1. Tashkent Medical Academy
Department of Skin and Venereal Diseases
generalized pruritus
Professor Vaisov Adham Shavkatovich
Tashkent-2011

2. The position of a general physician rural medical centres
A general practitioner (GP) - A graduate with higher medical education in the profile "medicine" or "GP", which has the right to conduct activities in support of medical multidisciplinary primary health care and disease prevention attached to the population, regardless of gender and age.
The GP provides outpatient care and home visits, to provide hospital emergency and urgent care, the comprehensive preventive, immunological, anti-epidemic, medical diagnostics and rehabilitation measures, assist in addressing health and social problems of families attached to the population according to qualification requirements specifications.
The population served by the RMC, established by the parent body of the health care for each individual SVP, but the load on a GP should not exceed 1500 attached population.

3. Services Category 1
  Providing early and correct diagnosis and the full, effective treatment of certain conditions and diseases (listed below) at the level of SVP that GPs should be able to realize independence, under normal circumstances, and in most cases. Only in exceptional cases. When the patient's condition does not improve, the patient should be sent to a consultant dermatologist, or HPC for further consultation or effective treatment. Carries on the recommendation of the dermatologist rehabilitation and clinical examination of patients treated at the SVP or other institutions, and have long health problems that require special care and supervision.

4. SERVICES 1 category dermatitis seborrhea warts acne vulgaris
Patchy hair loss (Alopecia areata)
pediculosis
scabies
urticaria
Colorful lichen

5. Services Category 2
Implementation on the ability to properly diagnose or identify an acute condition and destination syndromic treatment where possible and necessary, such by AEP and DEP patients to the dermatologist or the ARC to conduct a full and proper diagnosis, more wholesome advice or treatment

6. Services Category 2 allergodermia toxicoderma pyoderma neurodermatitis
dermatophytosis
eczema
psoriasis
Lichen planus
zoster
leprosy
pemphigus
Pigmented lesions of the skin
Photodermatosis and lupus erythematosus
juccuya
serum sickness
Angioma, skin cancer
STIs (gonorrhea, syphilis, trichomoniasis,
candidiasis, chlamydia, herpes, AIDS)

7. Services category 3.1.
Implementation of a comprehensive, relevant (correct, adequate and effective) procedures, manipulation and studies of patients who have competently, professionally and independently run GPs.
Professional inquiries and patient survey
Specimen collection for examination under a microscope
Defining agents lice and scabies
Inspection of skin elements Wood's lamp
Principles and methods for topical treatment

8. Services category 3.2.
GP TO KNOW readings and location facilities where possible implementation of full, appropriate and necessary procedures, manipulation and research that can not be conducted in the SVP
Serological methods - Wasserman, RIT, RIF
The study of HIV infection
A skin biopsy
Microscopic and cultural methods

9. Services 4 categories
Providing individual preventive and educational assistance (training, advice, demonstrations it.d.) healthy and the sick, especially those that are prone to specific risks and inclinations.
Personal hygiene
Control occupational hazards
Prevention of head lice and scabies
Keeping passports patients with allergic diseases
sex education
Hygiene sex
placement

10. Generalized itching
Itching - an unpleasant sensation on the skin, which is trying to eliminate the patient instinctively.
   Itching can be a "sharp" and well localized, or "burning," badly localized.
       Itching is caused by a variety of stimuli and has 2 meanings.
    Itching reduces quality of life and a sign of an illness.

11. Pathophysiology of itching
Specific receptors or nerve endings, which receive no itching feeling rather different spatial and temporal excitation of different combinations of skin receptors detected in the central nervous system as a feeling of itching, pain, touch or pressure. From the skin nerve impulses are conducted by myelinated fiber diameter in the spinal ganglia, back to the thalamus, and then pass to the sensitive areas of the cortex. Despite indications of involvement of histamine in the pathogenesis of pruritus in most itchy, antihistamines are ineffective, suggesting that histamine is not the only mediator of itch.

12. The frequency and cause itching.
Itching is the most common symptom of many skin diseases and a frequent reason for seeking a patient to a doctor. For skin diseases Accompanying severe itching and rashes include:
  scabies
  pediculosis
  allergodermia
  urticaria
  neurodermatitis
  Lichen planus
  eczema
  diathesis

13. Neurodermatitis

14. Urticaria

15. SCABIES Allergodermia

16. ECZEMA

17. Lichen planus

18. Diathesis

19. Systemic diseases associated with generalized pruritus.
Kidney
Hepatic
Hematologic
Endocrine
Other
Chronic renal failure
Primary biliary cirrhosis
cholestasis of pregnancy
Extrahepatic biliary obstruction
hepatitis
Medication
polycythemia vera
Hodgkin's disease
Other lymphomas and leukemias
multiple Myeloma
mastocytosis
iron deficiency anemia
hyperthyroidism
carcinoid
diabetes mellitus
Malignant tumors of the internal organs
neurological syndromes
Acceptance of opiates
Drug allergy or toxic effects of drugs
psychosis
parasitic
age

20. Subclinical skin changes indicating a possible cause itching
Elements on the skin
possible Cause
Point scars, scabs or ecchymosis of subcutaneous veins
opiate addiction
The bugs (lice) pubic hair distribution, or other areas
pubic lice
Minor scratches, papules and vesicles in skin folds, interdigital intervals, at the head of the penis
scabies
Small groups of vesicles, erosions covered with crusts, especially in the elbows and rump
dermatitis herpetiformis

21. Laboratory tests are necessary for the study of patients with pruritus
Method
detectable pathology
blood test
Anemia (iron deficiency or by chronic disease)
Cellular composition of blood
polycythemia
leukosis
Some allergic conditions
The level of urea nitrogen and creatinine
Chronic renal failure
The level of alanine transferase, bilirubin, alkaline phosphatase in the blood
Primary biliary cirrhosis,
Cholestasis, hepatitis
Fasting glucose
diabetes mellitus
levels of thyroxine
hyperthyroidism
Urinalysis:
5 Gidroksindoluksusnaya acid
The level of drug in plasma and urine
carcinoid syndrome
Acceptance of opiates
Allergy to drugs
Fecal ova and parasites
Parasitic invasion
Chest X-ray
lymphoma,
Metastasis of malignant tumors

22. History and examination of the patient
1. Do you suffer, or how serious disease? The most common cause of generalized pruritus without rash systemic diseases are listed in Table 1.
2. Do you take any medications regularly, or drugs? Taking medications can cause drug allergy manifested by itching without skin rash, or may indicate the patient's existing condition. Aspirin, morphine-like drugs and some antibiotics can increase the itch by stimulating the release of histamine from mast cells. Other drugs can cause itching due to stimulation of cholestasis and opiates act directly on the central nervous system.
3. Have you not done in the past while traveling, trips to visit? Parasitic infections may be manifested by itching.
4. What do you think made ​​you itch? Patients with psychosis and hallucinations begin parasitosis often in great detail to describe their feelings.

23. 5. Have you not noticed the heat intolerance, irritability, palpitations, weight loss? Hyperthyroidism is often accompanied by itching.
6. No Where do you dry skin? Xerosis itself can cause itching, also a symptom of "dry skin" indicates subclinical skin or the presence of other dermatoses.
7. Did you have contact with your glass? Fiberglass particles penetrating the skin can cause intense itching without causing nzmeneny visible on the skin.
8. Do not provoke itching hot baths or showers? Believe that this is a typical symptom of itching in polycythemia vera, but it can also occur with any cause itching.
9. Women ask another obligatory question. It itch associated with the menstrual cycle, with the use of oral contraceptives or pregnancy? Moderate cholestasis caused by increased levels of estrogen and progesterone can cause itching.

24. Chronic renal failure
The cause of pruritus in uremia is hyperparathyroidism, which can cause increased levels of histamine in plasma, subtotal removal of the parathyroid glands in these patients often results in a rapid, temporary cessation of itching. In patients with uremia also observed hyperplasia of mast cells (the source of histamine). Established ineffectiveness of antihistamines (including H1 - H2-histamine blockers) and the effectiveness of phototherapy, and some effect of cholestyramine and activated charcoal

25. Hepatic cholestasis
Itching is one of the most unpleasant for the patient and the most constant symptoms of chronic cholestasis, which accompanies liver disease (Table 1.). Itching occurs in approximately 20-25% of patients with jaundice and almost 100% of patients with primary liver cirrhosis and almost 50% of them is the reason for seeking medical attention.
Itching is seen in pregnant women, the frequency of which is increased by cholestasis of pregnancy. Itching caused by cholestasis is also common in women taking oral contraceptives continuously, and itching appears in 50% of cases in the first menstrual cycle, and in 90% of cases, within the first six cycles.
Extrahepatic bile duct obstruction from any cause, drugs (phenothiazines, tolbutamide, erythromycin, anabolic hormones, estrogens and progestins) contribute to the development of cholestasis often cause itching.

26. Hematologic disorders
Many malignant blood disease are accompanied by generalized itching. Thus, approximately 50% of patients with polycythemia vera suffer itching, which is worse when taking hot baths. Up to 30% of patients with Hodgkin's disease also suffer from itching.

27. Other reasons
Generalized pruritus may be accompanied by adenocarcinoma and squamous cell carcinoma of many internal organs. Running brain tumors are often accompanied by itching, limited only by the nostrils.
Drug use can cause generalized itching due to central mechanisms or by degranulation of mast cells. Many medications can also cause itching without skin rash as a manifestation of sensitization.
Psychosis patients sometimes complain of marked itching, the etiology of which is unclear. Many of them have hallucinations in the form of "creeping Goosebumps" etc.
Invasion of intestinal, pulmonary and systemic parasites can cause generalized pruritus as a manifestation of allergic sensitization of the host.
         Frequent cause of generalized pruritus in the elderly is xerosis or one of the conditions listed above. With age increases the likelihood of idiopathic pruritus, or so-called "Senile pruritus", which may be accompanied by co-senile age degenerative changes of the peripheral nerves.

28. Principles of treatment of generalized pruritus
In the first place to establish the cause of itching and fix it. You must necessarily exclude:
The presence of skin disease
The presence of systemic disease
The impact of drugs and food