Pruritus - Paediatric Palliative Care
Description General and supportive care Medicine treatment Referral ICD-10 code: R29.9 DESCRIPTION An unpleasant cutaneous sensation that provokes the desire to scratch. Can interfere with sleep and activities of daily living. Scratch marks may lead to skin excoriation and secondary infections. May be difficult to control with incurable conditions. Commonly seen in cholestasis, renal failur
ICD-10 code: R29.9
DESCRIPTION
An unpleasant cutaneous sensation that provokes the desire to scratch. Can interfere with sleep and activities of daily living. Scratch marks may lead to skin excoriation and secondary infections. May be difficult to control with incurable conditions. Commonly seen in cholestasis, renal failure, burns, Hodgkin’s lymphoma and occasionally as a side effect of opioids.
GENERAL AND SUPPORTIVE CARE
- Keep nails short and cover fingers with mittens but do not restrain.
- Keep skin moist with aqueous cream and emollients.
MEDICINE TREATMENT
Treatment depends on the underlying cause:
| Cause | Mechanisms | Treatment |
| Opioid related | Stimulation of mu opioid receptors. NOT histamine mediated. |
- Opioid switch if possible. - Ondansetron |
| Uraemia (Chronic renal failure) | Several factors including dry skin, uraemic toxin accumulation, neuropathy. | - Non-sedating antihistamines have NOT been shown to be effective. - Refer to tertiary level for consideration of a gabapentinoid. |
| Cholestasis | Bile acids in skin. | - Phenobarbitone |
| Burn wounds | Post burn during healing phase: caused by peripheral sensitisation. |
- Refer to tertiary level for consideration of a gabapentinoid. |
Corticosteroid creams should not be used for generalized pruritus unless associated with inflammatory conditions (e.g. atopic eczema) as they will result in skin thinning and damage.
REFERRAL
- Severe pruritus not responding to standard treatment.
Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter: 21. Palliative Care, 21.1 Symptom Control, 21.1.4 Dermatological Symptoms, 21.1.4.1 Pruritus