Review Article

Pruritus dan modalitas terapi terkini: Sebuah tinjauan pustaka

Odilia Dea Novena , Ni Gusti Putu Raka Ariani

Odilia Dea Novena
Dokter Magang Rumah Sakit Umum Bangli, Bangli, Bali, Indonesia. Email: odiliadeanovenaa@gmail.com

Ni Gusti Putu Raka Ariani
Dokter Magang Rumah Sakit Umum Bangli, Bangli, Bali, Indonesia
Online First: October 05, 2021 | Cite this Article
Novena, O., Ariani, N. 2021. Pruritus dan modalitas terapi terkini: Sebuah tinjauan pustaka. Intisari Sains Medis 12(3): 694-698. DOI:10.15562/ism.v12i3.1128


Pruritus or itching is an unpleasant feeling that causes the urge to scratch, the most common symptom found in skin diseases. Histamine and several other mediators such as opioid peptides and 5-hydroxytryptamine (5-HT) also influence the occurrence of pruritus. The prevalence of pruritus in the general population varies from 8% to 38% worldwide. Pruritus is categorized into 4 types, neuropathic, psychogenic, neurogenic, and pruriroceptive pruritus. When physically examining the skin, primary skin lesions must be distinguished from secondary lesions due to chronic scratching. Dermatological signs of chronic scratching include excoriation, lichenification, prurigo nodularis or a combination of these. Management of pruritus depends on the underlying etiology. Therapy should be focused on the underlying etiology. There are pharmacological and non-pharmacological therapies, where non-pharmacological therapies focus on avoiding precipitating factors and phototherapy. Pharmacological therapy can be in the form of topical and oral therapy. Some examples of topical therapies used in daily practice are emollients, corticosteroids, immunomodulators, capsaicin, antihistamines and topical anesthetics. Oral drugs that are currently the main choice for treating pruritus are antihistamines, but there are several other options being considered, namely anticonvulsants, opioid modulators, and antidepressants. A comprehensive history and physical examination are needed to determine the triggering factors for the onset of pruritus. The management of pruritus depends on the underlying etiology and the success of therapy is also influenced by the patient's adherence to treatment. Treatment of pruritus can be in the form of non-pharmacological therapy and pharmacological therapy. Pharmacological therapy can be both topical and systemic. Commonly used topical therapies are emollients, corticosteroids and topical anesthetics. Antihistamines remain the mainstay of systemic therapy used for pruritus. The purpose of writing this article is to discuss more deeply about the treatment modalities of pruritus which are summarized from various journals and research in order to provide consideration when choosing the right therapy in daily practice.

 

 

Pruritus atau rasa gatal adalah perasaan tidak menyenangkan yang menyebabkan keinginan untuk menggaruk merupakan gejala yang paling umum ditemukan pada penyakit kulit. Histamin dan beberapa mediator lainnya seperti peptida opiod dan 5-hidroksitriptamin (5-HT) juga memengaruhi terjadinya pruritus. Prevalensi pruritus pada populasi umum bervariasi mulai dari 8% sampai dengan 38% di seluruh dunia. Pruritus dikategorikan menjadi 4 tipe, yaitu pruritus neuropatik, psikogenik, neurogenik, dan pruriroseptif. Saat memeriksa kulit secara fisik, lesi kulit primer harus dibedakan dari lesi sekunder akibat garukan kronis. Tanda-tanda dermatologis dari garukan kronis termasuk ekskoriasi, likenifikasi, prurigo nodularis atau kombinasi dari semuanya. Penatalaksanaan pruritus bergantung pada etiologi yang mendasari. Terapi yang diberikan harus difokuskan pada etiologi yang mendasari. Terdapat terapi farmakologi dan non-farmakologi, dimana terapi non farmakologi fokus terhadap menghindari faktor pencetus serta fototerapi. Terapi farmakologi dapat berupa terapi topikal dan oral. Beberapa contoh terapi topikal yang digunakan dalam praktik sehari-hari adalah emolien, kortikosteroid, imunomodulator, capsaisin, antihistamin dan anestesi topikal. Obat oral yang hingga saat ini menjadi pilihan utama terapi pruritus adalah antihistamin, namun terdapat beberapa pilihan lain yang dipertimbangkan yaitu antikonvulsan, modulator opioid, antidepresan. Anamnesis dan pemeriksaan fisik yang komprehensif sangat diperlukan untuk mengetahui faktor pencetus timbulnya pruritus. Penatalaksanaan pruritus bergantung pada etiologi yang mendasari dan keberhasilan terapi juga dipengaruhi oleh ketaatan pasien dalam berobat. Terapi pruritus dapat berupa terapi non-farmakologis dan terapi farmakologis. Terapi farmakologis dapat berupa topikal dan sistemik. Terapi topikal yang umum digunakan adalah emolien, kortikosteroid dan anestesi topikal. Antihistamin tetap menjadi pilihan utama terapi sistemik yang digunakan untuk pruritus. Penulisan artikel ini bertujuan untuk membahas lebih dalam tentang modalitas terapi pruritus yang dirangkum dari berbagai jurnal serta penelitian agar dapat memberikan pertimbangan saat memilih terapi yang tepat dalam praktik sehari-hari.

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