American Board of Internal Medicine (ABIM) Certification Practice Exam

How is pruritus managed in SSc patients?

1. Topical steroids

2. Antihistamines and skin emollients

3. Oral antihistamines only

4. Moisturizing lotions only

The correct answer is: Antihistamines and skin emollients

Pruritus, or itching, is a common symptom experienced by patients with systemic sclerosis (SSc), often related to skin involvement and changes that occur as a result of the disease. The management of pruritus in these patients involves using a combination of antihistamines and skin emollients. Antihistamines help in alleviating itchiness by blocking histamine receptors, which can be activated in inflammatory skin conditions. This action can reduce the sensation of itching, providing symptom relief. Skin emollients are essential because they help to hydrate the skin and improve its barrier function, which can also contribute to reducing pruritus. In SSc, the skin becomes dry and tight due to fibrosis; using moisturizing agents is crucial to prevent dryness and further irritation. While topical steroids may have some anti-inflammatory effects, their use doesn't provide comprehensive management of pruritus in SSc patients, as the underlying cause is often multifactorial, not solely inflammatory. Oral antihistamines only would provide partial relief and do not address the dry skin aspect, while relying solely on moisturizing lotions may not be sufficient for effective management. Therefore, combining both antihistamines and skin emollients offers a more effective approach to managing pruritus in SSc