Chronic pruritus is a skin condition that afflicts mainly the elderly and can impact their quality of life.

What is chronic pruritus?

Chronic pruritus (CP) is defined as a prolonged itching of the skin that persists for more than six weeks.

Who is most susceptible?

Prolonged itching is the most common skinrelated complaint among the elderly who are aged 65 and older, as ageing often leads to dry skin and changes to the skin nerves. The prevalence of CP in an inpatient geriatric patient population in Singapore is reported to be 48.5 per cent.

Causes of CP

The causes of CP are usually multifactorial and often misunderstood, which makes it more challenging to diagnose and treat. Symptoms may recur, which leaves the patient feeling frustrated. They are then driven to seek temporary relief of the symptoms rather than regular preventive management of the condition.

Impact of CP

Prolonged itching can interfere with one’s sleep, exercise, hobbies and social life. The condition has also been found to result in anxiety and depression. Many patients may rub or scratch the affected area, causing injury to the skin, or resort to frequent washing of the site to find temporary relief. They may also change their eating habits and adopt certain diets in an attempt to relieve the itch.


The treatment for CP involves both shortand long-term approaches. The usual practice involves treating the acute symptoms with oral antihistamines, oral steroids, or topical steroid creams.

Most patients in Singapore with CP are treated with sedating antihistamines. However, these can have negative consequences, such as the increased likelihood of falls and reduced concentration at work.

Non-sedating antihistamines are safer, but curbing the symptoms requires long-term use, which may add to the pill burden of the elderly.

Key findings from a local study

The first local study by SingHealth Polyclinics of 13 patients with CP was conducted in 2021. The results of the qualitative research found that the elderly respondents perceived the condition as a chronic “problem”, rather than a disease that can be cured. Their perceptions of the causes were also diverse due to the lack of clear explanation by their doctors. In addition:

  • Patients alluded to emotional disturbances such as feeling depressed, frustrated, embarrassed, angry, guilty, fearful and sad.
  • CP led to isolation and avoidance behaviours (e.g. some patients would confine themselves solely to indoor activities).
  • Patients also reported sleep disruption and dermatological complications (e.g. scratching until skin is broken, skin thickening or scarring).
  • To cope with their condition, they sought help from friends, consulted multiple doctors, or used alternative therapies.

The results of the findings suggest that in order to prevent possible maladaptive behaviour of patients — such as frequent doctor changes that result in a higher healthcare cost — a more person-centric approach is recommended to provide personalised care to patients.

Following the above study, SHP has since developed an Itch Assessment

Questionnaire (IAQ), which will be used for the next study to assess the magnitude and morbidity of itch in the local population. Subsequently, IAQ will be used to monitor patient symptoms and severity in clinical care. The recruitment for the study began in the second half of 2023, and will include 250 adults.

Read more: Up to 50% of all seniors have this skin problem. Here are simple ways to manage it 

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