Acta Dermato-Venereologica 97-4

433 SPECIAL REPORT A Literature Review of Senile Pruritus: From Diagnosis to Treatment Caroline-Jade CLERC and Laurent MISERY Department of Dermatology, University Hospital of Brest, Brest, France Pruritus occurs frequently in the elderly population, but it has not been fully defined and its precise pre- valence is unknown. Putative causes of pruritus are numerous and patients’ quality of life can be greatly reduced. In the absence of any specific cause, a diag- nosis of senile pruritus is proposed, suggesting that itch is secondary to ageing. However, the relationship of pruritus with skin ageing and/or neuronal ageing and/or immune ageing is poorly understood. Many treatments have been reported, but are poorly effec- tive. This paper reviews the literature on senile pruri- tus, in order to improve understanding of this condi- tion and to enable improved diagnosis and treatment. Key words: senile; elderly; itch; pruritus. Accepted Nov 10, 2016; Epub ahead of print Nov 14, 2016 Acta Derm Venereol 2017; 97: 433–440. Corr: Laurent Misery, Department of Dermatology, University Hospital of Brest, 2 avenue Foch, FR-29200 Brest, France. E-mail: Laurent.misery@ chu-brest.fr P ruritus is an unpleasant sensation associated with the need to scratch (1). It can be distinguished as acute or chronic, with the latter defined as pruritus lasting 6 or more weeks (2). The International Forum for the Study of Itch (IFSI) proposed a classification system for chro- nic pruritus into 3 groups: group I, pruritus on diseased skin; group II, pruritus on non-diseased skin; group III, pruritus presenting with severe chronic secondary scratch lesions. The IFSI also specified the following 6 categories of underlying pruritogenic diseases: dermatological, sys- temic, neurological, psychogenic/psychosomatic, mixed, and other. The category “other” is also called “pruritus of undetermined origin” (PUO) (2). WHO defines elderly people as those aged ≥ 60 years (3). In clinical research, this population is traditionally defined as people aged 65 years and over (4–8). How ever, in France, medical practice on a geriatric ward defines the threshold of old age as 75 years and older (Institut National de la Statistique et des Études Éco- nomiques; INSEE). The WHO predicts that the global population of those aged 60 years and older will reach 1.7 billion by 2050 (9). Elderly people often report pruritus; it is the most com- mon complaint among patients during a dermatological consultation (4, 10). Pruritus in elderly people can be defined as chronic pruritus in a person over 65 years old (11). Determining the aetiology is the first step in providing support. However, sometimes no underlying cause is found. Senile pruritus can be defined as a chronic itch in a person aged 65 years or older, with no aetiology deter- mined by an appropriate examination and check-up (6), although a clear and consensual definition is lacking. It is a diagnosis of exclusion. The pathophysiology of senile pruritus is unknown, but the senile character suggests a role for skin ageing (12). Research into senile pruritus is necessary to help elderly people. Finding an appropriate treatment for senile pruritus is a priority that will be achieved only through a thorough understanding of the underlying cause. The aim of this paper is to review the literature on se- nile pruritus, in order to provide physicians with a better understanding of this condition and to enable improved diagnosis and treatment. METHODS Medline and Cochrane databases where searched, using the follo- wing combinations of Medical Subject Headings (MESH): “senile pruritus” OR “elderly pruritus” OR “elderly” AND “idiopathic pruritus”. The search was limited to human data and English, French or Spanish language articles on patients older than 65 years. No date limits were used for the search. A total of 2,451 articles were found in Medline and 147 articles in the Cochrane databases; in all 2,598 references. After removing duplicates, 2,582 references remained. Of these, 2,525 were excluded after 16 duplicates 2,582 articles Excluded articles : 2,525 – 11 inappropriate language – 2,503 off topic This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2017 Acta Dermato-Venereologica. Cochrane: 147 articles PubMed : 2,451 articles Articles added during research : 20 Selected articles: 77 Fig. 1. Study selection process. doi: 10.2340/00015555-2574 Acta Derm Venereol 2017; 97: 433–440

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