Generalized pruritus Dermatologic arising from diseases of the

Generalized pruritus ØDermatologic (arising from diseases of the skin) • • • Xerosis Atopic dermatitis Contact dermatitis Urticaria Bullouse pemphigoid Dermatitis herpetiformis and … ØNon-dermatologic • Systemic (liver, kidney, blood and drugs) • Neurologic (MS, brain tumor and …) • Psychogenic (depression, anxiety, OCD, , , )

Generalized pruritus ØDermatologic (arising from diseases of the skin) • Xerosis • • • atopic dermatitis contact dermatitis Urticaria bullouse pemphigoid dermatitis herpetiformis and … Ø Non-dermatologic • Systemic (liver, kidney, blood and drugs) • Neurologic (MS, brain tumor and …) • Psychogenic (depression, anxiety, OCD, , , )

Generalized Pruritus Winter Itch ØXerosis (dry skin)

Generalized Pruritus Winter itch ØXerosis (dry skin) ØAggravated by low ambient humidity, repeated exposure to water ØGreat frequency in elderly patients

Generalized Pruritus Winter itch ØXerosis (dry skin) ØAggravated by low ambient humidity, repeated exposure to water ØGreat frequency in elderly patients ØPhysical exam • Dry, cracked and scaly skin on the lower leg

Generalized Pruritus Winter itch ØXerosis (dry skin) ØAggravated by low ambient humidity, repeated exposure to water ØGreat frequency in elderly patients ØPhysical exam • Dry, crackednand scaly skin on the lower leg ØTreatment

Generalized Pruritus Winter itch ØXerosis (dry skin) ØAggravated by low ambient humidity, repeated exposure to water ØGreat frequency in elderly patients ØPhysical exam • Dry, crackednand scaly skin on the lower leg ØTreatment • Limiting frequency, duration and water temperature of bathing

Generalized Pruritus Winter itch ØXerosis (dry skin) ØAggravated by low ambient humidity, repeated exposure to water ØGreat frequency in elderly patients ØPhysical exam • Dry, crackednand scaly skin on the lower leg ØTreatment • Limiting frequency, duration and water temperature of bathing • Use superfatted soaps or syndet bars

Generalized Pruritus Winter itch ØXerosis (dry skin) ØAggravated by low ambient humidity, repeated exposure to water ØGreat frequency in elderly patients ØPhysical exam • Dry, crackednand scaly skin on the lower leg ØTreatment • Limiting frequency, duration and water temperature of bathing • Use superfatted soaps or syndet bars • Use emollients immediately after bath of shower

Generalized Pruritus Winter itch ØXerosis (dry skin) ØAggravated by low ambient humidity, repeated exposure to water ØGreat frequency in elderly patients ØPhysical exam • Dry, crackednand scaly skin on the lower leg ØTreatment • Limiting frequency, duration and water temperature of bathing • Use superfatted soaps or syndet bars • Use emollients immediately after bath of shower • Oral antihistamins

Generalized pruritus ØDermatologic (arising from diseases of the skin) • Xerosis • Atopic dermatitis • • contact dermatitis Urticaria bullouse pemphigoid dermatitis herpetiformis and … Ø Non-dermatologic • Systemic (liver, kidney, blood and drugs) • Neurologic (MS, brain tumor and …) • Psychogenic (depression, anxiety, OCD, , , )

Generalized pruritus Atopic Dermatitis ØDiagnostic criteria for atopic dermatitis

Generalized pruritus Atopic Dermatitis ØDiagnostic criteria for atopic dermatitis • Pruritus (primary lesion)

Generalized pruritus Atopic Dermatitis ØDiagnostic criteria for atopic dermatitis • Pruritus (primary lesion) • Typical morphology and distribution of lesions for age

Generalized pruritus Atopic Dermatitis ØDiagnostic criteria for atopic dermatitis • Pruritus (primary lesion) • Typical morphology and distribution of lesions for age • Chronic relapsing course

Generalized pruritus Atopic Dermatitis ØDiagnostic criteria for atopic dermatitis • Pruritus (primary lesion) • Typical morphology and distribution of lesions for age • Chronic relapsing course • Personal or family history of asthma, allergic rhinitis or atopic dermatitis

Generalized pruritus Atopic Dermatitis Ø Diagnostic criteria for atopic dermatitis • • Pruritus (primary lesion) Typical morphology and distribution of lesions for age Chronic relapsing course Personal or family history of asthma, allergic rhinitis or atopic dermatitis ØPresentation

Generalized pruritus Atopic Dermatitis Ø Diagnostic criteria for atopic dermatitis • • Pruritus (primary lesion) Typical morphology and distribution of lesions for age Chronic relapsing course Personal or family history of asthma, allergic rhinitis or atopic dermatitis ØPresentation • Infantile (2 mo to 2 y) • Cheeks

Generalized pruritus Atopic Dermatitis Ø Diagnostic criteria for atopic dermatitis • • Pruritus (primary lesion) Typical morphology and distribution of lesions for age Chronic relapsing course Personal or family history of asthma, allergic rhinitis or atopic dermatitis ØPresentation • Infantile (2 mo to 2 y) • Cheeks • Face

Generalized pruritus Atopic Dermatitis Ø Diagnostic criteria for atopic dermatitis • • Pruritus (primary lesion) Typical morphology and distribution of lesions for age Chronic relapsing course Personal or family history of asthma, allergic rhinitis or atopic dermatitis ØPresentation • Infantile (2 mo to 2 y) • Cheeks • Face • Ext surface of extremities

Generalized pruritus Atopic Dermatitis Ø Diagnostic criteria for atopic dermatitis • • Pruritus (primary lesion) Typical morphology and distribution of lesions for age Chronic relapsing course Personal or family history of asthma, allergic rhinitis or atopic dermatitis ØPresentation • Infantile • Childhood (3 to 11 y) • Flex surface of extremities

Generalized pruritus Atopic Dermatitis Ø Diagnostic criteria for atopic dermatitis • • Pruritus (primary lesion) Typical morphology and distribution of lesions for age Chronic relapsing course Personal or family history of asthma, allergic rhinitis or atopic dermatitis ØPresentation • Infantile • Childhood (3 to 11 y) • Flex surface of extrimities • Buttocks

Generalized pruritus Atopic Dermatitis Ø Diagnostic criteria for atopic dermatitis • • Pruritus (primary lesion) Typical morphology and distribution of lesions for age Chronic relapsing course Personal or family history of asthma, allergic rhinitis or atopic dermatitis ØPresentation • Infantile • Childhood (3 to 11 y) • Flex surface of extrimities • Buttocks • Back of thighs

Generalized pruritus Atopic Dermatitis Ø Diagnostic criteria for atopic dermatitis • • Pruritus (primary lesion) Typical morphology and distribution of lesions for age Chronic relapsing course Personal or family history of asthma, allergic rhinitis or atopic dermatitis ØPresentation • Infantile • Childhood • Adults • Mostly hands

Generalized pruritus Atopic Dermatitis Ø Diagnostic criteria for atopic dermatitis • • Pruritus (primary lesion) Typical morphology and distribution of lesions for age Chronic relapsing course Personal or family history of asthma, allergic rhinitis or atopic dermatitis ØPresentation • Infantile • Childhood • Adults • Mostly hands • Sometimes face and neck

Generalized pruritus Atopic Dermatitis Ø Diagnostic criteria for atopic dermatitis • • Pruritus (primary lesion) Typical morphology and distribution of lesions for age Chronic relapsing course Personal or family history of asthma, allergic rhinitis or atopic dermatitis ØPresentation • Infantile • Childhood • Adults • Mostly hands • Sometimes face and neck • Rarely diffuse area

Generalized pruritus Atopic Dermatitis Treatment ØAvoid provoking factors

Generalized pruritus Atopic Dermatitis Treatment ØAvoid provoking factors • Scrubbing

Generalized pruritus Atopic Dermatitis Treatment ØAvoid provoking factors • Scrubbing • Bathing > 10 min

Generalized pruritus Atopic Dermatitis Treatment ØAvoid provoking factors • Scrubbing • Bathing > 10 min • Hot water bathing

Generalized pruritus Atopic Dermatitis Treatment ØAvoid provoking factors • Scrubbing • Bathing > 10 min • Hot water bathing • Temperature extreme, …

Generalized pruritus Atopic Dermatitis Treatment Ø Avoid provoking factors • • Scrubbing bathing > 10 min hot water bathing temperature extreme, … ØApplying moisturizing

Generalized pruritus Atopic Dermatitis Treatment Ø Avoid provoking factors • • Scrubbing bathing > 10 min hot water bathing temperature extreme, … ØApplying moisturizing • Containing ceramid and vaselin

Generalized pruritus Atopic Dermatitis Treatment Ø Avoid provoking factors • • Scrubbing bathing > 10 min hot water bathing temperature extreme, … Ø Applying moisturizing • containing ceramid and vaselin • whitin 3 min of bathing ØKeep humidity between 35 -40%

Generalized Pruritus Atopic Dermatitis Treatment Subacute and Chronic lesions

Generalized Pruritus Atopic Dermatitis Treatment Subacute and Chronic lesions Topical CS

Generalized Pruritus Atopic Dermatitis Treatment Subacute and Chronic lesions Topical CS • Once daily use • Application in the evening more effective than morning

Generalized Pruritus Atopic Dermatitis Treatment Subacute and chronic lesions Topical CS • Once daily use • Application in the evening more effective than morning Acute and weeping lesion

Generalized Pruritus Atopic Dermatitis Treatment Subacute and chronic lesions Topical CS • Once daily use • Application in the evening more effective than morning Acute and weeping lesion Wet to dry compress

Generalized Pruritus Atopic Dermatitis Treatment Subacute and chronic lesions Topical CS • Once daily use • Application in the evening more effective than morning Acute and weeping lesion Wet to dry compress Role of antihistamins is minimal

Generalized Pruritus ØDermatologic (arising from diseases of the skin) • Xerosis • atopic dermatitis • Contact dermatitis • Urticaria • bullouse pemphigoid • dermatitis herpetiformis and … Ø Non-dermatologic • Systemic (liver, kidney, blood and drugs) • Neurologic (MS, brain tumor and …) • Psychogenic (depression, anxiety, OCD, , , )

Generalized Pruritus ØDermatologic (arising from diseases of the skin) • Xerosis • atopic dermatitis • Contact dermatitis • Urticaria • bullouse pemphigoid • dermatitis herpetiformis and … Ø Non-dermatologic • Systemic (liver, kidney, blood and drugs) • Neurologic (MS, brain tumor and …) • Psychogenic (depression, anxiety, OCD, , , )

Generalized Pruritus ØDermatologic (arising from diseases of the skin) • • Xerosis atopic dermatitis Contact dermatitis Urticaria • Bullouse pemphigoid • dermatitis herpetiformis and … Ø Non-dermatologic • Systemic (liver, kidney, blood and drugs) • Neurologic (MS, brain tumor and …) • Psychogenic (depression, anxiety, OCD, , , )

Generalized Pruritus Bullouse Pemphigoid ØBP is the disease of the elderly (after 60 y)

Generalized Pruritus Bullouse Pemphigoid ØBP is the disease of the eldery (after 60 y) ØIn non-bullouse phase sign and symptoms may be nonspecific

Generalized Pruritus Bullouse Pemphigoid ØBP is the disease of the eldery (after 60 y) ØIn non-bullouse phase sign and symptoms may be nonspecific • Mild to severe pruritus

Generalized Pruritus Bullouse Pemphigoid ØBP is the disease of the eldery (after 60 y) ØIn non-bullouse phase sign and symptoms may be nonspecific • Mild to severe pruritus • Eczematous lesions

Generalized Pruritus Bullouse Pemphigoid ØBP is the disease of the eldery (after 60 y) ØIn non-bullouse phase sign and symptoms may be nonspecific • Mild to severe pruritus • Eczematous lesions • Papular lesions

Generalized Pruritus Bullouse Pemphigoid ØBP is the disease of the eldery (after 60 y) ØIn non-bullouse phase sign and symptoms may be nonspecific • Mild to severe pruritus • Eczematous lesions • Papular lesions • Urticarial lesions

Generalized pruritus Bullouse pemphigoid ØBP is the disease of the eldery (after 60 y) ØIn non-bullouse phase sign and symptoms may be nonspecific • Mild to severe pruritus • Eczematous lesions • Papular lesions • Urticarial lesions • Persist for several weeks to months

Generalized pruritus Bullouse pemphigoid ØBP is the disease of the eldery (after 60 y) ØIn non-bullouse phase sign and symptoms may be nonspecific • Mild to severe pruritus • Eczematous lesions • Papular lesions • Urticarial lesions • Persist for several weeks to months • May remain the only sign of the disease

Generalized Pruritus ØDermatologic (arising from diseases of the skin) • • • Xerosis atopic dermatitis Contact dermatitis Urticaria Bullouse pemphigoid • Dermatitis herpetiformis and … Ø Non-dermatologic • Systemic (liver, kidney, blood and drugs) • Neurologic (MS, brain tumor and …) • Psychogenic (depression, anxiety, OCD, , , )

Generalized Pruritus Dermatitis Herpetiformis ØCutaneous manifestation of celiac disease

Generalized Pruritus Dermatitis Herpetiformis ØCutaneous manifestation of celiac disease ØAssociated with gluten sensitivity in all cases

Generalized Pruritus Dermatitis Herpetiformis ØCutaneous manifestation of celiac disease ØAssociated with gluten sensitivity in all cases ØSymmetric distribution of skin lesions

Generalized Pruritus Dermatitis Herpetiformis ØCutaneouse manifestation of celiac disease ØAssociated with gluten sensitivity an all cases ØSymmetric distribution of skin lesions • Elbows

Generalized Pruritus Dermatitis Herpetiformis ØCutaneouse manifestation of celiac disease Øassociated with gluten sensitivity an all cases ØSymmetric distribution of skin lesions • Elbows • Ext forearms

Generalized Pruritus Dermatitis Herpetiformis ØCutaneouse manifestation of celiac disease Øassociated with gluten sensitivity an all cases ØSymmetric distribution of skin lesions • Elbows • Ext forearms • Back

Generalized Pruritus Dermatitis Herpetiformis ØCutaneouse manifestation of celiac disease Øassociated with gluten sensitivity an all cases ØSymmetric distribution of skin lesions • Elbows • Ext forearms • Back • Buttocks • Knees

Generalized Pruritus Dermatitis Herpetiformis ØCutaneouse manifestation of celiac disease Øassociated with gluten sensitivity an all cases ØSymmetric distribution of skin lesions • Elbows • Ext forearms • Back • Buttocks • Knees

Generalized Pruritus Ø Dermatologic (arising from diseases of the skin) • • • Xerosis atopic dermatitis Contact dermatitis Urticaria Bullouse pemphigoid dermatitis herpetiformis and … ØNon-dermatologic • Systemic (liver, kidney, blood and drugs) • Neurologic (MS, brain tumor and …) • Psychogenic (depression, anxiety, OCD, , , )

Generalized Pruritus Ø Dermatologic (arising from diseases of the skin) • • • Xerosis atopic dermatitis Contact dermatitis Urticaria Bullouse pemphigoid dermatitis herpetiformis and … ØNon-dermatologic • Systemic (liver, kidney, blood and drugs) • Neurologic (MS, brain tumor and …) • Psychogenic (depression, anxiety, OCD, , , )

Generalized Pruritus Ø Dermatologic (arising from diseases of the skin) • • • Xerosis atopic dermatitis Contact dermatitis Urticaria Bullouse pemphigoid dermatitis herpetiformis and … ØNon-dermatologic • Systemic (liver, kidney, blood and drugs) • Neurologic (MS, brain tumor and …) • Psychogenic (depression, anxiety, OCD, , , )

Generalized Pruritus Ø Dermatologic (arising from diseases of the skin) • • • Xerosis atopic dermatitis Contact dermatitis Urticaria Bullouse pemphigoid dermatitis herpetiformis and … ØNon-dermatologic • Systemic (liver, kidney, blood and drugs) • Neurologic (MS, brain tumor and …) • Psychogenic (depression, anxiety, OCD, , , )