Evaluation and Management of Pruritus and Scabies in the Elderly Population

Chronic Pruritus in Geriatric Patients: Prevalence, Associated Factors, and Itch-related Quality of Life

Chronic pruritus is a common condition that significantly impacts quality of life. However, data on chronic pruritus in geriatric populations remain limited. A prospective observational study was conducted at the Centre for Geriatrics in Southern Saxony-Anhalt (ZASSA), involving 201 geriatric patients (mean age 83.5±5.1 years). Chronic pruritus was found in 23.4% of patients, persisting for an average of 8 years with moderate to severe intensity (mean=6.36 on a 0 to 10 numeric scale). It commonly affected the legs (48.9%) and arms (44.7%) and was linked to depressive symptoms and daily medication use. Chronic pruritus significantly impaired physical functioning, particularly in moderate activities and stair climbing, and increased pain levels. ItchyQoL scores highlighted adverse effects on symptoms, functioning, feelings, and self-perception. Overall, chronic pruritus is prevalent among geriatric patients and substantially reduces quality of life. Addressing both dermatological and psychological factors is essential for effective management and improving quality of life in this population.

Association between Scabies Treatment and Parkinson's Disease: A Nationwide, Population-Based Study

BACKGROUND

Scabies is typically treated with scabicides like lindane, which poses a risk for acute neural toxicity. Lindane's prolonged use, particularly in agriculture, is linked to neurodegenerative diseases, including Parkinson's disease (PD), the second most common neurodegenerative disorder. This study aimed to evaluate whether scabies patients, particularly those treated with topical lindane, are at increased risk of developing PD.

METHODS

A nationwide population-based cohort study was conducted using data from Taiwan's National Health Research Institutes claims database from 2000 to 2018. The study included 27,173 patients with scabies, matched to a control group, with both groups followed for up to 18 years. The primary outcome was the incidence of newly diagnosed PD, and the hazard ratio (HR) for PD was calculated, focusing on those treated with topical lindane.

RESULTS

Among the 54,346 patients, 1639 (3.0%) were newly diagnosed with PD, with 993 (60.6%) from the scabies group and 646 (39.4%) from the control group. Scabies patients had an adjusted hazard ratio (aHR) of 1.46 (95% CI 1.32-1.63) for developing PD compared to controls. However, patients treated with topical lindane had a significantly lower aHR for PD at 0.15 (95% CI 0.12-0.19; p < 0.001), with a lower cumulative incidence of PD also observed in this group (p < 0.001).

CONCLUSIONS

Scabies patients are at a 1.46-fold increased risk of developing PD, but those treated with lindane exhibit a significantly lower risk, suggesting potential protective effects of lindane against PD.

Empowering advanced clinical practitioners in managing acute dermatological emergencies

Advanced clinical practitioners (ACPs) encounter patients with acute dermatological presentations ranging from minor to life-threatening conditions in both primary and secondary care settings. However, ACPs often feel unprepared to assess and treat patients with dermatological emergencies. This article aims to provide guidance to trainee and qualified ACPs, whether in acute hospital settings or primary care, in understanding the essential aspects to consider when consulting with patients presenting with acute dermatological emergencies. It also emphasises appropriate referrals to relevant specialties for necessary inpatient or outpatient investigations and ensure prompt treatment.

Ivermectin: A Multifaceted Drug With a Potential Beyond Anti-parasitic Therapy

Ivermectin was first discovered in the 1970s by Japanese microbiologist Satoshi Omura and Irish parasitologist William C. Campbell. Ivermectin has become a versatile pharmaceutical over the past 50 years. Ivermectin is a derivative of avermectin originally used to treat parasitic infections. Emerging literature has suggested that its role goes beyond this and may help treat inflammatory conditions, viral infections, and cancers. Ivermectin's anti-parasitic, anti-inflammatory, anti-viral, and anticancer effects were explored. Its traditional mechanism of action in parasitic diseases, such as scabies and malaria, rests on its ability to interfere with the glutamate-gated chloride channels in invertebrates and the lack of P-glycoprotein in many parasites. More recently, it has been discovered that the ability of ivermectin to block the nuclear factor kappa-light-chain enhancer of the activated B (NF-κB) pathway that modulates the expression and production of proinflammatory cytokines is implicated in its role as an anti-inflammatory agent to treat rosacea. Ivermectin has also been evaluated for treating infections caused by viruses, such as SARS-CoV-2 and adenoviruses, through inhibition of viral protein transportation and acting on the importin α/β1 interface. It has also been suggested that ivermectin can inhibit the proliferation of tumorigenic cells through various pathways that lead to the management of certain cancers. The review aimed to evaluate its multifaceted effects and potential clinical applications beyond its traditional use as an anthelmintic agent.