Factors Affecting The Etiology Of Intractable Pruritus In Hospitalized Patients Without Primary Skin Lesions

Abstract

Introduction: Pruritus is a common symptom that has dermatologic, systemic, neurological, psychogenic, mixed, and unknown causes. The aim of this study was to identify the underlying origin of pruritus (UOP) in hospitalized patients having intractable pruritus and presenting with secondary scratch lesions (SSLs) and to assess the factors affecting UOP. Methods: Data of 95 patients (male/female: 47/48) presenting with SSLs were examined retrospectively. Demographic and clinical characteristics, diagnostic procedures, and treatment agents were recorded. UOP was defined as dermatological and non-dermatological factors. Results: The median (range) age and disease duration were 61 years (11-91) and 2 months (0.06-120), respectively. Pruritus was related to dermatological and non-dermatological reasons in 78% and 22% of patients. Univariate analysis revealed that factors showing an association between patients with and without underlying dermatological origin of [pruritus (UDOP)] were age, disease duration, disease onset, >= 3 months of continuous drug use, intake of drugs attributed to lead to pruritus, accompanying systemic diseases, polypharmacy, renal function tests, and the presence of sleep disorders (p=0.001, p=0.001, p=0.001, p=0.03, p=0.045, p=0.02, p=0.004, p=0.047 and p=0.01, respectively). Multivariate analyses revealed that acute onset of pruritus increased the risk of UDOP by 15.28 times (p=0.005, 95% confidence interval (CI): 2.30-101.67) compared to patients with chronic onset. The lack of sleep disorders increased the risk of UDOP by 8.22 times (p=0.01, 95% CI: 1.67-40.56) compared to patients who had sleep disorders. Conclusion: Acute onset of pruritus and lack of sleep disorders were independent predictors of UDOP in patients with SSLs. The remaining patients without UDOP should be directed to the relevant departments for accurate diagnosis and management.