Itch and malignancy prognosis in generalized pruritus: A 6-year follow-up of 125 patients

doi:10.1016/S0190-9622(87)70154-6

Journal of the American Academy of Dermatology

Volume 16, Issue 6, June 1987, Pages 1179-1182

https://doi.org/10.1016/S0190-9622(87)70154-6 Get rights and content

When 125 patients with generalized pruritus were followed up for 6 years, 66% reported continuing pruritus. In four patients a malignancy had been identified at the time of the initial examination, and four other patients developed malignancies during the follow-up period. Seven of the patients died of the malignancy during the follow-up period. This incidence of malignancies does not differ significantly from the value expected in a general population, matched for age and sex. However, two of the cancers were lymphomas, and this incidence is significantly (p < 0.01) higher than that expected in a similarly matched population. As a whole our study indicates that no significant overall increase of malignant neoplasms is to be expected in patients with generalized pruritus and, therefore, any general efforts for cancer follow-up screening seem unwarranted in patients with pruritus.

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Receptors, cells and circuits involved in pruritus of systemic disorders
2014, Biochimica et Biophysica Acta - Molecular Basis of Disease
Citation Excerpt :
Generalized pruritus has been reported in case reports, case series and larger studies in patients with thyroid carcinoma [488], laryngeal cancer [489,490], metastasized squamous cell carcinoma of the tongue [491], lung cancer [321,488,492–494], (metastasized) breast cancer [493,494], stomach cancer [490,494], pancreas cancer [495], metastatic colon cancer [493], sarcoma [496], uterine cancer [493], prostate [497] and renal cancer [494]. Pruritus may precede the diagnosis of malignancy up to several years [490,494]. One study investigating 125 patients with generalized pruritus were followed over a time period of six years.
Pruritus is a sensory phenomenon accompanying a broad range of systemic disorders including hematologic and lymphoproliferative disorders, metabolic and endocrine diseases, solid tumours, and infectious diseases. The molecular mechanisms involved in itch sensation remain enigmatic in most of these diseases. However, from studies in patients and animal models a large number of mediators and receptors responsible for scratching behaviour have been identified in recent years. New insights into the interplay between neuronal and non-neuronal cells in the initiation, modulation and sensitization of itch sensation have been acquired. This review highlights the current knowledge of the molecular mechanism involved in pruritus of systemic disorders and summarizes the signalling pathways of biogenic amines, neuropeptides, proteases, eicosanoids, cytokines, opioids, endocannabinoids, neurotrophins, phospholipids and other signalling molecules participating in pruritus.
Five-year malignancy incidence in patients with chronic pruritus: A population-based cohort study aimed at limiting unnecessary screening practices
2014, Journal of the American Academy of Dermatology
Citation Excerpt :
Our study suggests that chronic pruritus without coded concomitant skin changes is not an indicator of increase risk of an undetected malignancy overall, but may be an indicator of increased risk of undetected hematologic and bile duct malignancies. These data confirm the findings of a previously published uncontrolled longitudinal study of patients with chronic pruritus that found no increased incidence of overall malignancy, but an increased incidence of hematologic malignancies compared with the expected incidence in the general population.12 Mechanistically, patients with undiagnosed bile duct malignancies (cholangiocarcinoma) are likely developing hyperbilirubinemia, which is driving their pruritus.
The incidence of malignancy in patients with chronic pruritus and nondiseased skin is unknown.
We sought to assess the hazard ratio (HR) of incident overall malignancy and incident malignancy by subtype in patients with chronic pruritus during the 5 years after diagnosis.
A population-based cohort study was performed in the Health Improvement Network. In all, 8744 patients with chronic pruritus were matched with 31,580 patients without chronic pruritus based on sex, age, and practice. Primary outcomes were HR of incident malignancy and HR of malignancy subtypes.
The fully adjusted HR for incident malignancy in patients with chronic pruritus was 1.14 (95% confidence interval 0.98-1.33). The fully adjusted HR for incident hematologic malignancy and incident bile duct malignancy in patients with chronic pruritus was 2.02 (95% confidence interval 1.48-2.75) and 3.73 (95% confidence interval 1.55-8.97), respectively. The incidence of hematologic malignancy and cholangiocarcinoma in patients with chronic pruritus was 0.0016 and 0.0003 per person-year, respectively.
Potential for misclassification and detection biases is a limitation.
Chronic pruritus without concomitant skin changes is a risk factor for having undiagnosed hematologic and bile duct malignancies, but not other malignancies. The overall incidence of these malignancies in patients with chronic pruritus is very low.
Itch complicating malignant diseases
2011, Supportive Oncology: (Expert Consult - Online and Print)
Itch complicating malignant diseases
2011, Supportive Oncology
Prurigo
2009, Presse Medicale
Prurigo is a medical term which includes several clinical, pathological and etiologic entities.
Diagnostic and therapeutic management is different depending on if we face acute prurigo or chronic prurigo. Acute prurigo is almost always linked to parasites or insects. Chronic prurigo can be linked to dermatologic diseases or may reveal internal pathologies. Complementary exams we should ask for are focused on these diseases.
Idiopathic chronic prurigo, without underlying disease, is the most frequent one. It needs regular survey, as it can reveal cutaneous or internal diseases after months or even years.
Treatment of prurigo is treatment of the underlying disease. Symptomatic treatment against pruritus, topic or systemic, must be added.
Le terme prurigo correspond à une entité diversement définie sur les plans clinique, histopathologique et étiologique.
La conduite à tenir diagnostique et thérapeutique est différente selon qu’il s’agisse d’un prurigo aigu ou chronique. Le prurigo aigu est essentiellement de cause parasitaire, surtout ectoparasitaire. Le prurigo chronique peut être associé à une maladie cutanée ou révéler une maladie interne. Les examens complémentaires à demander face à un prurigo chronique sont axés sur la recherche de ces causes.
Le prurigo chronique idiopathique, sans cause trouvée, est le plus fréquent. Il nécessite une surveillance régulière car peut révéler au bout de plusieurs mois ou années une maladie cutanée ou interne.
Le traitement du prurigo est étiologique en cas de cause trouvée, et symptomatique (anti-prurit) local et/ou général.

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View full text

Itch and malignancy prognosis in generalized pruritus: A 6-year follow-up of 125 patients

J Am Acad Dermatol

Tubercle

Generalized pruritus. A study of 43 cases

Clin Exp Dermatol

The itching patient. A review of the causes of pruritus

Scot Med J

Pruritus as a symptom of systemic disease

Va Med Monthly

Investigation of patients suffering from generalized pruritus, with special references to systemic diseases

Acta Derm Venereol (Stockh)

No panacea for pruritus and still much ignorance

JAMA

Pruritus

Ann Rev Med

Cutaneous manifestations of internal malignancies

Med Clin North Am