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Pruritus: Pathogenesis, Therapy, and Significance in Systemic Disease States

Pruritus: Pathogenesis, Therapy, and Significance in Systemic Disease States Abstract • Pruritus is a cutaneous sensation sharing neural receptors and pathways with pain but is characterized by its own precipitants, potentiators, and range of severity. Among patients with generalized pruritus, the prevalence of systemic disease has been reported as 10% to 50%, with renal, hepatic, hematopoietic, or endocrine causes most commonly identified. Malignant neoplasms, neurologic disorders, certain drugs, or advanced age also may be responsible. Although the pathogenesis of pruritus is unknown, clinically relevant potential mediators have been investigated in several settings. Therapy often fails when the underlying disorder cannot be corrected, but for pruritus associated with chronic renal failure or hepatic cholestasis, specific and usually effective treatments exist. (Arch Intern Med 1982;142:101-105) References 1. Tonnesen MG: Pruritus , in Fitzpatrick TB, Eisen AZ, Wolff K, et al (eds): Dermatology in General Medicine , ed 2. New York, McGraw-Hill Book Co, 1979, pp 32-34. 2. Lorincz AL: Neurophysiologic reactions of the skin: Pathophysiology of pruritus , in Fitzpatrick TB, Eisen AZ, Wolff K, et al (eds): Dermatology in General Medicine , ed 2. New York, McGraw-Hill Book Co, 1979, pp 221-224. 3. Shelley WB, Arthur RP: Studies on cowhage (Mucuna pruriens) and its pruritogenic proteinase, mucanin. Arch Dermatol 1955;72:399-406.Crossref 4. Herndon JH Jr: Itching: The pathophysiology of pruritus. Int J Dermatol 1975;14:465-484.Crossref 5. Shelley WB, Arthur RP: The neurohistology and neurophysiology of the itch sensation in man. Arch Dermatol 1957;76:296-323.Crossref 6. Cormia FE, Dougherty JW: Proteolytic activity in development of pain and itching: Cutaneous reactions to bradykinin and kallikerin. J Invest Dermatol 1960;35:21-26.Crossref 7. Hagermark O: Studies on experimental itch produced by kallikrein and bradykinin. Acta Derm Venereol 1974;54:397-400. 8. Herndon JH Jr: Pathophysiology of pruritus associated with elevated bile acid levels in serum. Arch Intern Med 1972;130:632-637.Crossref 9. Rothman S: Pathophysiology of itch sensation , in Montagna W (ed): Advances in the Biology of Skin . New York, Pergamon Press Inc, 1960, pp 189-201. 10. Scuka M: Analysis of the effects of histamine on the end-plate potential. Neuropharmacology 1973;12:441-450.Crossref 11. Arndt KA: Manual of Dermatologic Therapeutics , ed 2. Boston, Little Brown & Co, 1978, pp 263-266. 12. Marx JL: Brain peptides: Is substance P a transmitter of pain signals? Science 1979;205:886-889.Crossref 13. Hokfelt T, Ljungdahl A, Terenius L, et al: Immunohistochemical analysis of peptide pathways possibly related to pain and analgesia: Enkephalin and substance P. Proc Natl Acad Sci USA 1977;74:3081-3085.Crossref 14. Cuello AC, Falgre G, Milstein C: Detection of substance P in the central nervous system by a monoclonal antibody. Proc Natl Acad Sci USA 1979;76:3532-3536.Crossref 15. Hokfelt T, Kellerth JO, Millson G, et al: Substance P: Localization in the central nervous system and in some primary sensory neurons. Science 1975;190:889-890.Crossref 16. Hagermark O, Hokfelt T, Pernow B: Flare and itch induced by substance P in human skin. J Invest Dermatol 1978;71:233-235.Crossref 17. Lovell CR, Burton PA, Duncan EHL, et al: Prostaglandins and pruritus. Br J Dermatol 1976;94:527-530. 18. Hagermark O, Strandberg K, Hamberg M: Potentiation of itch and flare responses in human skin by prostaglandins E2 and F2 and a prostaglandin endoperoxide analog. J Invest Dermatol 1977;69:527-530.Crossref 19. Lyell A: The itching patient: A review of the causes of pruritus. Scott Med J 1972;17:334-347. 20. Beare JM: Generalized pruritus: A study of 43 cases. Clin Exp Dermatol 1976;1:343-352.Crossref 21. Rajka G: Investigation of patients suffering from generalized pruritus, with special reference to systemic diseases. Acta Derm Venereol 1966;49:190-194. 22. Chapin L, Keil H: Skin disease in non-surgical renal disease. Arch Dermatol 1932;26:314-335.Crossref 23. Young AW Jr, Sweeney EW, David DS, et al: Dermatologic evaluation of pruritus in patients on hemodialysis. NY State J Med 1973;73:2670-2674. 24. Gilchrest BA, Rowe JW, Mihm MC Jr: Clinical and histologic cutaneous findings in uremia: Evidence for a dialysis-resistant, transplant responsive microangiopathy. Lancet 1980;2:1271-1275.Crossref 25. Botero F: Pruritus as a manifestation of systemic disorders. Cutis 1978;21:873-880. 26. Massry SG, Popovtzer MM, Coburn JW, et al: Intractable pruritus as a manifestation of secondary hyperparathyroidism in uremia. N Engl J Med 1968;279:697-700.Crossref 27. Hampers CL, Katz AI, Wilson RE: Disappearance of 'uremic' itching after subtotal parathyroidectomy. N Engl J Med 1968;279:695-697.Crossref 28. Neiman RS, Bischel MD, Lukes RJ: Uremia and mast cell proliferation. Lancet 1972;2:959.Crossref 29. Zappacosta AR, Haus D: Cimetidine doesn't help pruritus of uremia. N Engl J Med 1979;300:1280. 30. Gilchrest BA, Rowe JW, Brown RS, et al: Ultraviolet phototherapy of uremic pruritus: Long term results and possible mechanism of action. Ann Intern Med 1979;91:17-21.Crossref 31. Silverberg DS, Iaina A, Reisin E, et al: Cholestyramine in uremic pruritus. Br Med J 1977;1:752-753.Crossref 32. Ahrens EH, Payne MA, Kunkel HG, et al: Primary biliary cirrhosis. Medicine 1950;29:299-364.Crossref 33. Drill VA: Benign cholestatic jaundice of pregnancy and benign cholestatic jaundice from oral contraceptives. Am J Obstet Gynecol 1974;119:165-174. 34. Johnston WG, Baskett TF: Obstetric cholestasis: A 14 year review. Am J Obstet Gynecol 1979;133:299-301. 35. Dahl M: Premenstrual pruritus due to recurrent cholestasis. Trans St Johns Hosp Dermatol Soc 1970;56:11-13. 36. Makipour H, Cooperman A, Danzi JT, et al: Carcinoma of the ampulla of Vater: Review of 38 cases with emphasis on treatment prognostic factors. Ann Surg 1976;183:341-344.Crossref 37. Cello JP: Cholestasis in ulcerative colitis: Long term complications and medical therapy. Gastroenterology 1977;73:373-374. 38. Thorne EG: Coping with pruritus: A common geriatric complaint. Geriatrics 1978;33:47-49. 39. Corey JB, Williams G: Relief of the pruritus of jaundice with a bile acid sequestering resin. JAMA 1961;176:432-435.Crossref 40. Lottsfeldt FI, Krwit W, Anst JB, et al: Cholestyramine therapy in intrahepatic biliary atresia. N Engl J Med 1963;269:186-189.Crossref 41. Rosenoer VM, Gokim G Jr: Management of patients with chronic obstructive jaundice. Med Clin North Am 1972;56:759-770. 42. Lauterburg BH, Pineda AA, Dickson ER, et al: Plasma perfusion for the treatment of intractable pruritus of cholestasis. Mayo Clin Proc 1978;53:403-407. 43. Schoenfield LJ, Sjövall J, Permen E: Bile acids on the skin of patients with pruritic hepatobiliary disease. Nature 1967;213:93-94.Crossref 44. Ghent CN, Bloomer JR, Klatskin G: Elevations in skin tissue levels of bile acids in human cholestasis: Relation to serum levels and to pruritus. Gastroenterology 1977;73:1125-1130. 45. Easton P, Galbraith PR: Cimetidine treatment of pruritus in polycytemia vera. N Engl J Med 1978;299:1134. 46. Klein H: Polycythemia: Theory & Management . Springfield, Ill, Charles C Thomas Publisher, 1973, p 96. 47. Winkelmann RK: Dermatologic clinics: I. Comments on pruritus related to systemic disease. Proc Staff Meetings Mayo Clinic 1961;36:187-196. 48. Bluefarb SM: Cutaneous Manifestations of Malignant Lymphomas . Springfield, Ill, Charles C Thomas Publisher, 1959, p 534. 49. Feiner AS, Mahmood T, Willner SF: Prognostic importance of pruritus in Hodgkin's disease. JAMA 1978;240:2738-2740.Crossref 50. Lamberg SI, Green SB, Byar DP, et al: Status report of 376 mycosis fungoides patients at four years, Mycosis Fungoides Cooperative Group. Cancer Treat Rep 1979;63:701-707. 51. Erskine JG, Rowan RM, Alexander JO, et al: Pruritus as a presentation of myelomatosis. Br Med J 1977;1:687-688.Crossref 52. Zelicovici A: Pruritus as a possible early sign of paraproteinemia. Isr J Med Sci 1969;5:1079-1081. 53. Lewiecki EM, Rahman F: Pruritus: A manifestation of iron deficiency. JAMA 1976;236:2319-2320.Crossref 54. Vickers CF: Iron-deficiency pruritus. JAMA 1977;238:129.Crossref 55. Barnes HM, Sarkany I, Calnan CD: Pruritus and thyrotoxicosis. Trans St Johns Hosp Dermatol Soc 1974;60:59-62. 56. Isaacs NJ, Ertel NH: Urticaria and pruritus: Uncommon manifestation of hyperthyroidism. J Allergy Clin Immunol 1971;48:73-81.Crossref 57. Greenwood AM: A study of the skin in 500 cases of diabetes. JAMA 1927;89:774-776.Crossref 58. Stawiski MA, Voorhees JJ: Cutaneous signs of diabetes mellitus. Cutis 1976;18:415-421. 59. Menzel CE: Cutaneous manifestations of the malignant carcinoid syndrome. Ann Intern Med 1963;58:989-993.Crossref 60. Kahil ME, Brown H, Fred HL: The carcinoid crisis. Arch Intern Med 1964;114:26.Crossref 61. Marks JM, Shuster S: The skin and disorders of the alimentary tract , in Fitzpatrick TB, Eisen AZ, Wolff K, et al (eds): Dermatology in General Medicine , ed 2. New York, McGraw-Hill Book Co, 1979, pp 1193-1205. 62. Cormia FE: Pruritus, an uncommon but important symptom of systemic carcinoma. Arch Dermatol 1965;92:36-39.Crossref 63. Ostermann PO, Westerberg CE: Paroxysmal attacks in multiple sclerosis. Brain 1975;98:189-202.Crossref 64. Lidell K: Post-herpetic pruritus. Br Med J 1974;4:165.Crossref 65. Rothman S: Physiology of itching. Physiol Rev 1941;21:357-381. 66. Felding W, Paton WDM: Release of histamine from skin and muscle in the cat by opium alkaloids and other histamine liberators. J Physiol 1951;114:490-509. 67. Rathod NH, Alarcon RDE, Thomson IG: Signs of heroin usage detected by drug users and their parents. Lancet 1978;2:1411. 68. Young AW Jr, Sweeney EW: Cutaneous clues to heroin addiction. Am Fam Physician 1973;7:79-87. 69. Bernstein JE, Swift R: Relief of intractable pruritus with naloxone. Arch Dermatol 1979;15:1366-1367.Crossref 70. Melski JW, Tanenbaum L, Parrish JA, et al: Oral methoxsalen photochemotherapy for the treatment of psoriasis: A cooperative clinical trail. J Invest Dermatol 1977;68:328-335.Crossref 71. Jordan WP: PUVA, pruritus, and the loss of the axon flare. Arch Dermatol 1979;115:636.Crossref 72. Griesmer RD, Nadelson T: Emotional aspects of cutaneous disease , in Fitzpatrick TB, Eisen AZ, Wolff K, et al (eds): Dermatology in General Medicine , ed 2. New York, McGraw-Hill Book Co, 1979, pp 1353-1363. 73. Tapia L, Cheigh JS, David DS, et al: Pruritus in dialysis patients treated with parenteral lidocaine. N Engl J Med 1977;296:261-262.Crossref 74. Gilchrest BA, Rowe JW, Brown RS, et al: Relief of uremic pruritus with ultraviolet phototherapy. N Engl J Med 1977;297:136-138.Crossref 75. Shultz BC, Roenigk HH Jr: Uremic pruritus treated with ultraviolet light. JAMA 1980;243:1836-1837.Crossref 76. Pederson JA, Matter BJ, Czerwinski AW, et al: Relief of idiopathic generalized pruritus in dialysis patients treated with activated oral charcoal. Ann Intern Med 1980;93:446-448.Crossref 77. Freedman MR, Holzbach RT, Ferguson DR: Pruritus in cholestasis: No direct causative role for bile acid retention. Am J Med 1981;70:1011-1016.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Pruritus: Pathogenesis, Therapy, and Significance in Systemic Disease States

Archives of Internal Medicine , Volume 142 (1) – Jan 1, 1982

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American Medical Association
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Copyright © 1982 American Medical Association. All Rights Reserved.
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0003-9926
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1538-3679
DOI
10.1001/archinte.1982.00340140103018
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Abstract

Abstract • Pruritus is a cutaneous sensation sharing neural receptors and pathways with pain but is characterized by its own precipitants, potentiators, and range of severity. Among patients with generalized pruritus, the prevalence of systemic disease has been reported as 10% to 50%, with renal, hepatic, hematopoietic, or endocrine causes most commonly identified. Malignant neoplasms, neurologic disorders, certain drugs, or advanced age also may be responsible. Although the pathogenesis of pruritus is unknown, clinically relevant potential mediators have been investigated in several settings. Therapy often fails when the underlying disorder cannot be corrected, but for pruritus associated with chronic renal failure or hepatic cholestasis, specific and usually effective treatments exist. (Arch Intern Med 1982;142:101-105) References 1. Tonnesen MG: Pruritus , in Fitzpatrick TB, Eisen AZ, Wolff K, et al (eds): Dermatology in General Medicine , ed 2. New York, McGraw-Hill Book Co, 1979, pp 32-34. 2. Lorincz AL: Neurophysiologic reactions of the skin: Pathophysiology of pruritus , in Fitzpatrick TB, Eisen AZ, Wolff K, et al (eds): Dermatology in General Medicine , ed 2. New York, McGraw-Hill Book Co, 1979, pp 221-224. 3. Shelley WB, Arthur RP: Studies on cowhage (Mucuna pruriens) and its pruritogenic proteinase, mucanin. Arch Dermatol 1955;72:399-406.Crossref 4. Herndon JH Jr: Itching: The pathophysiology of pruritus. Int J Dermatol 1975;14:465-484.Crossref 5. Shelley WB, Arthur RP: The neurohistology and neurophysiology of the itch sensation in man. Arch Dermatol 1957;76:296-323.Crossref 6. Cormia FE, Dougherty JW: Proteolytic activity in development of pain and itching: Cutaneous reactions to bradykinin and kallikerin. J Invest Dermatol 1960;35:21-26.Crossref 7. Hagermark O: Studies on experimental itch produced by kallikrein and bradykinin. Acta Derm Venereol 1974;54:397-400. 8. Herndon JH Jr: Pathophysiology of pruritus associated with elevated bile acid levels in serum. Arch Intern Med 1972;130:632-637.Crossref 9. Rothman S: Pathophysiology of itch sensation , in Montagna W (ed): Advances in the Biology of Skin . New York, Pergamon Press Inc, 1960, pp 189-201. 10. Scuka M: Analysis of the effects of histamine on the end-plate potential. Neuropharmacology 1973;12:441-450.Crossref 11. Arndt KA: Manual of Dermatologic Therapeutics , ed 2. Boston, Little Brown & Co, 1978, pp 263-266. 12. Marx JL: Brain peptides: Is substance P a transmitter of pain signals? Science 1979;205:886-889.Crossref 13. Hokfelt T, Ljungdahl A, Terenius L, et al: Immunohistochemical analysis of peptide pathways possibly related to pain and analgesia: Enkephalin and substance P. Proc Natl Acad Sci USA 1977;74:3081-3085.Crossref 14. Cuello AC, Falgre G, Milstein C: Detection of substance P in the central nervous system by a monoclonal antibody. Proc Natl Acad Sci USA 1979;76:3532-3536.Crossref 15. Hokfelt T, Kellerth JO, Millson G, et al: Substance P: Localization in the central nervous system and in some primary sensory neurons. Science 1975;190:889-890.Crossref 16. Hagermark O, Hokfelt T, Pernow B: Flare and itch induced by substance P in human skin. J Invest Dermatol 1978;71:233-235.Crossref 17. Lovell CR, Burton PA, Duncan EHL, et al: Prostaglandins and pruritus. Br J Dermatol 1976;94:527-530. 18. Hagermark O, Strandberg K, Hamberg M: Potentiation of itch and flare responses in human skin by prostaglandins E2 and F2 and a prostaglandin endoperoxide analog. J Invest Dermatol 1977;69:527-530.Crossref 19. Lyell A: The itching patient: A review of the causes of pruritus. Scott Med J 1972;17:334-347. 20. Beare JM: Generalized pruritus: A study of 43 cases. Clin Exp Dermatol 1976;1:343-352.Crossref 21. Rajka G: Investigation of patients suffering from generalized pruritus, with special reference to systemic diseases. Acta Derm Venereol 1966;49:190-194. 22. Chapin L, Keil H: Skin disease in non-surgical renal disease. Arch Dermatol 1932;26:314-335.Crossref 23. Young AW Jr, Sweeney EW, David DS, et al: Dermatologic evaluation of pruritus in patients on hemodialysis. NY State J Med 1973;73:2670-2674. 24. Gilchrest BA, Rowe JW, Mihm MC Jr: Clinical and histologic cutaneous findings in uremia: Evidence for a dialysis-resistant, transplant responsive microangiopathy. Lancet 1980;2:1271-1275.Crossref 25. Botero F: Pruritus as a manifestation of systemic disorders. Cutis 1978;21:873-880. 26. Massry SG, Popovtzer MM, Coburn JW, et al: Intractable pruritus as a manifestation of secondary hyperparathyroidism in uremia. N Engl J Med 1968;279:697-700.Crossref 27. Hampers CL, Katz AI, Wilson RE: Disappearance of 'uremic' itching after subtotal parathyroidectomy. N Engl J Med 1968;279:695-697.Crossref 28. Neiman RS, Bischel MD, Lukes RJ: Uremia and mast cell proliferation. Lancet 1972;2:959.Crossref 29. Zappacosta AR, Haus D: Cimetidine doesn't help pruritus of uremia. N Engl J Med 1979;300:1280. 30. Gilchrest BA, Rowe JW, Brown RS, et al: Ultraviolet phototherapy of uremic pruritus: Long term results and possible mechanism of action. Ann Intern Med 1979;91:17-21.Crossref 31. Silverberg DS, Iaina A, Reisin E, et al: Cholestyramine in uremic pruritus. Br Med J 1977;1:752-753.Crossref 32. Ahrens EH, Payne MA, Kunkel HG, et al: Primary biliary cirrhosis. Medicine 1950;29:299-364.Crossref 33. Drill VA: Benign cholestatic jaundice of pregnancy and benign cholestatic jaundice from oral contraceptives. Am J Obstet Gynecol 1974;119:165-174. 34. Johnston WG, Baskett TF: Obstetric cholestasis: A 14 year review. Am J Obstet Gynecol 1979;133:299-301. 35. Dahl M: Premenstrual pruritus due to recurrent cholestasis. Trans St Johns Hosp Dermatol Soc 1970;56:11-13. 36. Makipour H, Cooperman A, Danzi JT, et al: Carcinoma of the ampulla of Vater: Review of 38 cases with emphasis on treatment prognostic factors. Ann Surg 1976;183:341-344.Crossref 37. Cello JP: Cholestasis in ulcerative colitis: Long term complications and medical therapy. Gastroenterology 1977;73:373-374. 38. Thorne EG: Coping with pruritus: A common geriatric complaint. Geriatrics 1978;33:47-49. 39. Corey JB, Williams G: Relief of the pruritus of jaundice with a bile acid sequestering resin. JAMA 1961;176:432-435.Crossref 40. Lottsfeldt FI, Krwit W, Anst JB, et al: Cholestyramine therapy in intrahepatic biliary atresia. N Engl J Med 1963;269:186-189.Crossref 41. Rosenoer VM, Gokim G Jr: Management of patients with chronic obstructive jaundice. Med Clin North Am 1972;56:759-770. 42. Lauterburg BH, Pineda AA, Dickson ER, et al: Plasma perfusion for the treatment of intractable pruritus of cholestasis. Mayo Clin Proc 1978;53:403-407. 43. Schoenfield LJ, Sjövall J, Permen E: Bile acids on the skin of patients with pruritic hepatobiliary disease. Nature 1967;213:93-94.Crossref 44. Ghent CN, Bloomer JR, Klatskin G: Elevations in skin tissue levels of bile acids in human cholestasis: Relation to serum levels and to pruritus. Gastroenterology 1977;73:1125-1130. 45. Easton P, Galbraith PR: Cimetidine treatment of pruritus in polycytemia vera. N Engl J Med 1978;299:1134. 46. Klein H: Polycythemia: Theory & Management . Springfield, Ill, Charles C Thomas Publisher, 1973, p 96. 47. Winkelmann RK: Dermatologic clinics: I. Comments on pruritus related to systemic disease. Proc Staff Meetings Mayo Clinic 1961;36:187-196. 48. Bluefarb SM: Cutaneous Manifestations of Malignant Lymphomas . Springfield, Ill, Charles C Thomas Publisher, 1959, p 534. 49. Feiner AS, Mahmood T, Willner SF: Prognostic importance of pruritus in Hodgkin's disease. JAMA 1978;240:2738-2740.Crossref 50. Lamberg SI, Green SB, Byar DP, et al: Status report of 376 mycosis fungoides patients at four years, Mycosis Fungoides Cooperative Group. Cancer Treat Rep 1979;63:701-707. 51. Erskine JG, Rowan RM, Alexander JO, et al: Pruritus as a presentation of myelomatosis. Br Med J 1977;1:687-688.Crossref 52. Zelicovici A: Pruritus as a possible early sign of paraproteinemia. Isr J Med Sci 1969;5:1079-1081. 53. Lewiecki EM, Rahman F: Pruritus: A manifestation of iron deficiency. JAMA 1976;236:2319-2320.Crossref 54. Vickers CF: Iron-deficiency pruritus. JAMA 1977;238:129.Crossref 55. Barnes HM, Sarkany I, Calnan CD: Pruritus and thyrotoxicosis. Trans St Johns Hosp Dermatol Soc 1974;60:59-62. 56. Isaacs NJ, Ertel NH: Urticaria and pruritus: Uncommon manifestation of hyperthyroidism. J Allergy Clin Immunol 1971;48:73-81.Crossref 57. Greenwood AM: A study of the skin in 500 cases of diabetes. JAMA 1927;89:774-776.Crossref 58. Stawiski MA, Voorhees JJ: Cutaneous signs of diabetes mellitus. Cutis 1976;18:415-421. 59. Menzel CE: Cutaneous manifestations of the malignant carcinoid syndrome. Ann Intern Med 1963;58:989-993.Crossref 60. Kahil ME, Brown H, Fred HL: The carcinoid crisis. Arch Intern Med 1964;114:26.Crossref 61. Marks JM, Shuster S: The skin and disorders of the alimentary tract , in Fitzpatrick TB, Eisen AZ, Wolff K, et al (eds): Dermatology in General Medicine , ed 2. New York, McGraw-Hill Book Co, 1979, pp 1193-1205. 62. Cormia FE: Pruritus, an uncommon but important symptom of systemic carcinoma. Arch Dermatol 1965;92:36-39.Crossref 63. Ostermann PO, Westerberg CE: Paroxysmal attacks in multiple sclerosis. Brain 1975;98:189-202.Crossref 64. Lidell K: Post-herpetic pruritus. Br Med J 1974;4:165.Crossref 65. Rothman S: Physiology of itching. Physiol Rev 1941;21:357-381. 66. Felding W, Paton WDM: Release of histamine from skin and muscle in the cat by opium alkaloids and other histamine liberators. J Physiol 1951;114:490-509. 67. Rathod NH, Alarcon RDE, Thomson IG: Signs of heroin usage detected by drug users and their parents. Lancet 1978;2:1411. 68. Young AW Jr, Sweeney EW: Cutaneous clues to heroin addiction. Am Fam Physician 1973;7:79-87. 69. Bernstein JE, Swift R: Relief of intractable pruritus with naloxone. Arch Dermatol 1979;15:1366-1367.Crossref 70. Melski JW, Tanenbaum L, Parrish JA, et al: Oral methoxsalen photochemotherapy for the treatment of psoriasis: A cooperative clinical trail. J Invest Dermatol 1977;68:328-335.Crossref 71. Jordan WP: PUVA, pruritus, and the loss of the axon flare. Arch Dermatol 1979;115:636.Crossref 72. Griesmer RD, Nadelson T: Emotional aspects of cutaneous disease , in Fitzpatrick TB, Eisen AZ, Wolff K, et al (eds): Dermatology in General Medicine , ed 2. New York, McGraw-Hill Book Co, 1979, pp 1353-1363. 73. Tapia L, Cheigh JS, David DS, et al: Pruritus in dialysis patients treated with parenteral lidocaine. N Engl J Med 1977;296:261-262.Crossref 74. Gilchrest BA, Rowe JW, Brown RS, et al: Relief of uremic pruritus with ultraviolet phototherapy. N Engl J Med 1977;297:136-138.Crossref 75. Shultz BC, Roenigk HH Jr: Uremic pruritus treated with ultraviolet light. JAMA 1980;243:1836-1837.Crossref 76. Pederson JA, Matter BJ, Czerwinski AW, et al: Relief of idiopathic generalized pruritus in dialysis patients treated with activated oral charcoal. Ann Intern Med 1980;93:446-448.Crossref 77. Freedman MR, Holzbach RT, Ferguson DR: Pruritus in cholestasis: No direct causative role for bile acid retention. Am J Med 1981;70:1011-1016.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jan 1, 1982

References