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Therapeutics in Dermatology
A reference textbook in dermatology
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Prurigo

2 February 2015, by BARBAUD A.

Prurigo mainly affects children aged between 2 and 7 years. The predisposing factors are atopy and a disadvantaged socio-economic background. It is characterized by outbreaks of very pruritic lesions on exposed areas of the skin, the lower limbs, the neck and the trunk. The arrangement of the lesions is sometimes linear. The elementary lesion is an erythematous papule that often has a small blister in the centre. These lesions may be associated with more atypical, crusty, bullous or pseudo-urticarial lesions. Secondary infection is common with the lesions then becoming papulopustular.

Prurigo is due to delayed hypersensitivity to environmental parasites [1, 2]. These are mainly mites, whether house dust mites such as Dermatophagoides pteronyssinus, mites living on the surface of the skin of cats and dogs (Sarcoptes scabiei, Cheyletiella), or harvest mites such as Trombiculidae (chiggers). Arthropods carried by domestic animals such as fleas can also cause prurigo.

Treatment of prurigo is primarily symptomatic [2]. The itching may be improved by the administration of antihistamines (anti-H1). It is preferable to use second generation anti-H1, which are less sedative than the older cholinergic anti-H1. Oxatomide (Tinset® oral suspension) can be used regardless of age. Cetirizine (Zyrtec oral solution, Virlix®) or loratadine (Clarityne® syrup) may be prescribed in children over 2 years, and fexofenadine (Telfast® 180 mg) or mizolastine (Mistaline®, Mizollen®) from 12 years.

To avoid secondary infection from scratching, which is common, the children’s nails should be cut and antiseptic solutions should be used in the bath.

In most cases, the delayed hypersensitivity reaction requires the use of class II or III topical corticosteroids. Short courses of systemic corticosteroids should only be used exceptionally.

Since the hypersensitivity reaction is caused by parasites that do not remain on the skin, acaricide treatments for skin application such as benzyl benzoate and crotamiton (Eurax®) have not proven effective [2]. When the parasites of domestic animals are involved, it is essential to treat the animals. The decrease in exposure to dust mites in homes involves the removal of carpets, rugs, curtains, too numerous stuffed toys and wool mattresses. The efficacy of these measures, typically proposed for the management of atopy, and that of anti-mite treatments (sprays, mattress covers and pillows) has not been evaluated in the management of prurigo.

 

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