Publication:

Comprehensive geriatric dermatology: a contemporary review of pathophysiological mechanisms and multimodal therapeutic strategies for pruritus in the elderly population

Pruritus in the senile population, or geriatric pruritus, represents a pervasive and clinically significant dermatological condition that substantially impairs quality of life and often signals underlying systemic pathology. This extensive review synthesizes current medical literature to elucidate the complex, multifactorial etiology of this condition, which extends beyond mere xerosis cutis to encompass neuropathic, systemic, psychogenic, and iatrogenic pathways. We delve into the age-related physiological alterations, including epidermal barrier dysfunction, diminished immune function, and neurodegeneration of cutaneous sensory nerves, that create a predisposed state for chronic itch. A critical analysis of diagnostic algorithms is presented, emphasizing the necessity of a thorough, systematic evaluation to rule out occult renal, hepatic, hematologic, and endocrine disorders, as underscored by recent consensus guidelines from the International Forum for the Study of Itch (IFSI). Therapeutically, this review advocates for a stratified, patient-centric approach, integrating rigorous skin barrier repair with emollients containing physiologic lipids, targeted pharmacotherapy (including neuromodulators such as gabapentinoids and selective serotonin reuptake inhibitors, and novel agents targeting the interleukin-31 and Janus kinase pathways), and non-pharmacological interventions. Special consideration is given to the principles of geriatric pharmacodynamics, highlighting the imperative of mitigating polypharmacy risks and adverse drug events. The synthesis of evidence from recent randomized controlled trials and cohort studies informs a pragmatic framework for management, aiming to optimize patient outcomes through an interdisciplinary care model involving dermatology, geriatrics, and palliative medicine.