【Health Lecture】What is senile pruritus

In order to ensure the popularization effect of learning health knowledge in the "2024 China Elderly Health Knowledge Competition", the organizer has collected various health science articles suitable for the elderly from various hospitals. We will share them through the "Health Lecture" column. Today, Wang Congcong, a teacher from the Dermatology and Venereology Department of Zibo Central Hospital, brought "What is Senile Pruritus" and welcomes elderly friends to learn.

Senile pruritus is the most common geriatric skin disease, which is defined as skin itching in the elderly (≥60 years old) without obvious primary rash, daily or almost daily itching, and lasting for more than 6 weeks. The disease is mainly caused by various internal or external factors. It is a senile skin dysfunction skin disease. The clinical manifestations of patients are characterized by severe itching of the skin, scratches, blood crusts, skin hypertrophy, lichenification and other rashes after scratching, and may be accompanied by a variety of skin disease manifestations, including dry skin, rash, infection, scratches, chapped skin, ulcers, etc. Senile pruritus is one of the common skin diseases in clinical practice.

What are the most common causes of itchy skin in the elderly?

The cause of the disease is related to many factors such as reduced sebum secretion, clothing irritation, emotional disorders, temperature changes, and poor quality cosmetics.

1. Lifestyle: The itching of the elderly’s skin is closely related to their lifestyle. For example, some elderly people who love cleanliness will insist on taking a bath every day in the cold winter. In order to avoid catching a cold, they will take a bath with very hot water. In addition, the use of highly alkaline soap will cause the already dry skin to lose the moisture of sebum and induce itching.

2. Environmental factors: Dry climate can also aggravate the symptoms of itchy skin in the elderly. Because the elderly's skin will gradually shrink due to physiological aging, the epidermis will become thinner, and the function of the sebaceous glands and sweat glands will gradually decrease. The reduction of water content and sebum in the skin will cause dry and itchy skin. Especially in a dry environment, the skin cannot absorb moisture from the atmosphere, and the itching will be more obvious than in the humid summer.

3. Daily medication: Many elderly people have some physical problems, and they need to take medicine every day, which is also a major factor leading to skin itching. For example, common diabetes, atherosclerosis, thyroid disease and even some blood system diseases and malignant tumors, these diseases usually need to rely on drugs to control the condition, and a considerable number of drugs have great side effects, which may induce skin itching, not only in summer, but also in winter, the symptoms of this itching will be aggravated.

4. Physiological factors: From the perspective of traditional Chinese medicine, the liver function of the elderly is weak, the qi, blood, body fluid and essence are deficient, the skin loses nourishment, the meridians are not smooth, qi stagnation and blood stasis or insufficient qi and blood will lead to the attack of wind and cold external evil, and the combination of internal and external evil. Therefore, we can see that senile skin pruritus is more common in the dry and cold seasons of summer and autumn, and it will be alleviated in the warm and humid seasons of summer.

5. Other factors: It is also related to certain visceral diseases, such as liver disease, renal failure, hyperthyroidism or hypothyroidism, iron deficiency anemia, and tumors of various tissues. Pruritus may occur in the early stages of these diseases, or may be the first symptom. Diabetic patients may also experience or aggravate itching as their blood sugar levels rise.

Elderly people prone to itchy skin

1. People with dry skin: They develop pruritus earlier than their peers and the symptoms are relatively more obvious.

2. Elderly people with many chronic underlying diseases: Some elderly people have many underlying diseases. When the disease is not well controlled, it will cause skin itching.

3. Elderly people with long-term negative emotions: When the elderly have more negative emotions such as boredom, loneliness, depression, and negativity, their immunity decreases and they are more likely to have skin itching.

Misunderstandings in the treatment of elderly patients with pruritus

1. Some patients tend to solve the problem on their own when they have skin itching, and they often use pepper water, ginger, garlic, etc. to wipe the itchy parts. Most of these foods are warm in nature, pungent and dispersing, and are dry and strong. They are very irritating to the skin. Acting on the skin can easily make the damaged barrier weaker, forming a vicious circle. The more irritating, the more severe the itching. 2. Many patients take hot water baths when they have severe itching at night. Multiple rinses will cause the skin to lose more oil and moisture, making the skin, which already lacks nourishment, even drier, and the itching more intense. 3. Some patients will buy medicines by themselves when they have skin itching, but due to insufficient awareness of the disease, some of the purchased medicines are irritating, which will burn the skin and damage the skin barrier. Not only will they fail to achieve the treatment effect, but they will make the itching more and more severe.

Treatment of itchy skin in the elderly:

1. Avoid washing with hot water, excessive scratching, and spicy food.

2. Repair the skin barrier function through external moisturizers to relieve dry skin and itching caused by external stimuli.

3. Topical glucocorticoids or immunomodulators such as tacrolimus and pimecrolimus can interfere with certain pruritus factors and relieve itching; other antipruritic drugs such as calamine lotion, camphor-containing menthol, etc. can also be used externally.

4. Oral antihistamines, such as ebastine and loratadine, can inhibit histamine and relieve itching; severe patients can take small doses of hormones orally.

How to prevent the trouble caused by itching in life

1. Maintain appropriate temperature and humidity: In winter, keep warm while maintaining indoor humidity. If conditions permit, use a humidifier to keep the skin hydrated. You can also use odorless and colorless skin care products with good moisturizing effect to moisturize and repair the skin barrier to prevent the occurrence of pruritus. Take a warm shower. The bathing time should not be too long, generally 15-20 minutes. Avoid excessive scalding and excessive bathing. Avoid using a bath towel. Generally, bathing once every 1-2 weeks is sufficient.

2. Pay attention to diet: Eat light food, stay away from tobacco, alcohol, strong tea, spicy food, drink plenty of water to replenish the body's water, supplement vitamin C in moderation, and avoid eating shrimp, crab and seafood to prevent pruritus.

3. Choose pure cotton clothes: It is best to use pure cotton products for clothes and bedding, and reduce or avoid wool and chemical fiber products to reduce static electricity that may induce skin itching.

4. Keep bowel movements smooth: Constipation is one of the causes of aggravated itching. You should eat more fruits and vegetables, drink more water, exercise more, and keep bowel movements smooth.

5. Psychological care: Encourage patients to actively participate in elderly aerobics or watch TV, listen to music, etc., to divert attention from the itching and prevent mental factors from aggravating the itching.

Therefore, using daily skin care products to repair and enhance the skin barrier function to relieve itching is a safer and more convenient way. The elderly should pay attention to skin care, pay attention to the skin condition at any time, try to avoid using alkaline toiletries, and use skin care products reasonably. At the same time, wearing loose clothes, smoking and drinking less, eating light food, maintaining a good attitude and a regular work and rest schedule can reduce the probability of inducing itching, prevent and relieve itching problems in the elderly. You can use compound glycerin lotion, calamine lotion and other drugs under the guidance of a doctor, or you can take antihistamines such as loratadine and cetirizine orally for symptomatic treatment of itching.

Author: Wang Congcong

Image: Qianku.com

About the Author

Wang Congcong, attending physician, master's degree student, Department of Dermatology and Venereology, Zibo Central Hospital, graduated from Tianjin Medical University in 2015, majoring in dermatology and venereology. He is mainly good at the diagnosis and treatment of common diseases in skin diseases and venereal diseases. He published two papers in core journals in 2017 and 2021, and one SCI paper in 2023. He won the second prize of Science and Technology Progress in Zibo City. In September 2020, he went to the Department of Dermatology and Venereology of Peking University First Hospital for half a year of advanced study in dermatology surgery, followed Professor Li Hang to learn mosh surgery and conventional surgical operations, and then studied in dermatology for half a year. He is proficient in the diagnosis and treatment of common dermatological diseases and has a certain understanding of rare diseases. He is currently a member of the Science Popularization Committee of the Chinese Medical Education Association, a member of the Skin and Cosmetology Branch of the Chinese Association for the Promotion of Traditional Chinese Medicine Research, a member of the Skin and Venereology Branch of the Shandong Research Hospital Association, a member of the Hemangioma and Vascular Malformation Branch of the Shandong Health Management Association, and a member of the Skin Tumor and Skin Surgery Professional Committee of the Shandong Geriatrics Society.