Oğuz TEKİN, Evren SARIFAKIOĞLU, Pınar ÖZTAŞ, Olgun GÖKTAŞ

Jeneralize pruritus: Dahili bir patoloji mi yoksa somatizasyon mu?

Jeneralize pruritusun çok basit bir problem olmadığını söyleyebiliriz. Çoğu araştırmacı, problemin multifaktöryel sebeplerden kaynaklandığını belirtmişlerdir. Jeneralize kaşıntı şikayeti, iç hastalıkları, aile hekimliği ve dermato-loji kliniklerindeki doktorları çoğu zaman uğraştırır, çünkü geniş bir etyolojik yelpaze söz konusudur. Biz jeneralize kaşıntıyı iki ana başlık altında toplayabiliriz; dermatolojik lezyonla birlikte olanlar ve olmayanlar. Jeneralize kaşıntıya yol açan dermatolojik lezyonlar, ürtiker, dermatitis herpetiformis, uyuz, atopik dermatit, kontak dermatit ve kserozis olarak sıralanabilir. Derma-tolojik olmayan sebepler de geniş bir spektrum altında incelenir. Demir eksikliği anemisi, polisitemia vera, hepatik ve kolestatik olaylar, iç hastalıkları ile ilgili değişik sebeplerdir. Bir diğer spektrum, endokrinolojik ve metabolik sebeplerdir. Bunlardan önemli olanlar diabetes mellitus, tiroid hastalıkları, hiperkalsemi, üremik (veya renal) pruritus olarak sıralanabilir. Bunun yanısıra değişik maligniteler de pruritusa sebep olabilirler. Alerjik, immünolojik veya infeksiyöz sebepler de aşağıda sıra-lanacaktır. Psikolojik faktörler de pruritusa yol açabilir. Olayı incelemede bazı gruplamalar yapılabilir. 1) Cilt lezyonu mevcut 2) Cilt lezyonu yok, akciğer grafisi anormal 3) Cilt lezyonu yok, serum kalsiyumu yüksek 4) Cilt lezyonu yok, alerjik testler pozitif 5) Cilt lezyonu yok, glukoz tolerans testleri pozitif 6) Cilt lezyonu yok, renal fonksiyon testleri pozitif 7) Cilt lezyonu yok, hepatobiliyer testler bozuk 8) Cilt lezyonu yok, hemogram bozuk 9) Cilt lezyonu yok, tiroid fonk-siyon testleri bozuk 10) Cilt lezyonu yok, parazitik testler pozitif 11) Cilt lezyonu yok, tüm testler normal.

Generalized pruritus: Internal pathology or somatisation?

To sum up we can say that the problem is not that much simple. Yet all the researches that have been completed so far shows that the problem is multifactorial. It is obvious that generalized pruritus (as a subject of complaint) will always keep Internal Medicine, Family Medicine, Dermatology clinics’ doctors or patients busy because the pathogenesis of pruritus has a wide aspect as we have mentioned above. Furthermore we classified the causes of pruritus in two different headings: With dermatologic and without dermatologic lesions. Dermatologic lesions that lead to pruritus may be urticaria, dermatitis herpetiformis, scabies, atopic dermatitis, contact dermatitis and xerosis as well. Nondermatologic causes of pruritus constitute a wide spectrum. Iron deficiency, polycythaemia rubra vera, and hepatic or cholestatic events are three different titles that are related to general internal pathology. Another classifica-tion of generalized pruritus is Endocrin-Methabolic pathology. Although we can not explain all the factors, important clues are being discussed on diabetes mellitus, thyroid disease, hypercalcemia, uraemic or renal pruritus. Moreover malignancy can induce pruritus. Allergic-Immunologic-Injectious aspect of pruritus is quite clear in the following. Psychogenic factors might cause pruritus symptoms also. Finally an intensive evaluation of patients with generalized pruritus has been completed by grouping them as: 1) Skin lesion present, 2) Skin lesion absent, Lung graphy abnormal, 3) Skin lesion absent, Serum calcium high, 4) Skin Lesion absent, allergic tests positive, 5) Skin lesion absent, glucose tolerance tests abnormal, 6) Skin lesion absent, renal function tests abnormal, 7) Skin lesion absent, hepatobiliary tests abnormal, 8) Skin lesion absent, hemogram abnormal, 9) Skin lesion absent, thyroid function tests abnormal, 10) Skin lesion absent, Paracytic tests positive, 11) Skin lesion absent, all tests normal

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