51
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Lai JW, Chen HC, Chou CY, Yen HR, Li TC, Sun MF, Chang HH, Huang CC, Tsai FJ, Tschen J, Chang CT. Transformation of 5-D itch scale and numerical rating scale in chronic hemodialysis patients. BMC Nephrol 2017; 18:56. [PMID: 28178931 PMCID: PMC5299664 DOI: 10.1186/s12882-017-0475-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 02/04/2017] [Indexed: 12/02/2022] Open
Abstract
Background Pruritus is a common and frustrating symptom in hemodialysis (HD) patients and 5-D itch scale is proposed as a reliable measurement of pruritus. However, information regarding 5-D itch scale categories is currently unavailable. We explored optimal cut-offs 5-D itching scale based on numerical rating scale (NRS) categories in HD patients. Methods Four hundred and nine HD patients in China Medical University Hospital in December 2014 were included and severity of pruritus was estimated using NRS and 5-D itch scale. The association of NRS and 5-D itch scale was analyzed by linear regression. The optimal cut-offs for 5-D itch scale based on NRS categories were generated. Results The average NRS was 3.4 ± 3.0 and the average 5-D itch scale was 10.9 ± 4.8. The 5-D score was strongly correlated with the NRS: r = 0.831 (p < 0.001). NRS = −2.31 + 0.52 × (5-D scale). The averages of 5-D scales were 6.4 ± 1.5, 9.6 ± 2.2, 13.1 ± 3.2, 15.7 ± 4.4, 19.5 ± 4.4 for no, mild, moderate, severe, and very severe pruritus based on categorized NRS. A 5-D itch scale categories were proposed, ≤ 8 for NRS = 0, 9–11 for mild pruritus, 12–17 for moderate pruritus, 18–21 for severe pruritus and ≥ 22 for very severe pruritus. Conclusions Categories for the 5-D itch scale were proposed based on the measurements of pruritus severity in HD patients. This information provides a simple solution that enables transformation between the 5-D itch scale and the numerical rating scale. Electronic supplementary material The online version of this article (doi:10.1186/s12882-017-0475-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jia-Wen Lai
- College of Life Sciences, National Chung Hsing University, Taichung, Taiwan.,Kidney Institute and Division of Nephrology, China Medical University Hospital, No. 2, Yu-der Road, North District, Taichung, 40447, Taiwan
| | - Hung-Chih Chen
- Kidney Institute and Division of Nephrology, China Medical University Hospital, No. 2, Yu-der Road, North District, Taichung, 40447, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Che-Yi Chou
- Kidney Institute and Division of Nephrology, China Medical University Hospital, No. 2, Yu-der Road, North District, Taichung, 40447, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan.,Department of Internal Medicine, Division of Nephrology, Asia University Hospital, Wufeng, Taichung, Taiwan.,Department of Biotechnology, Asia University, Wufeng, Taichung, Taiwan
| | - Hung-Rong Yen
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan.,School of Chinese, China Medical University, Taichung, Taiwan.,Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung, Taiwan.,Research Center for Traditional Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Tsai-Chung Li
- Graduate Institute of Biostatistics, China Medical University, Taichung, Taiwan
| | - Mao-Feng Sun
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan.,School of Chinese, China Medical University, Taichung, Taiwan.,Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung, Taiwan.,Research Center for Traditional Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Hen-Hong Chang
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan.,School of Chinese, China Medical University, Taichung, Taiwan.,Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung, Taiwan.,Research Center for Traditional Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Chiu-Ching Huang
- Kidney Institute and Division of Nephrology, China Medical University Hospital, No. 2, Yu-der Road, North District, Taichung, 40447, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Fuu-Jen Tsai
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan.,School of Chinese, China Medical University, Taichung, Taiwan.,Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung, Taiwan
| | - Johannes Tschen
- College of Life Sciences, National Chung Hsing University, Taichung, Taiwan
| | - Chiz-Tzung Chang
- Kidney Institute and Division of Nephrology, China Medical University Hospital, No. 2, Yu-der Road, North District, Taichung, 40447, Taiwan. .,College of Medicine, China Medical University, Taichung, Taiwan. .,Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung, Taiwan.
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52
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Haydek CG, Love E, Mollanazar NK, Valdes Rodriguez R, Lee H, Yosipovitch G, Tharp MD, Hanifin JM, Chen KH, Chen SC. Validation and Banding of the ItchyQuant: A Self-Report Itch Severity Scale. J Invest Dermatol 2017; 137:57-61. [DOI: 10.1016/j.jid.2016.06.633] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 05/24/2016] [Accepted: 06/21/2016] [Indexed: 10/21/2022]
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53
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Bissonnette R, Papp K, Poulin Y, Gooderham M, Raman M, Mallbris L, Wang C, Purohit V, Mamolo C, Papacharalambous J, Ports W. Topical tofacitinib for atopic dermatitis: a phase
II
a randomized trial. Br J Dermatol 2016; 175:902-911. [DOI: 10.1111/bjd.14871] [Citation(s) in RCA: 279] [Impact Index Per Article: 34.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2016] [Indexed: 12/11/2022]
Affiliation(s)
| | - K.A. Papp
- K Papp Clinical Research and Probity Medical Research Inc. Waterloo ON Canada
| | - Y. Poulin
- Centre de Recherche Dermatologique du Quebec Metropolitain Quebec QC Canada
| | - M. Gooderham
- SKiN Centre for Dermatology and Probity Medical Research Inc. Peterborough ON Canada
| | - M. Raman
- The Centre for Dermatology and Probity Medical Research Inc. Richmond Hill ON Canada
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54
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Jin XY, Khan TM. Quality of life among patients suffering from cholestatic liver disease-induced pruritus: A systematic review. J Formos Med Assoc 2016; 115:689-702. [PMID: 27431691 DOI: 10.1016/j.jfma.2016.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/31/2016] [Accepted: 05/05/2016] [Indexed: 12/14/2022] Open
Abstract
A systematic assessment of literature was done to estimate the impact of pruritus on health-related quality of life among patients with cholestatic liver disease (CLD). All the articles were reviewed manually for study design, population, outcomes, and study quality. A qualitative approach was used to analyze and extract data from included studies. A total of eight studies were retrieved, of which one was a cohort study and the other seven were cross-sectional studies. Overall, it appears that the incidence of pruritus was a common complication reported by most of the studies. Among patients with CLD incidence of pruritus was 29%. Pruritus was found to have a substantial impact on patients' health-related quality of life. Greater health-related quality of life impairment was observed with increased severity of pruritus. Pruritus was found to have a significant association (p<0.05) in quality-of-life instrument domains such as role limitation-physical, role limitation-emotional, bodily pain, vitality, energy, and physical mobility. Evidence suggests that pruritus has a substantial impact on health-related quality of life among patients with CLD. More research is required to support the evidence.
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Affiliation(s)
- Xin Yee Jin
- School of Pharmacy, Monash University, Bandar Sunway, 45700, Selangor, Malaysia
| | - Tahir Mehmood Khan
- School of Pharmacy, Monash University, Bandar Sunway, 45700, Selangor, Malaysia.
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55
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Intractable pruritus in neuromyelitis optica. Neurol Sci 2016; 37:949-54. [DOI: 10.1007/s10072-016-2523-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 02/16/2016] [Indexed: 10/22/2022]
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56
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Patricio ES, Costa R, Figueiredo CP, Gers-Barlag K, Bicca MA, Manjavachi MN, Segat GC, Gentry C, Luiz AP, Fernandes ES, Cunha TM, Bevan S, Calixto JB. Mechanisms Underlying the Scratching Behavior Induced by the Activation of Proteinase-Activated Receptor-4 in Mice. J Invest Dermatol 2015; 135:2484-2491. [DOI: 10.1038/jid.2015.183] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 04/20/2015] [Accepted: 04/27/2015] [Indexed: 02/08/2023]
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57
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Cozzani E, Iurlo A, Merlo G, Cattaneo D, Burlando M, Pierri I, Gugliotta L, Parodi A. Essential Thrombocythemia: The Dermatologic Point of View. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15:739-47. [PMID: 26432058 DOI: 10.1016/j.clml.2015.08.086] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 08/18/2015] [Accepted: 08/24/2015] [Indexed: 12/12/2022]
Abstract
Essential thrombocythemia (ET) is a myeloproliferative neoplasm characterized by an increase in blood platelets and dominated by a predisposition to vascular events. Cutaneous manifestations can complicate its course. itching has been the most common symptom reported; however, the percentage has ranged from 3% to 46%, depending on the survey. Erythromelalgia is found in 6% of cases, and livedo reticularis, minor bleeding, acrocyanosis, and Raynaud's phenomenon are rare manifestations. It is important to recognize and treat these events, because they can affect patients' quality of life and could worsen the prognosis. In addition to skin involvement as a possible sign of ET, the treatment of ET can be associated with cutaneous complications. Hydroxycarbamide, interferon-alfa, and anagrelide can induce different skin lesions. Hydroxycarbamide has been associated with major complications, including painful leg ulcers and actinic keratoses. Minor events include alopecia and hyperpigmentation. Xerosis, pruritus, and photosensitivity are some of the complications reported by patients treated with interferon-alfa. Anagrelide has proved to be associated with fewer dermatologic effects, only detected in single cases. Knowledge of the ET cutaneous manifestations, together with the clinical examination findings, can result in an earlier diagnosis and the start of effective treatment.
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Affiliation(s)
- Emanuele Cozzani
- Di. S. Sal. Section of Dermatology, IRCCS Azienda Ospedaliera Universitaria, San Martino-IST, Genoa, Italy.
| | - Alessandra Iurlo
- Oncohematology Division, Oncohematology Unit of the Elderly, IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation, Milan, Italy
| | - Giulia Merlo
- Di. S. Sal. Section of Dermatology, IRCCS Azienda Ospedaliera Universitaria, San Martino-IST, Genoa, Italy
| | - Daniele Cattaneo
- Oncohematology Division, IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation, Milan, Italy
| | - Martina Burlando
- Di. S. Sal. Section of Dermatology, IRCCS Azienda Ospedaliera Universitaria, San Martino-IST, Genoa, Italy
| | - Ivana Pierri
- Department of Hematology and Oncology, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy
| | - Luigi Gugliotta
- Institute of Hematology "L. e A. Seragnoli", S. Orsola Malpighi University Hospital, Bologna, Italy
| | - Aurora Parodi
- Di. S. Sal. Section of Dermatology, IRCCS Azienda Ospedaliera Universitaria, San Martino-IST, Genoa, Italy
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58
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Warlich B, Fritz F, Osada N, Bruland P, Stumpf A, Schneider G, Dugas M, Pfleiderer B, St�nder S. Health-Related Quality of Life in Chronic Pruritus: An Analysis Related to Disease Etiology, Clinical Skin Conditions and Itch Intensity. Dermatology 2015; 231:253-9. [DOI: 10.1159/000437206] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 06/22/2015] [Indexed: 11/19/2022] Open
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Abstract
The burden of chronic pruritus is increasingly recognized as significant worldwide. As wet-laboratory researchers investigate the pathophysiology of chronic pruritus, epidemiologists and health services researchers are quantifying the impact of pruritus by incidence, prevalence, and quality of life measures. Outcomes researchers are also investigating factors that may predict chronic pruritus incidence and severity. Such efforts will direct resources for research, public health intervention, and clinical care.
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60
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Ostadhadi S, Kordjazy N, Haj-Mirzaian A, Mansouri P, Dehpour AR. 5-HT3 receptors antagonists reduce serotonin-induced scratching in mice. Fundam Clin Pharmacol 2015; 29:310-5. [DOI: 10.1111/fcp.12112] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 02/17/2015] [Accepted: 02/20/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Sattar Ostadhadi
- Experimental Medicine Research Center; Tehran University of Medical Sciences; Tehran Iran
- Department of Pharmacology; School of Medicine; Tehran University of Medical Sciences; Tehran Iran
| | - Nastaran Kordjazy
- Experimental Medicine Research Center; Tehran University of Medical Sciences; Tehran Iran
- Department of Pharmacology; School of Medicine; Tehran University of Medical Sciences; Tehran Iran
| | - Arya Haj-Mirzaian
- Experimental Medicine Research Center; Tehran University of Medical Sciences; Tehran Iran
- Department of Pharmacology; School of Medicine; Tehran University of Medical Sciences; Tehran Iran
| | - Parvin Mansouri
- Skin and Stem cell Research Center; Tehran University of Medical Sciences; Tehran Iran
| | - Ahmad Reza Dehpour
- Experimental Medicine Research Center; Tehran University of Medical Sciences; Tehran Iran
- Department of Pharmacology; School of Medicine; Tehran University of Medical Sciences; Tehran Iran
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61
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Ruppert L, Apfelbacher C, Molin S, Bauer A, Mahler V, Schmitt J, Elsner P, Diepgen TL, Weisshaar E. Itching in patients with chronic hand eczema: data from the CARPE registry. Dermatology 2014; 229:146-53. [PMID: 25138355 DOI: 10.1159/000362901] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 04/16/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Itching is a leading symptom of chronic hand eczema (CHE) having a great impact on patients. The determinants of itching in CHE are unclear. OBJECTIVE We performed a cross-sectional analysis investigating factors associated with the presence and severity of itch in CHE patients from the CARPE registry. METHODS We present baseline data on itch in relationship with sociodemographic factors, severity of CHE, atopy, contact allergy, treatment and patient- reported outcomes including health-related quality of life (HRQoL). RESULTS Of 1,051 patients with CHE, 78.1% reported itching. Significant positive associations with itching were observed for younger age groups (17-25 and 26-45 years), for moderate, severe and very severe CHE and for small/moderate impairment in HRQoL. Atopic skin diathesis, hardly being able to realize treatment recommendations and very or extremely large impairments in HRQoL were associated with itch severity. CONCLUSION Taking the identified variables into account may help identify vulnerable groups most affected by (severe) itch.
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Affiliation(s)
- Linda Ruppert
- Department of Clinical Social Medicine, Occupational and Environmental Dermatology, University Hospital, Ruprecht Karls University, Heidelberg, Germany
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62
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Receptors, cells and circuits involved in pruritus of systemic disorders. Biochim Biophys Acta Mol Basis Dis 2014; 1842:869-92. [DOI: 10.1016/j.bbadis.2014.02.007] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 02/16/2014] [Accepted: 02/18/2014] [Indexed: 12/12/2022]
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63
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Tominaga M, Takamori K. Itch and nerve fibers with special reference to atopic dermatitis: Therapeutic implications. J Dermatol 2014; 41:205-12. [DOI: 10.1111/1346-8138.12317] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 09/13/2013] [Indexed: 01/10/2023]
Affiliation(s)
- Mitsutoshi Tominaga
- Institute for Environmental and Gender Specific Medicine; Juntendo University Graduate School of Medicine; Urayasu Chiba Japan
| | - Kenji Takamori
- Institute for Environmental and Gender Specific Medicine; Juntendo University Graduate School of Medicine; Urayasu Chiba Japan
- Department of Dermatology; Juntendo University Urayasu Hospital; Urayasu Chiba Japan
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64
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van Zuuren EJ, Apfelbacher CJ, Fedorowicz Z, Jupiter A, Matterne U, Weisshaar E. No high level evidence to support the use of oral H1 antihistamines as monotherapy for eczema: a summary of a Cochrane systematic review. Syst Rev 2014; 3:25. [PMID: 24625301 PMCID: PMC3984691 DOI: 10.1186/2046-4053-3-25] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 02/24/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The most important symptom as well as one of the major diagnostic criteria for eczema is itch. Although oral antihistamines continue to be prescribed for people with eczema, it is unclear if they are effective and safe in relieving itch and skin lesions. We sought to evaluate the available evidence on effectiveness of oral antihistamines (H1 antagonists) as monotherapy in children and adults with eczema. METHODS Searches included 10 databases and trial registers as well as conference proceedings (January 2014). Randomised controlled trials that assessed the effects of oral H1 antihistamines as monotherapy in children and adults with eczema were included. RESULTS Our searches retrieved 757 references, but no randomised controlled trial met our inclusion criteria. Most studies allowed concomitant treatments, making the assessment of the individual effects of oral H1 antihistamines impossible. CONCLUSIONS There is currently no high-level evidence to support or refute the efficacy or safety of oral H1 antihistamines used as monotherapy for eczema. A further review of studies that assesses the effects of oral H1 antihistamines as 'add-on' therapy together with concomitant treatments is warranted to determine the beneficial effects of this group of medications in the treatment of eczema.
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Affiliation(s)
- Esther J van Zuuren
- Department of Dermatology, B1-Q, Leiden University Medical Centre, Leiden, the Netherlands.
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65
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Curto L, Carnero L, López-Aventin D, Traveria G, Roura G, Giménez-Arnau A. Fast itch relief in an experimental model for methylprednisolone aceponate topical corticosteroid activity, based on allergic contact eczema to nickel sulphate. J Eur Acad Dermatol Venereol 2013; 28:1356-62. [DOI: 10.1111/jdv.12292] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 09/18/2013] [Indexed: 01/06/2023]
Affiliation(s)
- L. Curto
- Department of Dermatology; Hospital del Mar; Universitat Autònoma; Barcelona Spain
| | - Ll. Carnero
- Department of Dermatology; Hospital del Mar; Universitat Autònoma; Barcelona Spain
| | - D. López-Aventin
- Department of Dermatology; Hospital del Mar; Universitat Autònoma; Barcelona Spain
| | | | - G. Roura
- Adknoma; Health Research; Barcelona Spain
| | - A.M. Giménez-Arnau
- Department of Dermatology; Hospital del Mar; Universitat Autònoma; Barcelona Spain
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66
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Akiyama T, Tominaga M, Takamori K, Carstens MI, Carstens E. Roles of glutamate, substance P, and gastrin-releasing peptide as spinal neurotransmitters of histaminergic and nonhistaminergic itch. Pain 2013; 155:80-92. [PMID: 24041961 DOI: 10.1016/j.pain.2013.09.011] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 08/15/2013] [Accepted: 09/09/2013] [Indexed: 10/26/2022]
Abstract
We investigated roles for substance P (SP), gastrin-releasing peptide (GRP), and glutamate in the spinal neurotransmission of histamine-dependent and -independent itch. In anesthetized mice, responses of single superficial dorsal horn neurons to intradermal (i.d.) injection of chloroquine were partially reduced by spinal application of the α-amino-3-hydroxy-5-methyl-4-isoxazole proprionate acid (AMPA)/kainate antagonist 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX). Co-application of CNQX plus a neurokinin-1 (NK-1) antagonist produced stronger inhibition, while co-application of CNQX, NK-1, and GRP receptor (GRPR) antagonists completely inhibited firing. Nociceptive-specific and wide dynamic range-type neurons exhibited differential suppression by CNQX plus either the GRPR or NK-1 antagonist, respectively. Neuronal responses elicited by i.d. histamine were abolished by CNQX alone. In behavioral studies, individual intrathecal administration of a GRPR, NK-1, or AMPA antagonist each significantly attenuated chloroquine-evoked scratching behavior. Co-administration of the NK-1 and AMPA antagonists was more effective, and administration of all 3 antagonists abolished scratching. Intrathecal CNQX alone prevented histamine-evoked scratching behavior. We additionally employed a double-label strategy to investigate molecular markers of pruritogen-sensitive dorsal root ganglion (DRG) cells. DRG cells responsive to histamine and/or chloroquine, identified by calcium imaging, were then processed for co-expression of SP, GRP, or vesicular glutamate transporter type 2 (VGLUT2) immunofluorescence. Subpopulations of chloroquine- and/or histamine-sensitive DRG cells were immunopositive for SP and/or GRP, with >80% immunopositive for VGLUT2. These results indicate that SP, GRP, and glutamate each partially contribute to histamine-independent itch. Histamine-evoked itch is mediated primarily by glutamate, with GRP playing a lesser role. Co-application of NK-1, GRP, and AMPA receptor antagonists may prove beneficial in treating chronic itch.
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Affiliation(s)
- Tasuku Akiyama
- Department of Neurobiology, Physiology & Behavior, University of California, Davis, CA, USA Institute for Environmental and Gender Specific Medicine, Juntendo University Graduate School of Medicine, Urayasu, Chiba 279-0021, Japan
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67
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Apfelbacher CJ, van Zuuren EJ, Fedorowicz Z, Jupiter A, Matterne U, Weisshaar E. Oral H1 antihistamines as monotherapy for eczema. Cochrane Database Syst Rev 2013; 2013:CD007770. [PMID: 23450580 PMCID: PMC6823266 DOI: 10.1002/14651858.cd007770.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Eczema is a common skin disease in many countries, and although the majority of cases of eczema occur before the age of five years and often resolve during childhood or adolescence, it can also persist into adulthood. Itch is the most important aspect of eczema, often impacting significantly on the quality of life of an affected individual. OBJECTIVES To assess the effects of oral antihistamines (H1 antagonists) as monotherapy in children and adults with eczema. SEARCH METHODS We searched the following databases up to March 2012: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2012, Issue 3), MEDLINE (from 1946), EMBASE (from 1974), and LILACS (from 1982). We examined the reference lists of excluded studies in order to identify further references to relevant trials. We searched trials registers for ongoing and unpublished trials. We also handsearched the abstracts of the International Research Workshops on eczema, as well as the conference proceedings of the European Academy of Dermatology and Venereology (EADV) and the European Academy of Allergology and Clinical Immunology (EAACI), from 2000 to 2011. SELECTION CRITERIA We sought to include randomised controlled trials that assessed the effects and safety of oral H1 antihistamines as monotherapy in children and adults with eczema. We excluded studies that compared an antihistamine versus another antihistamine and had no placebo control arm. We also excluded topical antihistamines and oral H1 antihistamines as 'add-on' therapy and studies using any concomitant therapy other than emollients or moisturisers, principally because some of these forms of concomitant therapy may be considered treatment modifiers in assessments of the effects of antihistamines on eczema. DATA COLLECTION AND ANALYSIS Our search retrieved 409 references to studies. Based on assessments of their titles, abstracts, or both, we excluded all except 36 of these studies. After evaluation of the full text of each report, we excluded a further 35 studies, and 1 study is awaiting classification pending a response from the trial investigators. MAIN RESULTS No randomised controlled trials met our inclusion criteria. AUTHORS' CONCLUSIONS There is currently no high-level evidence to support or refute the efficacy or safety of oral H1 antihistamines used as monotherapy for eczema. Because most of the studies allowed the use of concomitant medications and involved multi-therapeutic approaches, meaningful assessments of the individual effects of oral H1 antihistamines on eczema were not feasible. Although well-designed randomised controlled trials excluding concomitant medications appear to be needed, consideration should be given to the potential ethical issues raised with the use of antihistamines as monotherapy for the management of eczema by withholding the use of rescue or additional therapies. A further systematic review of studies in which concomitant therapies were permitted might be of value in determining the potential benefits of oral H1 antihistamines as add-on therapy.
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Affiliation(s)
- Christian J Apfelbacher
- Medical Sociology, Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.
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68
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Apfelbacher CJ, van Zuuren EJ, Fedorowicz Z, Jupiter A, Matterne U, Weisshaar E. Oral H1 antihistamines as monotherapy for eczema. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [PMID: 23450580 DOI: 10.1002/14651858.cd012167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Eczema is a common skin disease in many countries, and although the majority of cases of eczema occur before the age of five years and often resolve during childhood or adolescence, it can also persist into adulthood. Itch is the most important aspect of eczema, often impacting significantly on the quality of life of an affected individual. OBJECTIVES To assess the effects of oral antihistamines (H1 antagonists) as monotherapy in children and adults with eczema. SEARCH METHODS We searched the following databases up to March 2012: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2012, Issue 3), MEDLINE (from 1946), EMBASE (from 1974), and LILACS (from 1982). We examined the reference lists of excluded studies in order to identify further references to relevant trials. We searched trials registers for ongoing and unpublished trials. We also handsearched the abstracts of the International Research Workshops on eczema, as well as the conference proceedings of the European Academy of Dermatology and Venereology (EADV) and the European Academy of Allergology and Clinical Immunology (EAACI), from 2000 to 2011. SELECTION CRITERIA We sought to include randomised controlled trials that assessed the effects and safety of oral H1 antihistamines as monotherapy in children and adults with eczema. We excluded studies that compared an antihistamine versus another antihistamine and had no placebo control arm. We also excluded topical antihistamines and oral H1 antihistamines as 'add-on' therapy and studies using any concomitant therapy other than emollients or moisturisers, principally because some of these forms of concomitant therapy may be considered treatment modifiers in assessments of the effects of antihistamines on eczema. DATA COLLECTION AND ANALYSIS Our search retrieved 409 references to studies. Based on assessments of their titles, abstracts, or both, we excluded all except 36 of these studies. After evaluation of the full text of each report, we excluded a further 35 studies, and 1 study is awaiting classification pending a response from the trial investigators. MAIN RESULTS No randomised controlled trials met our inclusion criteria. AUTHORS' CONCLUSIONS There is currently no high-level evidence to support or refute the efficacy or safety of oral H1 antihistamines used as monotherapy for eczema. Because most of the studies allowed the use of concomitant medications and involved multi-therapeutic approaches, meaningful assessments of the individual effects of oral H1 antihistamines on eczema were not feasible. Although well-designed randomised controlled trials excluding concomitant medications appear to be needed, consideration should be given to the potential ethical issues raised with the use of antihistamines as monotherapy for the management of eczema by withholding the use of rescue or additional therapies. A further systematic review of studies in which concomitant therapies were permitted might be of value in determining the potential benefits of oral H1 antihistamines as add-on therapy.
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Affiliation(s)
- Christian J Apfelbacher
- Medical Sociology, Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.
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69
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Ständer S, Blome C, Breil B, Bruland P, Darsow U, Dugas M, Evers A, Fritz F, Metz M, Phan NQ, Raap U, Reich A, Schneider G, Steinke S, Szepietowski J, Weisshaar E, Augustin M. [Assessment of pruritus - current standards and implications for clinical practice : consensus paper of the Action Group Pruritus Parameter of the International Working Group on Pruritus Research (AGP)]. Hautarzt 2012; 63:521-2, 524-31. [PMID: 22733240 DOI: 10.1007/s00105-011-2318-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
With a prevalence of 20%, chronic pruritus is a symptom of many diseases with major impact on healthcare costs. The lack of specific therapeutic measures makes the development of new drugs and their testing in clinical trials urgent. It is not possible to measure pruritus in an objective way. For these reasons, it is necessary to have a series of standardized measures to characterize pruritus in a reliable way. Intensity scales such as the visual analog scale (VAS) are most frequently used to document the course of the symptoms. However, for assessing pruritus intensity, VAS is not an optimal instrument, although it cannot be dispensed with. The VAS should be combined with other scales in clinical studies in order to internally test the consistency of data. Other instruments for assessing intensity and course of pruritus are in the process of development. Presently scratch activity and scratch-associated lesions can be documented in a descriptive fashion. There are some studies that have employed devices to document scratch activity; however, methodological studies are not yet available. The patient-benefit index is an indispensable tool in clinical trials. A questionnaire for gathering data on the history and some pruritus-specific parameters has been developed and published. Questionnaires on patient quality of life, anxiety and depression are helpful in obtaining data on other cost-relevant parameters. A questionnaire on the quality of life, for instance, can provide important help in the assessment of the burden of the disease. The results of these questionnaires can be correlated with data on pruritus intensity scales. The relevant questionnaires have been partially digitalized so that they are available immediately as part of patient care. Additional methodological developments and studies are required in order to define a robust set of instruments for measuring pruritus in daily practice and in clinical studies.
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Affiliation(s)
- S Ständer
- Klinik für Hautkrankheiten und Kompetenzzentrum Chronischer Pruritus, Universitätsklinikum Münster, Deutschland.
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70
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Weisshaar E. [Pruritus and psoriasis : an important but frequently underestimated relation]. Hautarzt 2012; 63:547-52. [PMID: 22648457 DOI: 10.1007/s00105-011-2323-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Pruritus is a frequent but often unrecognized and underestimated symptom in patients with psoriasis. The underreporting may be due to lower frequency and reduced intensity of pruritus compared to other pruritic diseases such as atopic eczema or uremic pruritus, as well as impairment of psychosocial well-being caused by e.g. depression, social withdraw and secretiveness. Recent studies show pruritus being more prevalent in psoriasis, especially plaque-type psoriasis, than previously believed and severely affecting patients' quality of life. The assessment of pruritus and its associated effects is a significant component of clinical management of psoriasis. The presented suggest we should not underestimate pruritus in psoriasis and must consider this symptom in planning therapy.
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Affiliation(s)
- E Weisshaar
- Abteilung Klinische Sozialmedizin, Schwerpunkt: Berufs- und Umweltdermatologie, Universität Heidelberg, Deutschland.
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71
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Akiyama T, Tominaga M, Davoodi A, Nagamine M, Blansit K, Horwitz A, Carstens MI, Carstens E. Roles for substance P and gastrin-releasing peptide as neurotransmitters released by primary afferent pruriceptors. J Neurophysiol 2012; 109:742-8. [PMID: 23155177 DOI: 10.1152/jn.00539.2012] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Recent studies support roles for neurokinin-1 (NK-1) and gastrin-releasing peptide (GRP) receptor-expressing spinal neurons in itch. We presently investigated expression of substance P (SP) and GRP in pruritogen-responsive primary sensory neurons and roles for these neuropeptides in itch signaling. Responses of dorsal root ganglion (DRG) cells to various pruritogens were observed by calcium imaging. DRG cells were then processed for SP, GRP, and isolectin B-4 (IB4; a marker for nonpeptidergic neurons) immunofluorescence. Of pruritogen-responsive DRG cells, 11.8-26.8%, 21.8-40.0%, and 21.4-26.8% were immunopositive for SP, GRP, and IB4, respectively. In behavioral studies, both systemic and intrathecal administration of a NK-1 receptor antagonist significantly attenuated scratching evoked by chloroquine and a protease-activated receptor 2 agonist, SLIGRL, but not histamine, bovine adrenal medulla peptide 8-22 (BAM8-22), or serotonin. Systemic or intrathecal administration of a GRP receptor antagonist attenuated scratching evoked by chloroquine and SLIGRL but not BAM8-22 or histamine. The GRP receptor antagonist enhanced scratching evoked by serotonin. These results indicate that SP and GRP expressed in primary sensory neurons are partially involved as neurotransmitters in histamine-independent itch signaling from the skin to the spinal cord.
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Affiliation(s)
- Tasuku Akiyama
- Dept. of Neurobiology, Physiology & Behavior, Univ. of California, Davis, Davis, CA 95616, USA
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72
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Abstract
Background Pruritus affects the quality of life (QoL) in the patients. However, little is known of the impacts of itching on the QoL in the literature. Objective In this study, a questionnaire eliciting specific responses about pruritus was used to determine the effect of itching and its severity on QoL in chronic pruritic patients. Methods One hundred ten adult patients with chronic pruritus were surveyed. Once itch severity had been self-reported by patients, together with Skindex-29, they have been given the 18-item Pruritus-related Life Quality Index (PLQI) questionnaire, which was used to generated the new index. Results Significant correlations have been found between the pruritus severity score of participants and their total Skindex-29 (p<0.001) with its function, emotion and symptom subscale scores (p<0.001 for each). Also, significant correlations were evident between total PLQI (p<0.001) and its psychosocial negativities, difficulties in everyday activities and social live subscale scores (p<0.001 for each). In particular, the emotion subscale of Skindex-29 (p=0.02) and psychosocial negativity subscale of PLQI (p=0.02) were significantly high in psychopathologic patients. A highly positive statistical correlation between Skindex-29 and PLQI scales was evident (r=0.845, p<0.001). For reliability, Cronbach's coefficient a coefficients were 0.931 for the Skindex-29 scale and 0.918 for the PLQI scale. Conclusion The results demonstrate that chronic pruritus appreciably reduces the QoL. PLQI could be used in the development of new questionnaires for determining the QoL of patients with chronic itch.
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Affiliation(s)
- Irem Eren Erturk
- Department of Dermatology and Venereology, Tekirdag State Hospital, Tekirdag, Turkey
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73
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Akiyama T, Tominaga M, Davoodi A, Nagamine M, Blansit K, Horwitz A, Carstens MI, Carstens E. Cross-sensitization of histamine-independent itch in mouse primary sensory neurons. Neuroscience 2012; 226:305-12. [PMID: 23000623 DOI: 10.1016/j.neuroscience.2012.09.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 08/10/2012] [Accepted: 09/08/2012] [Indexed: 10/27/2022]
Abstract
Overexpression of pruritogens and their precursors may contribute to the sensitization of histamine-dependent and -independent itch-signaling pathways in chronic itch. We presently investigated self- and cross-sensitization of scratching behavior elicited by various pruritogens, and their effects on primary sensory neurons. The MrgprC11 agonist BAM8-22 exhibited self- and reciprocal cross-sensitization of scratching evoked by the protease-activated receptor-2 (PAR-2) agonist SLIGRL. The MrgprA3 agonist chloroquine unidirectionally cross-sensitized BAM8-22-evoked scratching. Histamine unidirectionally cross-sensitized scratching evoked by chloroquine and BAM8-22. SLIGRL unidirectionally cross-sensitized scratching evoked by chloroquine. Dorsal root ganglion (DRG) cells responded to various combinations of pruritogens and algogens. Neither chloroquine, BAM8-22 nor histamine had any effect on responses of DRG cell responses to subsequently applied pruritogens, implying that their behavioral self- and cross-sensitization effects are mediated indirectly. SLIGRL unilaterally cross-sensitized responses of DRG cells to chloroquine and BAM8-22, consistent with the behavioral data. These results indicate that unidirectional cross-sensitization of histamine-independent itch-signaling pathways might occur at a peripheral site through PAR-2. PAR-2 expressed in pruriceptive nerve endings is a potential target to reduce sensitization associated with chronic itch.
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Affiliation(s)
- T Akiyama
- University of California, Davis, Department of Neurobiology, Physiology & Behavior, 1 Shields Avenue, Davis, CA 95616, USA
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74
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75
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Panahi Y, Taherzadeh ES, Davoudi SM, Sahebkar A, Ranjbar R. Investigation of serum substance P status in patients with chronic pruritic skin lesions due to sulfur mustard: a cross-sectional study. Cutan Ocul Toxicol 2012; 32:4-8. [DOI: 10.3109/15569527.2012.686077] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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76
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Bathe A, Weisshaar E, Matterne U. Chronic pruritus--more than a symptom: a qualitative investigation into patients' subjective illness perceptions. J Adv Nurs 2012; 69:316-26. [PMID: 22571475 DOI: 10.1111/j.1365-2648.2012.06009.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM This article is a report of a study exploring the subjective illness perceptions of patients with chronic pruritus (>6 weeks). BACKGROUND Pruritus is a common symptom of dermatological as well as other conditions. This pervasive symptom has a substantial impact on quality of life. Little is known about how patients with chronic pruritus construct the symptom, what causes they ascribe, consequences they endure, how they control the symptom and experience the healthcare system. DESIGN A qualitative design taking a constructivist inquiry perspective. METHODS Semi-structured interviews with 16 patients were conducted between September 2008-February 2009 and analysed by qualitative content analysis. RESULTS Many patients find it very difficult to adequately describe the symptom to others resulting sometimes in bizarre accounts of the symptom that provoke irritation in lay people and health professionals. This irritation frequently leaves the sufferer feeling misunderstood. Patients often feel their burden is not taken seriously by health professionals. This and various other reasons contribute to difficulties in accepting a given diagnosis. This can leave patients unsatisfied with their current health care and the system. They respond with frequent doctor changes and consideration of complementary and alternative therapeutic methods. CONCLUSION Assisting patients with chronic pruritus in their efforts to adequately describe the symptom along with unconditional regard and empathy are key factors that can help enhance the provider-patient relationship and subsequent acceptance of a given diagnosis. A stronger emphasis on the perspectives of these patients may also improve the quality of healthcare provision.
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Affiliation(s)
- Anja Bathe
- Department of Clinical Social Medicine, University Hospital Heidelberg, Germany.
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77
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Abstract
Health-related quality of life (QoL) is a patient-reported outcome that describes the impact of the disease in question to all aspects of persons' life, including psychosocial, emotional, physical, and functional impact. As such, health-related QoL is particularly relevant in conditions that have no physical signs and need to rely on patient reports to know whether they are improving or not. Work is beginning in pruritus to develop instruments that can measure pruritus-related QoL. This article reviews the instruments that have been developed and used in pruritus and also reviews the literature regarding the impact of pruritus on QoL.
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Affiliation(s)
- Suephy C Chen
- Division of Dermatology, Atlanta Veterans Affairs Medical Center, Decatur, GA 30322, USA.
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78
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Improvement of sulphur mustard-induced chronic pruritus, quality of life and antioxidant status by curcumin: results of a randomised, double-blind, placebo-controlled trial. Br J Nutr 2011; 108:1272-9. [DOI: 10.1017/s0007114511006544] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Skin is among the first and most heavily damaged organs upon sulphur mustard (SM) exposure. Pruritus is the most common chronic skin complication of SM, which adversely affects the quality of life (QoL). However, current therapies for the management of SM-induced pruritus are very limited and associated with side effects. The present trial investigated the efficacy of curcumin in the alleviation of SM-induced chronic pruritic symptoms. A total of ninety-six male Iranian veterans (age 37–59 years) were randomised to receive either curcumin (1 g/d, n 46) or placebo (n 50) for 4 weeks. Serum concentrations of substance P and activities of antioxidant enzymes were measured at baseline and at the end of the trial. Assessment of pruritus severity was performed using the pruritus score, visual analogue scale (VAS) and scoring atopic dermatitis (SCORAD) index. QoL was evaluated using the Dermatology Life Quality Index (DLQI) questionnaire. Serum concentrations of substance P (P < 0·001) as well as activities of superoxide dismutase (P = 0·02), glutathione peroxidase (P = 0·006) and catalase (P < 0·001) were significantly reduced in the curcumin group, while no significant change was observed in the placebo group. Curcumin supplementation was also associated with significant reductions in measures of pruritus severity including the pruritus score (P < 0·001), VAS score (P < 0·001), overall (P < 0·001) and objective SCORAD (P = 0·009), and DLQI's first question (P < 0·001). None of these measures was significantly changed in the placebo group. As for the QoL, although DLQI scores decreased in both groups (P < 0·001 and P = 0·003 in the curcumin and placebo groups, respectively), the magnitude of reduction was significantly greater in the curcumin group (P < 0·001). In conclusion, curcumin may be regarded as a natural, safe, widely available and inexpensive treatment for the management of SM-induced chronic pruritus.
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79
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Weisshaar E, Ständer S, Gieler U, Matterne U, Darsow U. Entwicklung eines deutschsprachigen Fragebogens zur Erfassung von chronischem Pruritus (AGP-Fragebogen). Hautarzt 2011; 62:914-27. [PMID: 21987174 DOI: 10.1007/s00105-011-2236-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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81
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Weisshaar E, Kallen U, Klintworth N, Zenk J. Pruritus, Erytheme & Co. HNO 2011; 59:301-9; quiz 310. [DOI: 10.1007/s00106-011-2260-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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82
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Abstract
Pruritus is an integral part of the patient's symptoms in numerous dermatological and systemic diseases in humans and animals. Comparable to chronic pain, pruritus can have a dramatic impact on the quality of life of the patient. In recent years, pruritus has been defined as an autonomous, pain-independent sensation, and itch-specific neurons, mediators, spinal neurons and cortical areas have been identified. These observations have not only improved our understanding of the neurobiology of itch but will also lead to improved diagnosis and to the development of new and more efficient therapeutic options. This article reviews the role of itch fibres and their response to various mediators of pruritus including histamine, vasoactive intestinal peptide (VIP), calcitonin gene-related peptide (CGRP), and substance P (SP), and opioids. Substances that may be involved in the induction or modulation of itch may be termed pruritogenic mediators and examples discussed include proteases, lipid mediators, neuropeptides, opioids and various cytokines. There is no single, generally accepted clinical classification of chronic pruritus. In the past pruritus has been classified on the basis of the neuroanatomical origin and on the potential underlying disease. Therapeutic options for the management of pruritus are discussed including topical and systemic therapies, assuming that trigger factors have been eliminated where possible. Topical agents may include capsaicin, the calcineurin inhibitors tacrolimus and pimecrolimus, and cannabinoid agonists such as N-palmitoyl ethanolamine. Systemic therapies may include antihistamines, anticonvulsants, opiate receptor antagonist or agonists, antidepressants, ciclosporin, and UV light.
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Affiliation(s)
- Martin Metz
- Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Germany.
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83
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El-Baalbaki G, Razykov I, Hudson M, Bassel M, Baron M, Thombs BD. Association of pruritus with quality of life and disability in systemic sclerosis. Arthritis Care Res (Hoboken) 2010; 62:1489-95. [DOI: 10.1002/acr.20257] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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84
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Abstract
Chronic pruritus, one of the main symptoms in dermatologic diseases, is often intractable and has a high impact on a patient´s quality of life. In addition to dermatologic disorders, chronic pruritus is associated with systemic and neurologic, as well as psychologic, diseases. Aging skin is considered to be more susceptible to pruritic disorders. Thus, owing to demographic changes, pruritus is becoming more prevalent. The elderly are often afflicted with comorbidities and polypharmacy, which can complicate diagnosis and therapy. In this review we present a rational work-up adapted to the special premises and needs of geriatric patients. This may facilitate the choice of suitable therapeutic regimens.
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Affiliation(s)
- Sonja A Grundmann
- Neurodermatology & Competence Center Pruritus, Department of Dermatology, University of Münster, Germany
| | - Sonja Ständer
- Neurodermatology & Competence Center Pruritus, Department of Dermatology, University of Münster, Germany
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85
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Reitamo S, Allsopp R. Treatment with twice-weekly tacrolimus ointment in patients with moderate to severe atopic dermatitis: Results from two randomized, multicentre, comparative studies. J DERMATOL TREAT 2010; 21:34-44. [DOI: 10.3109/09546630903401488] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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86
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Razykov I, Thombs BD, Hudson M, Bassel M, Baron M. Prevalence and clinical correlates of pruritus in patients with systemic sclerosis. ACTA ACUST UNITED AC 2009; 61:1765-70. [DOI: 10.1002/art.25010] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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87
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Apfelbacher CJ, Loerbroks A, Matterne U, Strassner T, Büttner M, Weisshaar E. Informed Consent Affects Prevalence Estimates in an Epidemiological Study on Chronic Pruritus: Lessons Learned from a Pretest. Ann Epidemiol 2009; 19:754-6. [DOI: 10.1016/j.annepidem.2009.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 05/28/2009] [Accepted: 06/23/2009] [Indexed: 10/20/2022]
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88
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Doss N, Reitamo S, Dubertret L, Fekete GL, Kamoun MR, Lahfa M, Ortonne JP. Superiority of tacrolimus 0.1% ointment compared with fluticasone 0.005% in adults with moderate to severe atopic dermatitis of the face: results from a randomized, double-blind trial. Br J Dermatol 2009; 161:427-34. [PMID: 19416227 DOI: 10.1111/j.1365-2133.2009.09143.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND No specific data are available on tacrolimus ointment as a second-line treatment in adults with facial eczema. OBJECTIVES To compare tacrolimus 0.1% and fluticasone 0.005% ointments in adults with moderate to severe atopic dermatitis (AD) of the face in whom conventional treatment was ineffective or poorly tolerated. METHODS Patients were randomized to double-blind treatment of facial AD with twice-daily tacrolimus ointment (n = 288) or fluticasone ointment (n = 280) for 3 weeks or until clearance. After day 21, patients could continue without the study treatment, apply the same ointment once daily, or switch to the other medication twice daily, depending on lesion clearance and patient/physician satisfaction. The primary endpoint was the day-21 response [> or = 60% reduction in the modified Local Eczema and Severity Index (mLEASI) score]. Secondary endpoints included facial erythema and pruritus, global clinical response, treatment switching at day 21 and safety. RESULTS Response with tacrolimus ointment (93%) was superior to that with fluticasone (88%; P = 0.026). Improvements in mLEASI components were also greater with tacrolimus ointment. Facial erythema and pruritus improved in both groups. Global clinical response was rated 'marked improvement' or better in 88% and 79% of patients in the tacrolimus ointment and fluticasone groups, respectively. At day 21, 9% of patients switched from fluticasone to tacrolimus ointment, while 4.5% switched from tacrolimus ointment to fluticasone. Adverse events were more frequent with tacrolimus ointment as a result of the higher incidence of application-site skin burning sensation. Safety of both drugs was in line with their respective summary of product characteristics. CONCLUSIONS Tacrolimus 0.1% ointment has superior efficacy to fluticasone 0.005% ointment for twice-daily treatment of adults with moderate to severe facial AD in whom conventional therapy was inadequately effective or not tolerated. Tacrolimus 0.1% ointment is a safe and effective second-line treatment for the control of moderate to severe AD of the face.
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Affiliation(s)
- N Doss
- Department of Dermatology, Military Hospital of Tunis, 1006 Tunis, Tunisia.
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89
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Panahi Y, Davoudi SM, Sadr SB, Naghizadeh MM, Mohammadi-Mofrad M. Impact of pruritus on quality of life in sulfur mustard-exposed Iranian veterans. Int J Dermatol 2008; 47:557-61. [DOI: 10.1111/j.1365-4632.2008.03650.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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90
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Gangat N, Strand JJ, Lasho TL, Li CY, Pardanani A, Tefferi A. Pruritus in polycythemia vera is associated with a lower risk of arterial thrombosis. Am J Hematol 2008; 83:451-3. [PMID: 18257107 DOI: 10.1002/ajh.21156] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Among 418 patients with polycythemia vera seen at our institution and in whom pruritus history was recorded, the presence of pruritus at diagnosis was documented in 131 (31%) and its absence in 287 (69%). Pruritus was less frequently reported by smokers (12% vs. 24%; P = 0.004) and diabetics (5% vs. 11%; P = 0.04). The presence of pruritus was associated with a lower rate of arterial thrombosis, both at diagnosis (8% vs. 17%; P = 0.01) and during follow-up (16% vs. 30%; P = 0.003). Multivariable analysis revealed that these associations were independent of other risk factors for thrombosis. High JAK2V617F allele burden clustered with pruritus (P = 0.002) but did not affect thrombosis rates.
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Affiliation(s)
- Naseema Gangat
- Division of Hematology, Department of Medicine and Laboratory Medicine, Mayo Clinic, Rochester, Minnesota55905, USA
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91
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Polat M, Oztas P, Ilhan MN, Yalçin B, Alli N. Generalized pruritus: a prospective study concerning etiology. Am J Clin Dermatol 2008; 9:39-44. [PMID: 18092842 DOI: 10.2165/00128071-200809010-00004] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Generalized pruritus can often be the primary manifestation of systemic disease. OBJECTIVE To determine how frequently generalized pruritus had a systemic etiology in an outpatient population seen in a dermatology department and whether any identifiable patient characteristics meant a systemic explanation of generalized pruritus was more likely. METHODS A prospective controlled study of 55 patients with generalized pruritus and 41 healthy age- and sex-matched control subjects. Clinical data were collected from patients and laboratory parameters investigated in both patients and healthy control subjects to determine the frequency of systemic disease in each group. RESULTS Of 55 patients, 12 had a systemic cause of pruritus. Pruritus was the initial symptom of systemic disease in eight of these patients. The underlying diseases included hypothyroidism, chronic lymphocytic leukemia, hepatitis C, hepatitis B, diabetes mellitus, lung cancer, uremia, and iron deficiency anemia. Of these, iron deficiency anemia was the most common cause. Compared with the control group, mean serum hemoglobin, iron, and cyanocobalamin (vitamin B(12)) levels in patients with generalized pruritus were lower. No other patient characteristics were statistically associated with systemic causes of pruritus. CONCLUSION Generalized pruritus was the initial symptom of a systemic disease in 8 of 55 patients presenting to a dermatology outpatient clinic with this complaint. A number of underlying diseases were identified, of which the most common was iron deficiency anemia.
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Affiliation(s)
- Muhterem Polat
- 1st Dermatology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey.
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Abstract
Chronic pruritus (starting from 6 weeks duration) is symptom of dermatological, internal, neurological or psychiatric disease. Identification and treatment of the underlying diseases is of great importance especially in the initial phase of chronic pruritus in order to prevent peripheral and central sensitization processes and thus chronification. Application of the redefined clinical classification, newly defined clinical algorithms and inquiry of clinical characteristics of pruritus is helpful in finding the underlying disease. In chronic pruritus existing for several years, clarifying the underlying origin is difficult and therapies are often ineffective. Next to conventional therapies such as antihistamines and corticosteroids, central effective substances can be applied preventing pruritus sensation on spinal or cerebral level.
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Affiliation(s)
- S Ständer
- Klinik und Poliklinik für Hautkrankheiten, Klinische Neurodermatologie, Universitätsklinikum Münster, Von-Esmarchstrasse 58, 48149 Münster, Germany.
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