An older adult may develop a generalized pruritus without apparent cause. Ward and Ernhard suggest using the term “Willan’s itch” (named for an early dermatologist) to avoid the word senile.


Criteria of Ward and Bernhard for idiopathic purpura in an elderly patient:

(1) elderly patient

(2) generalized pruritus

(3) exclusion of identifiable cause (which may take some time)


Differential diagnosis:

(1) xerosis (dry skin)

(2) drug-induced pruritus

(3) paraneoplastic pruritus (malignant lymphoma, etc)

(4) cholestasis

(5) uremia

(6) hyperthyroidism

(7) diabetes (general truncal pruritus)

(8) neuropathic pruritus (may be localized)

(9) scabies

(10) dermatitis or dermatopathy

(11) iron deficiency


Management of idiopathic senile pruritus involves control of symptoms rather than treating the precipitating cause. Gabapentin, histamine H1 receptor antagonists, or serotonin antagonists may be effective in symptom control. Phototherapy with UV radiation or topical therapy can also be used.


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