OVERVIEW AND PERSONAL PERSPECTIVE
on
PRURITUS
Obriz M. Paglinawan SWU-MHAM-CM Year III Medical Student, 1999
Dr. Reynaldo O. Joson Facilitator
Comments and Inquiries from Facilitator
(Comments and inquiries are contained in "text boxes or areas.")
I. Concept of Pruritus
A. Definition of Pruritus
It is a disagreeable sensation that provokes a desire to scratch. It is a primary sensory impulse carried on unmyelinated C fibers in the spinothalamic tract. It is modulated by central factors, including cortical ones. Not all cases of pruritus are mediated by histamine, though several mediators - bradykinin, neurotensin, secretin, and substance P - release histamine.
The sensation of itch may be elicited by a wide variety of dermatologic disorders and infections or by external stimuli, such as changes in temperature, stroking, or exposure to noxious agents. Itching may also be one manifestation of a systemic disease. Most systemic and cutaneous (delayed-type hypersensitivity) allergic reactions cause pruritus and often present a most challenging diagnostic problem.
Technically medically informative! How about layman concept? Itchiness, I supposed, that provokes a desire to scratch. Question: Can you have itchiness on the mucosa? Or is it confined to the skin only.
B. Effect of Pruritus on the health of the individual, family, and community
Once an individual experiences skin problems such as pruritus, there will be effects and changes that will happen to his life in such a way that these health problems can alter his normal function in his body and not only that, economically, the family where he belongs will also suffer due to the medications that they buy as well as the doctor's fee too.
However, not only the individual who is affected but also it has an effect on the family in terms of socio-economic prosperity. Moreover, the community is also affected in terms of its socio-economic prosperity for it can hinder its progress in terms of physical health, economic prosperity and social and moral functions.
In other words, pruritus can affect the biopsychosocial well-being of individuals who experience it. It may cause disability. Can it cause death? Pruritus per se? Pruritus can affect the socioeconomic productivity of individuals, families, and communities.
II. Common types of Pruritus
A. Generalized - this refers to the whole part of the body that becomes pruritic.
B. Localized - this refers to a certain part of the body that becomes pruritic.
Is there such a thing as mucosal pruritus? If there is, you can have also classify pruritus into skin and mucosal pruritus.
III. Common causes of Pruritus
GENERALIZED/ LOCALIZED
A. Skin Disorders
B. Systemic Disorders
C. Psychogenic Disorders
Which ones are prone to cause generalized pruritus? Localized pruritus? Indicate as these may be helpful in clinical diagnosis. Consider the tabulation I made outside this box. Also, you may want to change "skin disorders" into focal or primary skin disorders. Systemic and psychogenic disorders also cause skin disorders.
LOCALIZED PRURITUS
GENERALIZED PRURITUS
MAY HAVE LOCALIZED OR GENERALIZED PRURITUS
IV. Magnitude of the Health Problem (Global, National, Local)
There are no clinical records found in the DOH record section regarding the magnitude of this problem based on its types and causes. However, individual entities of the disease associated with pruritus reveals that contact and atopic dermatitis, eczema, scabies and etc are the more common causes of this skin problem.
Which ones are more common? Localized or generalized pruritus? Primary skin disorders or systemic disorders causing pruritus or psychogenic disorders causing pruritus? My personal experience tells me that localized is more common than generalized pruritus. Primary skin disorders most common. Psychogenic next. Last is systemic disorders. Can you verify these comparative frequencies? Remember, always start from general going to specific. The ones that you mentioned such as contact and atopic dermatitis, eczema, and scabies, do they cause localized or generalized pruritus? Are they primary skin disorders or psychogenic or systemic disorders?
V. Personal perspective on the possible solutions to the Health Problem
Goal/Objective:
To lessen the magnitude of pruritus and to educate the people on the approach of detecting such problem.
Strategies:
The people must be taught about the prevalence/incidence of pruritus, able to detect and able to understand its occurrence, how to avoid this problem as much as possible, and disseminate all information about pruritus through:
Establish and form or organize a group of people who are willing to volunteer and in upgrading/support the project of DOH in the community concerned such as:
Evaluation Indicators:
Target the cause of the pruritic problem rather than the pruritus itself. Prioritize. Example, off-hand, I think a primary skin disorders is more than systemic disorders and psychogenic disorders as a cause of pruritus. For the primary skin disorders, allergens, chemicals, and infestations are most common. I will, therefore, give priority to these problems in the community health management. Primary prevention is still the best strategy because the allergens, chemicals, and infestations are preventable.
Reactions from Dr. Obriz M. Paglinawan
Comments, Questions, and Reactions from Readers
Obriz M. Paglinawan's Response and Reactions to R.O. Joson's Comments and Inquiries
PBL and Distance Learning on Skin and Soft Tissue Problems
SWU-MHAM-CM