Pruritus in the Elderly: Differential Diagnosis and Management

Pruritis is a highly prevalent symptom in older adults significantly impacting their quality of life. It can manifest in the geriatric population due to a spectrum of etiologies including dermatological, systemic, psychological, medication-induced, and idiopathic causes. The purpose of this review was to explore pruritus in older adults with a discussion of common causes and current standards of management with a focus on the latest innovations within the last five years.

Common dermatological causes of pruritus in the elderly are atopic dermatitis, prurigo nodularis, psoriasis, seborrheic dermatitis, and transient Acantholytic Dermatosis also known as Grover’s disease. Noteworthy systemic causes are uremic or chronic kidney disease-associated pruritus, cholestatic disease, and paraneoplastic causes although additional etiologies such as neuropathic, psychogenic, drug-induced, or idiopathic itch must also be considered. Topical emollients and gentle cleansers are the foundation of managing pruritus in the elderly with adjuvant therapy focused on addressing the underlying trigger. Recent findings demonstrate immunobiologics having a greater role in treating skin conditions that cause pruritus although a variety of topical formulations are being investigated. The latest research on systemic causes of pruritus in the elderly is focused on addressing the underlying condition. Psychiatric medications and behavioral interventions are being explored for neuropathic and idiopathic causes of itch respectively.

Given the significant impact of pruritus on the quality of life of older adults, there is a need for further research on effective interventions for pruritus specifically among the elderly.