases that have a similar clinical picture. Nodular prurigo is difficult to differentiate from lichen planus. The peculiarities of the location of the rash in prurigo make it possible to distinguish it from scabies, atopic dermatitis and toxicoderma.

In the case of atopic dermatitis, the rash will be localized, as a rule, on the flexor surfaces. In the case of scabies, dermatoscopy will help to detect its typical passages, while a positive result of its examination will confirm the diagnosis. It should also be said that toxidermia is characterized by a connection between rashes and medications.

List of sources

• Zaslavsky D.V. Aspects of pediatric dermatology: from strophulus to atopic dermatitis / Medical advice. — 2021, No. 19 p. 154-157.
• Gorlanov I.A., Milyavskaya I.R., Leina L.M., Zaslavsky D.V., Olovyanishnikov O.V., Kulikova S.Yu. Pediatric dermatovenereology. M.: IG GEOTAR-Media, 2021. 512 p.
• Dermatovenerology. National leadership. Brief edition / ed. Yu. S. Butova, Yu. K. Skripkina, O. L. Ivanova. - M.: GEOTAR-Media, 2013. - 896 p.
• Zaslavsky D.V., Novikova V.P., Chuprov I.N. Probiotics in the prevention and treatment of atopic dermatitis in children. Questions of Practical Pediatrics, 2021, 11(2): 51-57.
• Ermilova A. I., Menshchikova G. V., Pilguy E. I. Pruritic dermatoses: approaches to treatment / Consilium medicum. Pediatrics. 2014 No. 3, pp. 74-77.

Treatment of prurigo

Treatment of prurigo in adults and children must begin with diagnostic measures - it is necessary to establish the provoking factor in each specific case of the disease, eliminate it, and only in this case will the treatment be successful.

If pruritus occurs in childhood or in a woman during pregnancy and breastfeeding, then they must undergo examinations for the presence/absence of helminths in the body. It is helminthic infestation that is most often accompanied by an allergic reaction, so the sudden development of prurigo may be associated with this factor. If the disease in question has developed against the background of pathologies of the gastrointestinal tract or other body systems, then the doctor first prescribes a course of treatment for them, and then therapeutic measures are taken in relation to pruritus.

The main drugs in the treatment regimen for pruritus are antihistamines, which eliminate the allergic reaction and reduce the sensation of itching. The duration of their use depends on the severity of the disease.

The following may be prescribed as desensitizing agents:

• calcium pantothenate;
• calcium gluconate;
• sodium thiosulfate;
• enterosorbents: Sorbex, Liquid coal, Smecta, Lactofiltrum, Enterosgel, etc.

Antihistamines recommended for pruritus:

• Dimetinden;
• Desloratadine;
• Hifenadine;
• Chlorapyramine;
• Clemastine;
• Mebhydrolin;
• Loratadine;
• Cetirizine.

To eliminate dysbiosis, probiotics are recommended:

• Bifi-forms;
• Linux;
• Acylact et al.

To improve digestion processes, a course of pancreatic enzymes is recommended:

• Pancreatin;
• Mezim;
• Creon;
• Enzistal et al.

In case of severe pruritus or absence of regression of the rash, PUVA therapy is used and systemic glucocorticosteroids are prescribed:

• Prednisolone;
• Dexamethasone.

In case of severe disturbances of the psycho-emotional state, the patient is prescribed sedatives or tranquilizers:

• peony tincture;
• valerian;
• Novo-passit;
• Adaptol, etc.

For local treatment of rash elements, the following measures are taken:

• glucocorticosteroid ointments;
• applications with 2% boron-ichthyol or 2% boron-naphthalan ointments;
• baths with bran and infusions of chamomile, oak bark or string.

In some cases, the following alternative treatments may be used to treat the rash:

• diathermocoagulation;
• irrigation with liquid nitrogen or chlorethyl;
• injections (injections) with hydrocortisone, celeston, dexamethasone or a solution of methylene blue with novocaine.

Depending on the results of diagnostic examinations, a patient with prurigo may need treatment for the following diseases and conditions:

• caries;
• diseases of the gastrointestinal tract;
• chronic diseases of the ENT organs;
• helminthic infestations;
• dysbacteriosis;
• endocrine diseases;
• oncological diseases.

Nutrition rules

Doctors believe that an important point in the treatment of the disease in question is nutrition - it should be balanced and fortified.

The diet of an adult patient should consist of vegetables and fruits, fish and dairy products. In principle, there are no strict restrictions on food, but you must adhere to the following rules:

• It is better to replace animal fats with sunflower oil;
• give preference to low-fat foods, steamed or baked foods;
• give up foods rich in carbohydrates - baked goods, pasta, potatoes;
• limit the amount of salt you consume, and preferably avoid it altogether.

Prurigo is a rather unpleasant disease that not only changes a person’s appearance, but also has a direct impact on the psycho-emotional background and rhythm of life. Only competent treatment and compliance with all the recommendations of the attending physician will completely get rid of this pathology.

Diet

Hypoallergenic diet

• Efficacy: therapeutic effect after 21-40 days
• Timing: constantly
• Cost of products: 1300-1400 rubles. in Week

Diet for allergies in children

• Efficacy: therapeutic effect after 15-21 days
• Time frame: until the allergic reaction to the food allergen disappears
• Cost of products: 1500-1600 rubles. in Week

Hypoallergenic diet for nursing mothers with child allergies

• Efficacy: therapeutic effect after 30 days
• Timing: constantly
• Cost of products: 1600-1700 rubles. in Week

Regardless of age, it is important to follow a hypoallergenic diet. Completely excluded:

• Products containing dyes and preservatives.
• Citrus.
• Eggs.
• Seafood.
• Sugar.
• Dried fruits, baked goods and other high-carbohydrate foods.
• Chocolate.
• Coffee and cocoa.
• Smoked meats.
• Spices.
• Canned food, marinades.
• Alcohol.
• Fatty and fried foods.

An anti-allergenic menu may include buckwheat, turnips, zucchini, greens, dairy products, plain yogurts, cucumbers, cabbage, spinach, plums, green apples, olive oil, boiled rabbit and veal, dried apples, bread (corn, oat, buckwheat), juices and fruit drinks. More detailed recommendations can be found in the diet for allergies in children and the hypoallergenic diet.