title: Practical guidelines for the use of steroid-sparing agents in the treatment of chronic pruritus.
abstract: Chronic pruritus in the adult patient is both an underappreciated and a difficult to treat condition. In the vast majority of cases, itch is the result of inflammatory skin disease and therefore may be responsive to systemic anti-inflammatory therapies. Urticarial dermatitis is an under-recognized cause of chronic itch in the adult population. Patients with this disorder are characterized by prolonged, prednisone-responsive pruritus, often in the absence of substantial cutaneous findings. Skin findings, when present, can range from subtle, persistent urticarial lesions to excoriated papules, often intermixed with urticaria, eczematous change, and lichenification secondary to chronic scratching. Hereby, we describe our algorithm for evaluation and management of adult patients with refractory pruritus (urticarial dermatitis in particular), including evaluation for other etiologies of pruritus, pre-immunosuppression workup, and the use of azathioprine and other steroid-sparing agents for treatment of recalcitrant itch.
authors.affiliation: Emory Department of Dermatology, Emory University, Atlanta, Georgia 30322, USA.
authors.forename: Maren E S
authors.initials: ME
authors.lastname: Cotes
authors.forename: Robert A
authors.initials: RA
authors.lastname: Swerlick
mesh_terms: D000328:Adult; D000465:Algorithms; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001379:Azathioprine / Q000627:therapeutic use; D002908:Chronic Disease; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011241:Prednisone / Q000627:therapeutic use; D011537:Pruritus / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D012871:Skin Diseases / Q000188:drug therapy / Q000473:pathology; D014581:Urticaria / Q000188:drug therapy / Q000473:pathology
chemical_list: D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D001379:Azathioprine; D011241:Prednisone