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Andrade A, Kuah CY, Martin‐Lopez JE, Chua S, Shpadaruk V, Sanclemente G, Franco JVA. Interventions for chronic pruritus of unknown origin. Cochrane Database Syst Rev 2020; 1:CD013128. [PMID: 31981369 PMCID: PMC6984650 DOI: 10.1002/14651858.cd013128.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Pruritus is a sensation that leads to the desire to scratch; its origin is unknown in 8% to 15% of affected patients. The prevalence of chronic pruritus of unknown origin (CPUO) in individuals with generalised pruritus ranges from 3.6% to 44.5%, with highest prevalence among the elderly. When the origin of pruritus is known, its management may be straightforward if an effective treatment for the causal disease is available. Treatment of CPUO is particularly difficult due to its unknown pathophysiology. OBJECTIVES To assess the effects of interventions for CPUO in adults and children. SEARCH METHODS We searched the following up to July 2019: Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, and trials registries. We checked the reference lists of included studies for additional references to relevant trials. SELECTION CRITERIA We sought to include randomised controlled trials and quasi-randomised controlled trials that assessed interventions for CPUO, as defined in category VI ('Other pruritus of undetermined origin, or chronic pruritus of unknown origin') of the International Forum for the Study of Itch (IFSI) classification, in children and adults. Eligible interventions were non-pharmacological or topical or systemic pharmacological interventions, and eligible comparators were another active treatment, placebo, sham procedures, or no treatment or equivalent (e.g. waiting list). DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Our primary outcomes were 'Patient- or parent-reported pruritus intensity' and 'Adverse events'. Our secondary outcomes were 'Health-related quality of life', 'Sleep disturbances', 'Depression', and 'Patient satisfaction'. We used GRADE to assess the certainty of evidence. MAIN RESULTS We found there was an absence of evidence for the main interventions of interest: emollient creams, cooling lotions, topical corticosteroids, topical antidepressants, systemic antihistamines, systemic antidepressants, systemic anticonvulsants, and phototherapy. We included one study with 257 randomised (253 analysed) participants, aged 18 to 65 years; 60.6% were female. This study investigated the safety and efficacy of three different doses of oral serlopitant (5 mg, 1 mg, and 0.25 mg, once daily for six weeks) compared to placebo for severe chronic pruritus; 25 US centres participated (clinical research centres and universities). All outcomes were measured at the end of treatment (six weeks from baseline), except adverse events, which were monitored throughout. A pharmaceutical company funded this study. Fifty-five per cent of participants suffered from CPUO, and approximately 45% presented a dermatological diagnosis (atopic dermatitis/eczema 37.3%, psoriasis 6.7%, acne 3.6%, among other diagnoses). We unsuccessfully attempted to retrieve outcome data from study authors for the subgroup of participants with CPUO. Participants had pruritus for six weeks or longer. Total study duration was 10 weeks. Participants who received serlopitant 5 mg may have a greater rate of relief of patient-reported pruritus intensity as measured by the visual analogue scale (VAS; a reduction in VAS score indicates improvement) compared to placebo (126 participants, risk ratio (RR) 2.06, 95% confidence interval (CI) 1.27 to 3.35; low-certainty evidence). We are uncertain of the effects of serlopitant 5 mg compared to placebo on the following outcomes due to very low-certainty evidence: adverse events (127 participants; RR 1.48, 95% CI 0.87 to 2.50); health-related quality of life (as measured by the Dermatology Life Quality Index (DLQI); a higher score indicates greater impairment; 127 participants; mean difference (MD) -4.20, 95% CI -11.68 to 3.28); and sleep disturbances (people with insomnia measured by the Pittsburgh Sleep Symptom Questionnaire-Insomnia (PSSQ-I), a dichotomous measure; 128 participants; RR 0.49, 95% CI 0.24 to 1.01). Participants who received serlopitant 1 mg may have a greater rate of relief of patient-reported pruritus intensity as measured by VAS compared to placebo; however, the 95% CI indicates that there may also be little to no difference between groups (126 participants; RR 1.50, 95% CI 0.89 to 2.54; low-certainty evidence). We are uncertain of the effects of serlopitant 1 mg compared to placebo on the following outcomes due to very low-certainty evidence: adverse events (128 participants; RR 1.45, 95% CI 0.86 to 2.47); health-related quality of life (DLQI; 128 participants; MD -6.90, 95% CI -14.38 to 0.58); and sleep disturbances (PSSQ-I; 128 participants; RR 0.38, 95% CI 0.17 to 0.84). Participants who received serlopitant 0.25 mg may have a greater rate of relief of patient-reported pruritus intensity as measured by VAS compared to placebo; however, the 95% CI indicates that there may also be little to no difference between groups (127 participants; RR 1.66, 95% CI 1.00 to 2.77; low-certainty evidence). We are uncertain of the effects of serlopitant 0.25 mg compared to placebo on the following outcomes due to very low-certainty evidence: adverse events (127 participants; RR 1.29, 95% CI 0.75 to 2.24); health-related quality of life (DLQI; 127 participants; MD -5.70, 95% CI -13.18 to 1.78); and sleep disturbances (PSSQ-I; 127 participants; RR 0.60, 95% CI 0.31 to 1.17). The most commonly reported adverse events were somnolence, diarrhoea, headache, and nasopharyngitis, among others. Our included study did not measure depression or patient satisfaction. We downgraded the certainty of evidence for all outcomes due to indirectness (only 55% of study participants had CPUO) and imprecision. We downgraded outcomes other than patient-reported pruritus intensity a further level due to concerns regarding risk of bias in selection of the reported result and some concerns with risk of bias due to missing outcome data (sleep disturbances only). We deemed risk of bias to be generally low. AUTHORS' CONCLUSIONS We found lack of evidence to address our review question: for most of our interventions of interest, we found no eligible studies. The neurokinin 1 receptor (NK1R) antagonist serlopitant was the only intervention that we could assess. One study provided low-certainty evidence suggesting that serlopitant may reduce pruritus intensity when compared with placebo. We are uncertain of the effects of serlopitant on other outcomes, as certainty of the evidence is very low. More studies with larger sample sizes, focused on patients with CPUO, are needed. Healthcare professionals, patients, and other stakeholders may have to rely on indirect evidence related to other forms of chronic pruritus when deciding between the main interventions currently used for this condition.
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Affiliation(s)
- Andrea Andrade
- Hospital Italiano de Buenos AiresDepartment of DermatologyTte. Peron 4230Buenos AiresArgentina1199
- Instituto Universitario Hospital ItalianoArgentine Cochrane CentrePotosi 4234Buenos AiresBuenos AiresArgentinaC1199ACL
| | - Chii Yang Kuah
- King's College Hospital NHS Foundation TrustDenmark HillLondonUKSE5 9RS
| | - Juliana Esther Martin‐Lopez
- Andalusian Public Foundation for Progress and HealthDepartment of Research for Health Technology Assessment ServiceSevilleSpain
| | - Shunjie Chua
- urong East St21 Blk288A #03‐358SingaporeSingapore601288
| | - Volha Shpadaruk
- University Hospitals of LeicesterDepartment of DermatologyLeicester Royal InfirmaryOPD3 Balmoral BuildingLeicesterUKLE1 5WW
| | - Gloria Sanclemente
- Universidad de AntioquiaGrupo de Investigación Dermatológica (GRID)Carrera 25 A #1 A Sur 45, Of 2026Torre Medica El TesoroMedellínColombia
| | - Juan VA Franco
- Instituto Universitario Hospital ItalianoArgentine Cochrane CentrePotosi 4234Buenos AiresBuenos AiresArgentinaC1199ACL
- Hospital Italiano de Buenos AiresFamily and Community Medicine ServiceTte. Gral. Juan Domingo Perón 4190Buenos AiresBuenos AiresArgentinaC1199ABB
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Pereira MP, Derichs L, Meyer Zu Hörste G, Agelopoulos K, Ständer S. Generalized chronic itch induced by small-fibre neuropathy: clinical profile and proposed diagnostic criteria. J Eur Acad Dermatol Venereol 2020; 34:1795-1802. [PMID: 31838774 DOI: 10.1111/jdv.16151] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 11/26/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Small-fibre neuropathy (SFN) is a known cause for pain, however, it may be also associated with chronic itch. The clinical profile of chronic itch due to SFN is poorly defined and accordingly under-diagnosed in clinical care. OBJECTIVES To establish the clinical profile of patients with SFN and to propose diagnostic criteria for this patient population. METHODS Clinical data from patients diagnosed with SFN [chronic generalized itch and reduced intraepidermal nerve fibre density (IENFD)] were analysed retrospectively. RESULTS A total of 142 patients (60 females, median age: 62.5 years) were included. Patients reported daily, moderate to severe itch intensity scores occurring mostly in attacks (62.5%). Only 11 patients experienced exclusively itch, while the remaining patients (92%) reported pruralgia (itch along with painful sensations). Burning (50%), a sensation like needle pricks (46%) and tingling (45%) were the sensory symptoms reported by most patients. Cold or ice application led to an alleviation of the symptoms. The IENFD did not correlate with itch intensity; however, patients with a severely reduced IENFD (<30% of the normative cut-off value) reported more frequently sharp, spiky and drilling sensations compared to the remaining patients. The quality of life was moderately impaired and correlated with itch intensity, whereas anxiety and depression scores were low. CONCLUSIONS Onset of pruralgia on normal appearing skin, occurrence in attacks and symptomatic alleviation with cold/ice application should alert physicians for a possible neuropathic SFN-related origin of itch. A reduced IENFD can confirm the diagnosis of SFN.
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Affiliation(s)
- M P Pereira
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - L Derichs
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - G Meyer Zu Hörste
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - K Agelopoulos
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - S Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
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153
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Zhang Y, Tan Y, Zou Y, Bulat V, Lugovic Mihic L, Kovacevic M, Lotti T, Verner I, Stanimirovic A, Situm M, Goldust M, Liu W, Vojvodic A, Goren A. Yeast extract demonstrates rapid itch relief in chronic pruritus. J Cosmet Dermatol 2020; 19:2131-2134. [PMID: 31922345 DOI: 10.1111/jocd.13265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 12/04/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Yiyi Zhang
- Department of Skin & Cosmetic Research Shanghai Skin Disease Hospital Shanghai China
| | - Yimei Tan
- Department of Skin & Cosmetic Research Shanghai Skin Disease Hospital Shanghai China
- Human Phenome Institute Fudan University Shanghai China
| | - Ying Zou
- Department of Skin & Cosmetic Research Shanghai Skin Disease Hospital Shanghai China
| | - Vedrana Bulat
- Department of Dermatovenereology Sestre Milosrdnice University Hospital Centre Zagreb Croatia
| | - Liborijia Lugovic Mihic
- Department of Dermatovenereology Sestre Milosrdnice University Hospital Centre Zagreb Croatia
| | - Maja Kovacevic
- Department of Dermatovenereology Sestre Milosrdnice University Hospital Centre Zagreb Croatia
| | - Torello Lotti
- Centro Studi per la Ricerca Multidisciplinare e Rigenerativa Universita Degli Studi "G. Marconi" Rome Italy
| | - Ines Verner
- Verner Clinic for Dermatology and Aesthetics Tel Aviv Israel
| | - Andrija Stanimirovic
- Department of Clinical Medicine University of Applied Health Sciences Zagreb Croatia
- School of Medicine European University Cyprus Nicosia Cyprus
| | - Mirna Situm
- Department of Dermatovenereology Sestre Milosrdnice University Hospital Centre Zagreb Croatia
| | - Mohamad Goldust
- Department of Dermatology University of Rome Guglielmo Marconi Rome Italy
- University Medical Center Mainz Mainz Germany
| | - Wei Liu
- Department of Skin & Cosmetic Research Shanghai Skin Disease Hospital Shanghai China
- Department of Dermatology Air Force General Hospital Beijing China
| | - Aleksandra Vojvodic
- Department of Dermatology and Venereology Military Medical Academy of Belgrade Belgrade Serbia
| | - Andy Goren
- Department of Dermatology Hairmore Hospital Beijing Beijing China
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Saeki H, Baba N, Oshiden K, Abe Y, Tsubouchi H. Phase 2, randomized, double-blind, placebo-controlled, 4-week study to evaluate the safety and efficacy of OPA- 15406 (difamilast), a new topical selective phosphodiesterase type-4 inhibitor, in Japanese pediatric patients aged 2-14 years with atopic dermatitis. J Dermatol 2020; 47:17-24. [PMID: 31713267 PMCID: PMC6972691 DOI: 10.1111/1346-8138.15137] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 10/09/2019] [Indexed: 11/29/2022]
Abstract
The safety and efficacy of OPA-15406 (international non-proprietary name, difamilast; also referred to as MM36), a new topical, selective phosphodiesterase type-4 inhibitor, in Japanese pediatric patients with atopic dermatitis aged 2-14 years were evaluated in a phase 2, randomized, double-blind, vehicle-controlled, 4-week study. Seventy-three patients were randomized 1:1:1 to receive OPA-15406 0.3%, OPA-15406 1% or vehicle ointment twice daily for 4 weeks. The mean age of patients was similar across treatment groups. No deaths or serious treatment-emergent adverse events were reported; all treatment-emergent adverse events were mild or moderate in severity. The incidence of treatment-emergent adverse events leading to treatment discontinuation was 4.2% (1/24) in the OPA-15406 0.3% group, 4.0% (1/25) in the OPA-15406 1% group and 16.7% (4/24) in the vehicle group, all of which were worsening of atopic dermatitis. Both OPA-15406 groups demonstrated a higher incidence of success in the Investigator Global Assessment score compared with the vehicle group over the 4-week study. The OPA-15406 groups also showed greater improvements from baseline compared with the vehicle group in the Investigator Global Assessment score, Eczema Area and Severity Index overall score and subscale (erythema, induration/papulation, excoriation and lichenification) scores, Visual Analog Scale pruritus score, Patient-Oriented Eczema Measure score, and percentage of affected body surface area over the 4-week study. Topical OPA-15406 twice daily for 4 weeks was considered a safe and effective treatment option in this phase 2 study in pediatric patients with atopic dermatitis, and phase 3 development is currently ongoing.
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Affiliation(s)
- Hidehisa Saeki
- Department of DermatologyNippon Medical SchoolTokyoJapan
| | - Naoko Baba
- Kanagawa Children’s Medical CenterKanagawaJapan
| | - Kazuhide Oshiden
- Headquarters of Clinical DevelopmentOtsuka Pharmaceutical Co., Ltd.OsakaJapan
| | - Yuji Abe
- Headquarters of Clinical DevelopmentOtsuka Pharmaceutical Co., Ltd.TokyoJapan
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155
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Antipruritic Effects of Kappa Opioid Receptor Agonists: Evidence from Rodents to Humans. Handb Exp Pharmacol 2020; 271:275-292. [PMID: 33296031 DOI: 10.1007/164_2020_420] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Centrally administered bombesin induces scratching and grooming in rats. These behaviors were blocked by early benzomorphan kappa opioid receptor (KOR) agonists as reported by Gmerek and Cowan in 1984. This was the first evidence that KORs may be involved in the sensation of itch-like behaviors. Subsequent development of additional animal models for acute and chronic itch has led to important discoveries since then. For example, it was found that (a) gastrin-releasing peptide (GRP), natriuretic polypeptide b and their cognate receptors are keys for the transmission of itch sensation at the spinal cord level, (b) dynorphins (Dyns), the endogenous KOR agonists, work as inhibitory neuromodulators of itch at the spinal cord level, (c) in a mouse model for acute itch, certain KOR antagonists elicit scratching, (d) in mouse models of acute or chronic itch, KOR agonists (e.g., U50,488, nalfurafine, CR 845, nalbuphine) suppress scratching induced by different pruritogens, and (e) nalfurafine, CR 845, and nalbuphine are in the clinic or in clinical trials for pruritus associated with chronic kidney disease and chronic liver disease, as well as pruritus in chronic skin diseases.
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156
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Mittal A, Meena M, Vyas K, Balai M, Khare A, Gupta L. Efficacy and safety of a sustained-release preparation of pregabalin in chronic pruritus. INDIAN JOURNAL OF DRUGS IN DERMATOLOGY 2020. [DOI: 10.4103/ijdd.ijdd_14_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Molkara S, Sabourirad S, Molooghi K. Infectious differential diagnosis of chronic generalized pruritus without primary cutaneous lesions: a review of the literature. Int J Dermatol 2020; 59:30-36. [PMID: 31364165 DOI: 10.1111/ijd.14587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 06/03/2019] [Accepted: 06/19/2019] [Indexed: 01/24/2023]
Abstract
Pruritus is one of the most common complaints among patients referred to a dermatology clinic. "Chronic generalized pruritus" is described as the sensation of itching on the entire body surface, which lasts at least 6 or more weeks. This symptom can be a disabling phenomenon for patients and may sometimes interfere with daily activities such as sleep. If specific dermatological findings are observed, the physician easily comes to a diagnosis and treats the condition, whereas, when primary lesions are not detected, the diagnosis can become challenging, and some patients have to undergo extensive evaluations. The association between some systemic disorders and chronic generalized pruritus is widely known and confirmed. Many infections have been associated with pruritus, but few are considered to cause chronic generalized pruritus without any characteristic skin lesions. We aimed to gather all the available data on infectious causes of chronic generalized pruritus with no diagnostic cutaneous lesions to assist fellow physicians in the process of evaluation of these challenging cases.
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Affiliation(s)
- Sara Molkara
- Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sara Sabourirad
- Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Kasra Molooghi
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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158
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Zhu T, Zhou D, Zhang Z, Long L, Liu Y, Fan Q, Chen F, Zhang X, Wu Y, Zeng H, Verkhratsky A, Zhao J, Nie H. Analgesic and antipruritic effects of oxymatrine sustained-release microgel cream in a mouse model of inflammatory itch and pain. Eur J Pharm Sci 2020; 141:105110. [DOI: 10.1016/j.ejps.2019.105110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 10/07/2019] [Accepted: 10/14/2019] [Indexed: 12/16/2022]
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159
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Synaptic control of spinal GRPR + neurons by local and long-range inhibitory inputs. Proc Natl Acad Sci U S A 2019; 116:27011-27017. [PMID: 31806757 DOI: 10.1073/pnas.1905658116] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Spinal gastrin-releasing peptide receptor-expressing (GRPR+) neurons play an essential role in itch signal processing. However, the circuit mechanisms underlying the modulation of spinal GRPR+ neurons by direct local and long-range inhibitory inputs remain elusive. Using viral tracing and electrophysiological approaches, we dissected the neural circuits underlying the inhibitory control of spinal GRPR+ neurons. We found that spinal galanin+ GABAergic neurons form inhibitory synapses with GRPR+ neurons in the spinal cord and play an important role in gating the GRPR+ neuron-dependent itch signaling pathway. Spinal GRPR+ neurons also receive inhibitory inputs from local neurons expressing neuronal nitric oxide synthase (nNOS). Moreover, spinal GRPR+ neurons are gated by strong inhibitory inputs from the rostral ventromedial medulla. Thus, both local and long-range inhibitory inputs could play important roles in gating itch processing in the spinal cord by directly modulating the activity of spinal GRPR+ neurons.
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160
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Sensitization Mechanisms of Chronic Itch. INTERNATIONAL JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2019. [DOI: 10.1097/jd9.0000000000000045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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161
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Rossi GM, Corradini M, Blanco V, Mattei S, Fiaccadori E, Vaglio A, Manenti L. Randomized trial of two after-dialysis gabapentin regimens for severe uremic pruritus in hemodialysis patients. Intern Emerg Med 2019; 14:1341-1346. [PMID: 31494816 DOI: 10.1007/s11739-019-02175-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 08/11/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Giovanni Maria Rossi
- U.O. Nefrologia, Dipartimento di Medicina Generale e Specialistica, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci, 14, Parma, 43126, Italy
| | - Mattia Corradini
- Nephrology and Dialysis Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Valentina Blanco
- Renal Unit, Nephrology and Dialysis Department, Sant'Andrea Hospital, La Spezia, Italy
| | - Silvia Mattei
- Nephrology and Dialysis Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Enrico Fiaccadori
- U.O. Nefrologia, Dipartimento di Medicina Generale e Specialistica, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci, 14, Parma, 43126, Italy
| | - Augusto Vaglio
- Department of Biomedical Clinical and Experimental Sciences "Mario Serio", University of Firenze, Florence, Italy
- Meyer Children's Hospital, Florence, Italy
| | - Lucio Manenti
- U.O. Nefrologia, Dipartimento di Medicina Generale e Specialistica, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci, 14, Parma, 43126, Italy.
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163
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Anzelc M, Burkhart CG. Pain and Pruritus: a study of their similarities and differences. Int J Dermatol 2019; 59:159-164. [PMID: 31605395 DOI: 10.1111/ijd.14678] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 11/29/2022]
Abstract
Pruritus is one of the most common dermatologic complaints and, as the most common dermatologic symptom, is a major contributor to frequent dermatology visits. Chronic pruritus mirrors another major medical condition faced by millions of Americans each year - chronic pain. In older literature, pain and pruritus were thought to have been conveyed by the same C fiber, and the proportion contributing to pruritus was just a small subset of this general fiber. Overall, pain and pruritus share many integral similarities. Although these sensations both initiate the body's awareness to injury, pain and itch may have evolved for sensing different damages such as a burrowing parasite or a noxious stimulus, respectively. This seems to have been validated through analyses of their pathophysiology, acute and chronic conditions, and treatment modalities. However, their symptoms and intrinsic mechanisms vary considerably. It is important to view pruritus in more of an overall, whole body experience, rather than just the sensory aspect. Future studies should investigate the psychological treatment of chronic pruritus, considering the immense similarities with its chronic pain counterpart.
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Affiliation(s)
- Madison Anzelc
- Department of Medicine, Division of Dermatology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Craig G Burkhart
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.,Department of Medicine, Ohio University of Osteopathic Medicine, Athens, OH, USA
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164
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Diagnostic Workup and Evaluation of Patients with Prurigo Nodularis. MEDICINES 2019; 6:medicines6040097. [PMID: 31561504 PMCID: PMC6963711 DOI: 10.3390/medicines6040097] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/18/2019] [Accepted: 09/23/2019] [Indexed: 12/29/2022]
Abstract
Prurigo nodularis (PN) is a chronic inflammatory skin disease characterized oftentimes by symmetrically distributed, severely pruritic nodules. Currently, the pathophysiology of PN remains to be fully elucidated, but emerging evidence suggests that neuroimmune alterations play principal roles in the pathogenesis of PN. There are several associated etiologic factors thought to be associated with PN, including dermatoses, systemic, infectious, psychiatric, and neurologic conditions. We conducted a systematic literature review to evaluate the clinical presentation, diagnosis, and etiologic factors of PN. In this review, we discuss common differential diagnoses of PN and recommend an evidence-based, standardized diagnostic evaluation for those with suspected PN.
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165
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Siiskonen H, Harvima I. Mast Cells and Sensory Nerves Contribute to Neurogenic Inflammation and Pruritus in Chronic Skin Inflammation. Front Cell Neurosci 2019; 13:422. [PMID: 31619965 PMCID: PMC6759746 DOI: 10.3389/fncel.2019.00422] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 09/03/2019] [Indexed: 12/12/2022] Open
Abstract
The intimate interaction between mast cells and sensory nerves can be illustrated by the wheal and surrounding flare in an urticarial reaction in human skin. This reaction is typically associated with an intense itch at the reaction site. Upon activation, cutaneous mast cells release powerful mediators, such as histamine, tryptase, cytokines, and growth factors that can directly stimulate corresponding receptors on itch-mediating sensory nerves. These include, e.g., H1- and H4-receptors, protease-activated receptor-2, IL-31 receptor, and the high-affinity receptor of nerve growth factor (TrkA). On the other hand, sensory nerves can release neuropeptides, including substance P and vasoactive intestinal peptide, that are able to stimulate mast cells to release mediators leading to potentiation of the reciprocal interaction, inflammation, and itch. Even though mast cells are well recognized for their role in allergic skin whealing and urticaria, increasing evidence supports the reciprocal function between mast cells and sensory nerves in neurogenic inflammation in chronic skin diseases, such as psoriasis and atopic dermatitis, which are often characterized by distressing itch, and exacerbated by psychological stress. Increased morphological contacts between mast cells and sensory nerves in the lesional skin in psoriasis and atopic dermatitis as well as experimental models in mice and rats support the essential role for mast cell-sensory nerve communication in consequent pruritus. Therefore, we summarize here the present literature pointing to a close association between mast cells and sensory nerves in pruritic skin diseases as well as review the essential supporting findings on pruritic models in mice and rats.
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Affiliation(s)
- Hanna Siiskonen
- Department of Dermatology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Ilkka Harvima
- Department of Dermatology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
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166
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Luk KM, Shaw FM, Zhang C, Culler SD, Chen SC. The Annual Direct and Indirect Health Care Costs for Patients with Chronic Pruritus and their Determining Factors. J Invest Dermatol 2019; 140:699-701.e5. [PMID: 31465742 DOI: 10.1016/j.jid.2019.07.711] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 07/12/2019] [Accepted: 07/16/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Kevin M Luk
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Fiona M Shaw
- Department of Internal Medicine, Division of Dermatology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Chao Zhang
- Department of Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Atlanta, Georgia, USA
| | - Steven D Culler
- Department of Health Policy and Management, Rollins School of Public Health, Atlanta, Georgia, USA
| | - Suephy C Chen
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia, USA; Regional Telehealth Services, VISN 7, Atlanta, Georgia, USA.
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167
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Itch sensitization? A systematic review of studies using quantitative sensory testing in patients with chronic itch. Pain 2019; 160:2661-2678. [DOI: 10.1097/j.pain.0000000000001678] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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168
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Schneider G, Grebe A, Bruland P, Heuft G, Ständer S. Chronic pruritus patients with psychiatric and psychosomatic comorbidity are highly burdened: a longitudinal study. J Eur Acad Dermatol Venereol 2019; 33:e288-e291. [DOI: 10.1111/jdv.15559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- G. Schneider
- Department of Psychosomatics and PsychotherapyUniversity Hospital Münster, Domagkstr 22, 48149 Muenster Germany
- Center for Chronic PruritusUniversity Hospital Münster, von Esmarch‐Strasse 56, 48149 Muenster Germany
| | - A. Grebe
- Department of Psychosomatics and PsychotherapyUniversity Hospital Münster, Domagkstr 22, 48149 Muenster Germany
| | - P. Bruland
- Institute of Medical InformaticsUniversity Hospital Münster, Albert‐Schweitzer‐Campus 1 / A11, 48149 Muenster Germany
| | - G. Heuft
- Department of Psychosomatics and PsychotherapyUniversity Hospital Münster, Domagkstr 22, 48149 Muenster Germany
- Center for Chronic PruritusUniversity Hospital Münster, von Esmarch‐Strasse 56, 48149 Muenster Germany
| | - S. Ständer
- Center for Chronic PruritusUniversity Hospital Münster, von Esmarch‐Strasse 56, 48149 Muenster Germany
- Department of DermatologyUniversity Hospital Münster, von Esmarch‐Strasse 56, 48149 Muenster Germany
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169
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Ishikawa T, Hashimoto T, Munetsugu T, Yokozeki H, Satoh T. Increased β‐endorphin and autotaxin in patients with prurigo. JOURNAL OF CUTANEOUS IMMUNOLOGY AND ALLERGY 2019. [DOI: 10.1002/cia2.12062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Takahiro Ishikawa
- Department of Dermatology National Defense Medical College Tokorozawa Japan
- Department of Dermatology, Graduate School Tokyo Medical and Dental University Tokyo Japan
| | - Takashi Hashimoto
- Department of Dermatology, Graduate School Tokyo Medical and Dental University Tokyo Japan
| | - Takichi Munetsugu
- Department of Dermatology National Defense Medical College Tokorozawa Japan
| | - Hiroo Yokozeki
- Department of Dermatology, Graduate School Tokyo Medical and Dental University Tokyo Japan
| | - Takahiro Satoh
- Department of Dermatology National Defense Medical College Tokorozawa Japan
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170
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The Complexity of Pruritus Requires a Variety of Treatment Strategies. CURRENT TREATMENT OPTIONS IN ALLERGY 2019. [DOI: 10.1007/s40521-019-00217-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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171
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Dong X, Dong X. Peripheral and Central Mechanisms of Itch. Neuron 2019; 98:482-494. [PMID: 29723501 DOI: 10.1016/j.neuron.2018.03.023] [Citation(s) in RCA: 222] [Impact Index Per Article: 44.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/12/2018] [Accepted: 03/15/2018] [Indexed: 12/15/2022]
Abstract
Itch is a unique sensory experience that is encoded by genetically distinguishable neurons both in the peripheral nervous system (PNS) and central nervous system (CNS) to elicit a characteristic behavioral response (scratching). Itch interacts with the other sensory modalities at multiple locations, from its initiation in a particular dermatome to its transmission to the brain where it is finally perceived. In this review, we summarize the current understanding of the molecular and neural mechanisms of itch by starting in the periphery, where itch is initiated, and discussing the circuits involved in itch processing in the CNS.
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Affiliation(s)
- Xintong Dong
- The Solomon H. Snyder Department of Neuroscience and the Center for Sensory Biology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; Howard Hughes Medical Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
| | - Xinzhong Dong
- The Solomon H. Snyder Department of Neuroscience and the Center for Sensory Biology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; Howard Hughes Medical Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
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172
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Tizek L, Schielein M, Rüth M, Ständer S, Pereira MP, Eberlein B, Biedermann T, Zink A. Influence of Climate on Google Internet Searches for Pruritus Across 16 German Cities: Retrospective Analysis. J Med Internet Res 2019; 21:e13739. [PMID: 31301128 PMCID: PMC6659391 DOI: 10.2196/13739] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/24/2019] [Accepted: 06/04/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The burden of pruritus is high, especially among patients with dermatologic diseases. Identifying trends in pruritus burden and people's medical needs is challenging, since not all affected people consult a physician. OBJECTIVE The purpose of this study was to investigate pruritus search behavior trends in Germany and identify associations with weather factors. METHODS Google AdWords Keyword Planner was used to quantify pruritus-related search queries in 16 German cities from August 2014 to July 2018. All identified keywords were qualitatively categorized and pruritus-related terms were descriptively analyzed. The number of search queries per 100,000 inhabitants of each city was compared to environmental factors such as temperature, humidity, particulate matter 10 micrometers or less in diameter (PM10), and sunshine duration to investigate potential correlations. RESULTS We included 1150 pruritus-related keywords, which resulted in 2,851,290 queries. "Pruritus" (n=115,680) and "anal pruritus" (n=102,390) were the most-searched-for keywords. Nearly half of all queries were related to the category localization, with Berlin and Munich having a comparatively high proportion of people that searched for pruritus in the genital and anal areas. People searched more frequently for information on chronic compared to acute pruritus. The most populated cities had the lowest number of queries per 100,000 inhabitants (Berlin, n=13,641; Hamburg, n=18,303; and Munich, n=21,363), while smaller cities (Kiel, n=35,027; and Freiburg, n=39,501) had the highest. Temperature had a greater effect on search query number (beta -7.94, 95% CI -10.74 to -5.15) than did PM10 (beta -5.13, 95% CI -7.04 to -3.22), humidity (beta 4.73, 95% CI 2.70 to 6.75), or sunshine duration (beta 0.66, 95% CI 0.36 to 0.97). The highest relative number of search queries occurred during the winter (ie, December to February). CONCLUSIONS By taking into account the study results, Google data analysis helps to examine people's search frequency, behavior, and interest across cities and regions. The results indicated a general increase in search queries during the winter as well as differences across cities located in the same region; for example, there was a decline in search volume in Saarbrucken, while there were increases in Cologne, Frankfurt, and Dortmund. In addition, the detected correlation between search volume and weather data seems to be valuable in predicting an increase in pruritus burden, since a significant association with rising humidity and sunshine duration, as well as declining temperature and PM10, was found. Accordingly, this is an unconventional and inexpensive method to identify search behavior trends and respective inhabitants' needs.
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Affiliation(s)
- Linda Tizek
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany.,The Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig Maximilian University Munich, Munich, Germany
| | - Maximilian Schielein
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany.,The Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig Maximilian University Munich, Munich, Germany
| | - Melvin Rüth
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Sonja Ständer
- Center for Chronic Pruritus, Department of Dermatology, University Hospital Münster, Muenster, Germany
| | - Manuel Pedro Pereira
- Center for Chronic Pruritus, Department of Dermatology, University Hospital Münster, Muenster, Germany
| | - Bernadette Eberlein
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Tilo Biedermann
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alexander Zink
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany
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173
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Schmid Y, Navarini A, Thomas ZRM, Pfleiderer B, Krähenbühl S, Mueller SM. Sex differences in the pharmacology of itch therapies-a narrative review. Curr Opin Pharmacol 2019; 46:122-142. [PMID: 31299512 DOI: 10.1016/j.coph.2019.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 05/17/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Chronic itch is the most common skin-related condition, associated with a high psychosocial and economic burden. In recent years, increasing evidence of sex differences in the perception, clinical presentation and treatment requirements of itch points towards potential benefits when using sex-adapted therapies. It is well-known that body composition, absorption, metabolism, elimination and adverse drug reactions (ADRs) differ between sexes, but only little is known about the impact of sex in the pharmacology of itch treatments, which could help to rationalise sex-adapted treatment strategies. AIM To evaluate and review sex effects in the pharmacokinetics and /-dynamics of drugs used to treat itch. METHODS In this narrative review we performed a PubMed and MEDLINE (Ovid) search using the terms (itch OR pruritus) AND (gender OR sex) AND (drug OR medication OR pharmacokinetics OR pharmacodynamics). Additional searches were performed for the topical and systemic drugs recommended by the European Guideline on Chronic Pruritus. RESULTS We found numerous reports with variable levels of evidence of sex effects with respect to the pharmacokinetics and/or pharmacodynamics of 14 drug classes used for the treatment of itch, including a total of 19 systemic and 3 topical drugs. Women seem to present higher plasma levels of several drugs used in itch treatment, including tri- and tetracyclic antidepressants (e.g. doxepin, amitriptyline, mirtazapine), serotonin reuptake inhibitors (e.g. paroxetine, sertraline, fluoxetine), immunosuppressive drugs (e.g. cyclosporine, mycophenolate mofetil), serotonin receptor antagonists (e.g. ondansetron) and betablockers (e.g. propranolol). Adverse drug reactions (ADRs) were generally more common in women. Being female was reported to be an independent risk factor for QTc-prolongation associated with antihistamines and tetracyclic antidepressants. Additionally, women seem to be more prone to sedative effects of antihistamines, and to suffer from a higher frequency as well as severity of side effects with systemic calcineurin inhibitors, opioid agonists, and opioid antagonists. Women were also sensitised more often to topically applied drugs. Of note, apart from only one experimental study with capsaicin, none of these reports were designed specifically to assess the effect of sex (and gender) in the treatment of itch. DISCUSSION/CONCLUSION Our review supports previous reports that sex is of importance in the pharmacokinetics and /-dynamics of several drugs used to treat itch although those drugs were mostly evaluated for non-itch indications. However, the results are limited by methodological limitations evident in most studies such as underrepresentation of women in clinical trials. This emphasises the need to study the impact of sex (and gender) in future itch trials to yield better outcomes and prevent ADRs in both sexes.
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Affiliation(s)
- Yasmin Schmid
- Clinical Pharmacology & Toxicology, University Hospital Basel, Switzerland
| | | | | | - Bettina Pfleiderer
- Department of Clinical Radiology, University Hospital Münster and Medical Faculty, University of Münster, Germany; Competence Center Chronic Pruritus (KCP), University of Muenster, Germany
| | - Stephan Krähenbühl
- Clinical Pharmacology & Toxicology, University Hospital Basel, Switzerland
| | - Simon M Mueller
- Department of Dermatology, University Hospital Basel, Switzerland.
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174
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Serotoninergic projection from dorsal raphe nucleus to insular cortex is involved in acute itch sensation processing in mice. Brain Res 2019; 1715:224-234. [DOI: 10.1016/j.brainres.2019.03.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/09/2019] [Accepted: 03/27/2019] [Indexed: 11/20/2022]
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175
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A systematic review of questionnaires on itch by the Special Interest Group “Questionnaires” of the International Forum for the Study of Itch (IFSI). ACTA ACUST UNITED AC 2019. [DOI: 10.1097/itx.0000000000000026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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176
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Zhai LL, Savage KT, Qiu CC, Jin A, Valdes-Rodriguez R, Mollanazar NK. Chronic Pruritus Responding to Dupilumab-A Case Series. MEDICINES 2019; 6:medicines6030072. [PMID: 31261951 PMCID: PMC6789555 DOI: 10.3390/medicines6030072] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 06/15/2019] [Accepted: 06/26/2019] [Indexed: 11/21/2022]
Abstract
Background: Chronic pruritus is defined as itch lasting for greater than six weeks. Pruritus is a burdensome manifestation of several internal and external disease states with a significant impact on quality of life. Dupilumab has shown promise in treating a number of conditions including atopic dermatitis (AD) and asthma. Its success in reducing pruritus in AD has generated interest regarding its potential application in other pruritic conditions, such as chronic pruritus of unknown origin, uremic pruritus, and pruigo nodularis. Methods: In this retrospective analysis, we present a series of 20 recalcitrant pruritus patients seen at a tertiary center treated with off-label dupilumab at standard AD dosing. Results: Dupilumab was successful at reducing itch in all treated patients, leading to complete resolution in 12/20 patients and an overall mean NRSi reduction of 7.55. Dupilumab was well tolerated with no significant adverse effects. Conclusions: Our case series suggests dupilumab may be a safe and efficacious therapeutic option in several pruritic conditions and demonstrates the need for further studies to better ascertain its place in the pruritus treatment armamentarium.
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Affiliation(s)
- Lisa L Zhai
- Department of Dermatology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Kevin T Savage
- Drexel University College of Medicine, Philadelphia, PA 19129, USA
| | - Connie C Qiu
- Department of Dermatology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA.
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA.
| | - Annie Jin
- Department of Dermatology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | | | - Nicholas K Mollanazar
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19140, USA
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Abstract
Aim: To explore the pattern of occurrence and characteristics of senile pruritus among elderly living in nursing homes in the Northern region of Denmark. Materials & methods: A Danish questionnaire was developed and distributed to six nursing homes from which 46 residents participated. Results: The prevalence of chronic itch was 28.9%. Evening–night and autumn–winter with an average daily itch of 30 min were reported. Itch interfered with night sleep and daily activities. Scratching was common with 61.5% accompanying scratch marks. Half of participants reported Xerosis. Cream, cold compress and cold shower were found to be the most effective remedies for itch relief. Conclusion: The present study revealed a high prevalence of chronic pruritus including cases of senile pruritus that needs further exploration for treatment or preventive strategies. Senile pruritus is chronic itch of unknown origin among the elderly. The occurrence and characteristics among Danish nursing home residents was not known. We developed a Danish questionnaire and distributed it to 6 nursing homes, where 46 residents participated. We found a high prevalence of chronic itch (28.9%). Disturbing itch was reported in evening–night and autumn–winter. Itch interfered with night sleep and daily activities. Scratching was common with scratch marks. Showering precipitated itch, while cold shower was a reliever. Further studies are required to enhance the knowledge about senile pruritus and prevention or treatment strategies for elderly living in nursing homes.
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178
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Saeki H, Kawashima M, Sugaya S, Oshiden K, Tsubouchi H. Efficacy and safety of topical OPA-15406, a new phosphodiesterase 4 inhibitor, in Japanese patients with atopic dermatitis for 8 weeks: A phase 2, randomized, double-blind, placebo-controlled study. J Dermatol 2019; 46:672-679. [PMID: 34263481 PMCID: PMC6771806 DOI: 10.1111/1346-8138.14979] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 05/21/2019] [Indexed: 12/12/2022]
Abstract
The efficacy and safety of topical OPA-15406, a new phosphodiesterase 4 inhibitor, were examined in Japanese patients aged 15-70 years with atopic dermatitis in a phase 2, randomized, double-blind, vehicle-controlled study. Two hundred patients were randomized to three treatment groups at a 1:1:1 ratio to receive OPA-15406 0.3%, OPA-15406 1% or vehicle ointment twice daily for 8 weeks. The OPA-15406 1% group was superior to the vehicle group in terms of the incidence of success based on the Investigator Global Assessment score at week 4 (P = 0.0328), which was the primary end-point, while the OPA-15406 0.3% group showed a trend toward improvement in the primary end-point. The mean Eczema Area and Severity Index total score and subscale (erythema, induration/papulation, excoriation and lichenification) scores, the Visual Analog Scale pruritus score and the Patient-Oriented Eczema Measure score were significantly improved and the percentage of affected body surface area was significantly decreased in both OPA-15406 groups relative to the vehicle group as early as week 1, and the improved scores and decreased percentages were generally maintained until week 8. No deaths or serious treatment-emergent adverse events occurred in the OPA-15406 treatment groups. Treatment-emergent adverse events frequently observed across treatment groups were worsening of atopic dermatitis, viral upper respiratory tract infection and pruritus, all of which were mild or moderate in severity in the OPA-15406 groups. OPA-15406 1% ointment showed favorable efficacy and safety profiles, indicating a promising treatment option for patients with atopic dermatitis.
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Affiliation(s)
- Hidehisa Saeki
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | - Makoto Kawashima
- Department of Dermatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Satoko Sugaya
- Headquarters of Clinical Development, Otsuka Pharmaceutical Co., Ltd, Tokyo, Japan
| | - Kazuhide Oshiden
- Headquarters of Clinical Development, Otsuka Pharmaceutical Co., Ltd, Osaka, Japan
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179
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Ständer S. How to define chronic pruritus: Symptom or disease? Exp Dermatol 2019; 28:1461-1465. [DOI: 10.1111/exd.13953] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 03/26/2019] [Accepted: 04/29/2019] [Indexed: 01/18/2023]
Affiliation(s)
- Sonja Ständer
- Department of Dermatology Center for Chronic Pruritus University Hospital Münster Münster Germany
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180
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Fawaz B, Chamseddin BH, Griffin JR. Defining the role of mirtazapine in the treatment of refractory pruritus. J DERMATOL TREAT 2019; 32:132-136. [PMID: 31180795 DOI: 10.1080/09546634.2019.1630702] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND/OBJECTIVE Mirtazapine has traditionally been used for the treatment of major depressive disorder, with an added benefit in patients who have comorbid insomnia or anxiety. Recent studies describe its usefulness in treating refractory pruritus of various causes as well. Our goal is to better define the use of mirtazapine in the treatment of refractory pruritus. METHOD Through a thorough literature review of PubMed, we identified all reports of the use of mirtazapine for pruritus. RESULTS Upon examination of 8 supporting articles, we found mirtazapine has quality evidence for the treatment of intra-thecal morphine-induced pruritus. Mirtazapine may also be effective in treating pruritus related to various other conditions, including psoriasis, atopic dermatitis, cutaneous malignancies (primary or metastatic), hematologic malignancies (lymphomas and leukemias), liver failure, renal failure, cholestasis, as well as pruritus of unknown origin. CONCLUSIONS Mirtazapine plays a role in treatment for intra-thecel morphine-induced pruritis yet high-quality trials are needed to confirm its efficacy in other dermatologic conditions.
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Affiliation(s)
- Bilal Fawaz
- Department of Dermatology, Baylor University Medical Center, Dallas, TX, USA
| | | | - John R Griffin
- Department of Dermatology, Baylor University Medical Center, Dallas, TX, USA
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181
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Ständer S, Yosipovitch G. Substance P and neurokinin 1 receptor are new targets for the treatment of chronic pruritus. Br J Dermatol 2019; 181:932-938. [PMID: 31016733 DOI: 10.1111/bjd.18025] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Chronic pruritus is a distressing symptom associated with various dermatological conditions and systemic diseases. Current treatment options are often inadequate, resulting in impaired quality of life for many patients. An understanding of the underlying mechanisms of itch across pruritic conditions is important for development of effective, targeted treatments for chronic pruritus. OBJECTIVES To provide an overview of the pathogenesis of chronic pruritus, focusing on the role of substance P (SP) and neurokinin 1 receptor (NK1 R) in itch signalling, and to describe data supporting NK1 R antagonism as a potential strategy for the treatment of chronic pruritus. METHODS A PubMed search was conducted to determine what data were available that investigated the role of SP and NK1 R in itch signalling. RESULTS SP is a neuropeptide that is a mediator of itch signalling. One of the target receptors for SP is NK1 R, which is expressed in the central nervous system and on multiple cell types involved in the initiation and transmission of itch. Studies demonstrating that SP and NK1 R are overexpressed across multiple chronic itch-inducing conditions and that NK1 R antagonism disrupts itch signalling and reduces itch provide a rationale for targeting this pathway as a potential treatment of chronic pruritus across multiple diseases. CONCLUSIONS A large and growing body of evidence, including recent phase II clinical studies of NK1 R antagonists, demonstrate that SP and NK1 R play an important role in itch signalling. Additional studies are ongoing to further evaluate the use of NK1 R antagonists for the treatment of chronic pruritus. What's already known about this topic? Chronic pruritus has a significant impact on quality of life. Current treatment options for chronic pruritus are inadequate. Substance P (SP) and neurokinin 1 receptor (NK1 R) have been shown to play a role in itch signalling, and may be a rational target for addressing chronic pruritus. NK1 R antagonists are being evaluated as potential treatment for chronic pruritus. What does this study add? This review provides a compilation of the most up-to-date data elucidating the role of SP and NK1 R in itch signalling, which supports targeting this pathway as a potential treatment of chronic pruritus. NK1 R antagonism disrupts itch signalling and reduces itch. A summary of the latest data on NK1 R antagonists in the treatment of pruritus is provided.
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Affiliation(s)
- S Ständer
- Center for Chronic Pruritus, Department of Dermatology, University Hospital Münster, Münster, Germany
| | - G Yosipovitch
- Miami Itch Center, Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL, U.S.A
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182
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Pereira MP, Ständer S. How to define chronic prurigo? Exp Dermatol 2019; 28:1455-1460. [DOI: 10.1111/exd.13972] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/10/2019] [Accepted: 05/14/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Manuel P. Pereira
- Department of Dermatology and Center for Chronic Pruritus University Hospital Münster Münster Germany
| | - Sonja Ständer
- Department of Dermatology and Center for Chronic Pruritus University Hospital Münster Münster Germany
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183
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Reszke R, Szepietowski JC. Can we use psychoactive drugs to treat pruritus? Exp Dermatol 2019; 28:1422-1431. [PMID: 31087719 DOI: 10.1111/exd.13959] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/09/2019] [Indexed: 12/21/2022]
Abstract
Pruritus is a frequent complaint both in dermatology and general medicine. This burdensome symptom has a complex and multifactorial pathogenesis, with the key involvement of central nervous system in its development. Psychoactive drugs (psychopharmaceuticals) encompass several therapeutic groups utilized mainly in psychiatry. However, these drugs are occasionally used in dermatological practice and may contribute to alleviation of pruritus in a variety of cutaneous and extracutaneous disorders. This review article summarizes the role of H1-antihistamines, antidepressants, antipsychotics and antiepileptics in managing pruritus.
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Affiliation(s)
- Radomir Reszke
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
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184
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Hegade VS, Mells GF, Fisher H, Kendrick S, DiBello J, Gilchrist K, Alexander GJ, Hirschfield GM, Sandford RN, Jones DEJ. Pruritus Is Common and Undertreated in Patients With Primary Biliary Cholangitis in the United Kingdom. Clin Gastroenterol Hepatol 2019; 17:1379-1387.e3. [PMID: 30557739 DOI: 10.1016/j.cgh.2018.12.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 11/13/2018] [Accepted: 12/06/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Little is known about the prevalence or treatment of pruritus associated with primary biliary cholangitis (PBC). We analyzed data from patients with PBC recruited from all clinical centers in the United Kingdom (UK) to characterize the prevalence, severity, progression, and treatment of pruritus. METHODS We performed cross-sectional and longitudinal studies of patients in the UK-PBC cohort to assess trajectories of pruritus. Data on pruritus frequency, severity, and therapy were collected via paper questionnaires completed by 2194 patients at their initial assessment in 2011 and then again in 2014 and 2017. Self-reported treatment data were validated against the prescription record of PBC cohort in the Clinical Practice Research Datalink, a primary care database. We defined persistent pruritus as itch that occurs frequently or all the time and severe pruritus as PBC-40 pruritus domain scores of 12 or more, throughout their disease course. Latent class mixed models were used to study pruritus trajectories and identify factors associated with high pruritus. RESULTS At initial assessment, 1613 (73.5%) patients had experienced pruritus at some point since their development of PBC-persistent pruritus was reported by 34.5% of the patients and severe pruritus by 11.7%. Only 37.4% of patients with persistent pruritus and 50% with severe pruritus reported ever receiving cholestyramine. Frequencies of rifampicin use were 11% in patients with persistent pruritus and 23% in patients with severe pruritus. Comparison of 2011 and 2014 surveys (comprising 1423 patients) showed consistent self-reported data on pruritus. Proportions of patients in the UK-PBC cohort treated with cholestyramine or naltrexone (37.4% and 4.4%) did not differ significantly from proportions treated in the Clinical Practice Research Datalink cohort (30.4% and 4.4%) (P = .07 for cholestyramine and P = .32 for naltrexone). Latent class mixed models (n = 1753) identified 3 different groups of pruritus. Multivariable analysis identified younger age at diagnosis and higher level of alkaline phosphatase at 12 months after diagnosis as factors significantly associated with persistent high pruritus. CONCLUSIONS In a large national cohort study of patients with PBC, we found a high prevalence of pruritus and inadequate guideline-recommended therapy. Patient-reported data used to determine pruritus prevalence and treatment are reliable. Younger age and levels of higher alkaline phosphatase were associated with persistent pruritus. We need to increase awareness and management of pruritus in PBC in the UK.
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Affiliation(s)
- Vinod S Hegade
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom; National Institute for Health Research Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, United Kingdom.
| | - George F Mells
- Department of Hepatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Academic Department of Medical Genetics, University of Cambridge, Cambridge, United Kingdom
| | - Holly Fisher
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Stuart Kendrick
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom; GlaxoSmithKline, Stevenage, United Kingdom
| | - Julia DiBello
- GlaxoSmithKline Research and Development, Collegeville, Pennsylvania
| | - Kim Gilchrist
- GlaxoSmithKline Research and Development, Collegeville, Pennsylvania
| | - Graeme J Alexander
- Department of Hepatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Academic Department of Medical Genetics, University of Cambridge, Cambridge, United Kingdom
| | - Gideon M Hirschfield
- Centre for Liver Research, National Institute for Health Research Biomedical Research Unit, University of Birmingham, Birmingham, United Kingdom
| | - Richard N Sandford
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, United Kingdom
| | - David E J Jones
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom; National Institute for Health Research Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, United Kingdom
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185
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Thomas J, Saple DG, Jerajani HR, Netha NRG, Rangasamy DU, Shaikh R, Babu RP, Powar I, Mhatre S, Vase S, Srisha MM, Mehta S, Mittal R, Acharya S, Charugulla SN. Real-World, Non-Interventional, Observational Study of Hydroxyzine Hydrochloride in Chronic Pruritus: a Prospective, Non-Comparative Study. Dermatol Ther (Heidelb) 2019; 9:299-308. [PMID: 30949959 PMCID: PMC6522615 DOI: 10.1007/s13555-019-0293-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Although hydroxyzine is widely used for symptom relief in pruritus, its clinical safety and efficacy data in the Indian setting are scarce. We conducted a study to assess the effectiveness and tolerability of hydroxyzine in the management of Indian patients with chronic pruritus in a real-world setting. METHODS This was a prospective, observational, patient-reported outcomes (PRO) study in patients with chronic pruritus due to dermatological causes treated with hydroxyzine as per the clinician's discretion for a period of up to 12 weeks. The primary outcome was improvement in quality of life from baseline, assessed using the 10-point Dermatology Quality of Life Index (DLQI) at week 12 of the study period. Secondary outcomes were improvement in the pruritus scores (5-D itch scale) at 12 weeks, improvements in the DLQI and 5-D itch scores at 2, 4 and 8 weeks and safety. RESULTS The study included 400 patients (179 males, 221 females) from 7 dermatology centres across India. Of the 400 patients recruited, 391 patients completed at least 2 weeks of treatment. There was significant (p < 0.0001) improvement from baseline in the DLQI scores and 5-D itch scores at 2, 4, 8 and 12 weeks; 189/391 (48.34%) patients had symptom relief leading to early termination. Overall, the treatment was well tolerated with a total of 11 mild-to-moderate adverse events reported during the study, which included dizziness, constipation, drowsiness, dry mouth and sedation. All events resolved without any intervention. There were no serious adverse events. CONCLUSION This real-world, observational, PRO study demonstrates that hydroxyzine significantly improves symptoms of pruritus and quality of life in patients with chronic pruritus due to dermatological causes over 12 weeks. Despite the sedating potential of the drug, hydroxyzine is well tolerated in real-world settings. TRIAL REGISTRATION CTRI/2017/06/008847. FUNDING Dr. Reddy's Laboratories.
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Affiliation(s)
| | | | - Hemangi R Jerajani
- Mahatma Gandhi Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | | | | | | | - Ravindra P Babu
- Raga's Skin Care, Skin and Cosmetology Clinic, Bangalore, Karnataka, India
| | | | - Sayalee Mhatre
- Mahatma Gandhi Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | - Santosh Vase
- Gandhi Medical College, Secunderabad, Telangana, India
| | | | - Suyog Mehta
- Medical Affairs, Dr. Reddy's Laboratories Ltd., Hyderabad, Telangana, India
| | - Rajan Mittal
- Medical Affairs, Dr. Reddy's Laboratories Ltd., Hyderabad, Telangana, India
| | - Shivani Acharya
- Medical Affairs, Dr. Reddy's Laboratories Ltd., Hyderabad, Telangana, India
| | - Sujeet N Charugulla
- Medical Affairs, Dr. Reddy's Laboratories Ltd., Hyderabad, Telangana, India.
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186
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Serlopitant reduced pruritus in patients with prurigo nodularis in a phase 2, randomized, placebo-controlled trial. J Am Acad Dermatol 2019; 80:1395-1402. [DOI: 10.1016/j.jaad.2019.01.052] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 01/17/2019] [Accepted: 01/21/2019] [Indexed: 01/30/2023]
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187
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Huguen J, Brenaut E, Clerc CJ, Poizeau F, Marcorelles P, Quereux G, Dupuy A, Misery L. Comparison of Characteristics of Neuropathic and Non-neuropathic Pruritus to Develop a Tool for the Diagnosis of Neuropathic Pruritus: The NP5. Front Med (Lausanne) 2019; 6:79. [PMID: 31111028 PMCID: PMC6499201 DOI: 10.3389/fmed.2019.00079] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 04/01/2019] [Indexed: 12/26/2022] Open
Abstract
The diagnosis of neuropathic pruritus (NP) may be difficult. The aim of this study was to compare the characteristics of both neuropathic pruritus and non-neuropathic pruritus (NNP) in order to elaborate a tool to help the diagnosis of NP without clinical examination. One hundred and seven patients were included: Fifty three in the NP group and Fifty four in the NNP group. In multiple regression, presence of twinges, absence of burning, worsening with activity, no worsening with stress, and relief with cold ambient temperature were independent factors that were associated with NP. A score of two criteria out of five was optimal to discriminate NP from NNP with a sensitivity of 76% and a specificity of 77%. Alloknesis, hyperknesis, or the ice cube test were not included because their evaluation is based on clinical examination. Future high-powered studies are needed to confirm the results of the present study.
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Affiliation(s)
- Johanna Huguen
- Department of Dermatology, University Hospital, Brest, France.,Department of Dermatology, Quimper Hospital, Quimper, France
| | - Emilie Brenaut
- Department of Dermatology, University Hospital, Brest, France.,Laboratoire Interactions Epitheliums Neurones, Université de Bretagne Occidentale, Brest, France
| | | | - Florence Poizeau
- Department of Dermatology, University Hospital, Rennes, France.,UPRES EA 7449 REPERES Pharmacoepidemiology and Health Services Research, Rennes University, Rennes, France
| | - Pascale Marcorelles
- Laboratoire Interactions Epitheliums Neurones, Université de Bretagne Occidentale, Brest, France.,Department of Pathology, University Hospital, Brest, France
| | - Gaëlle Quereux
- Department of Dermatology, University Hospital, Nantes, France
| | - Alain Dupuy
- Department of Dermatology, University Hospital, Rennes, France.,UPRES EA 7449 REPERES Pharmacoepidemiology and Health Services Research, Rennes University, Rennes, France
| | - Laurent Misery
- Laboratoire Interactions Epitheliums Neurones, Université de Bretagne Occidentale, Brest, France.,Department of Pathology, University Hospital, Brest, France
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188
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Plewig N, Ofenloch R, Mettang T, Weisshaar E. The course of chronic itch in hemodialysis patients: results of a 4-year follow-up study of GEHIS (German Epidemiological Hemodialysis Itch Study). J Eur Acad Dermatol Venereol 2019; 33:1429-1435. [PMID: 30742721 DOI: 10.1111/jdv.15483] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 12/19/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Chronic itch (CI) is a frequent symptom in hemodialysis (HD) patients. Previous studies demonstrated great impairments of general well-being and health-related quality of life (HRQOL) as well as a higher mortality in those suffering from CI. OBJECTIVE The German Epidemiological Hemodialysis Itch Study (GEHIS) is a representative cohort of HD patients in Germany. All patients were followed up 4 years later. The current analyses present data on the course of CI in HD patients, its associated factors including comorbidities, laboratory values and HRQOL. METHODS We assessed sociodemographic data, routine laboratory values, comorbidities, HRQOL (SF-12), depression and anxiety (HADS), sleep (duration and quality) and in those suffering from CI characteristics, intensity of CI and itch-related quality of life (ItchyQoL). Those with CI were offered a dermatological examination and CI was classified according to the IFSI classification. Patients were asked if they had consulted a physician about CI. RESULTS Of the patients who had suffered from CI in 2013 (n = 234), 90.5% (212) patients could be followed up. About 36.3% (n = 85) had died, 9.8% (n = 23) had received a kidney transplant in the meantime. A total of 52 HD patients still suffered from CI, in 52 CI had stopped. Those patients still suffering from CI (n = 52) reported a higher mean itch intensity, lower ItchyQoL, higher levels of anxiety and a lower mean sleeping time in 2013. On the other hand, those who did not suffer from CI anymore showed a significant increase of HRQOL compared to 2013. There was no significant difference in dialysis characteristics and laboratory values except for albumin. Only a minority of patients in HD had consulted a dermatologist because of CI (29.9%). CONCLUSION Our data demonstrate that CI is a persisting symptom in 50% of the HD patients and when it disappears HRQOL recovers. We confirm that CI is a disregarded symptom in HD patients.
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Affiliation(s)
- N Plewig
- Department of Clinical Social Medicine, Occupational and Environmental Dermatology, Ruprecht Karls University, University Hospital Heidelberg, Heidelberg, Germany
| | - R Ofenloch
- Department of Clinical Social Medicine, Occupational and Environmental Dermatology, Ruprecht Karls University, University Hospital Heidelberg, Heidelberg, Germany
| | - T Mettang
- Department of Nephrology, DKD Helios Clinic, Wiesbaden, Germany
| | - E Weisshaar
- Department of Clinical Social Medicine, Occupational and Environmental Dermatology, Ruprecht Karls University, University Hospital Heidelberg, Heidelberg, Germany
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189
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Kim YW, Zhou T, Ko EA, Kim S, Lee D, Seo Y, Kwon N, Choi T, Lim H, Cho S, Bae G, Hwang Y, Kim D, Park H, Lee M, Jang E, Choi J, Bae H, Lim I, Bang H, Ko JH. Prediction of itching diagnostic marker through RNA sequencing of contact hypersensitivity and skin scratching stimulation mice models. THE KOREAN JOURNAL OF PHYSIOLOGY & PHARMACOLOGY : OFFICIAL JOURNAL OF THE KOREAN PHYSIOLOGICAL SOCIETY AND THE KOREAN SOCIETY OF PHARMACOLOGY 2019; 23:151-159. [PMID: 30820159 PMCID: PMC6384194 DOI: 10.4196/kjpp.2019.23.2.151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 01/04/2019] [Accepted: 01/10/2019] [Indexed: 01/28/2023]
Abstract
Pruritus (itching) is classically defined as an unpleasant cutaneous sensation that leads to scratching behavior. Although the scientific criteria of classification for pruritic diseases are not clear, it can be divided as acute or chronic by duration of symptoms. In this study, we investigated whether skin injury caused by chemical (contact hypersensitivity, CHS) or physical (skin-scratching stimulation, SSS) stimuli causes initial pruritus and analyzed gene expression profiles systemically to determine how changes in skin gene expression in the affected area are related to itching. In both CHS and SSS, we ranked the Gene Ontology Biological Process terms that are generally associated with changes. The factors associated with upregulation were keratinization, inflammatory response and neutrophil chemotaxis. The Kyoto Encyclopedia of Genes and Genomes pathway shows the difference of immune system, cell growth and death, signaling molecules and interactions, and signal transduction pathways. Il1a , Il1b and Il22 were upregulated in the CHS, and Tnf, Tnfrsf1b, Il1b, Il1r1 and Il6 were upregulated in the SSS. Trpc1 channel genes were observed in representative itching-related candidate genes. By comparing and analyzing RNA-sequencing data obtained from the skin tissue of each animal model in these characteristic stages, it is possible to find useful diagnostic markers for the treatment of itching, to diagnose itching causes and to apply customized treatment.
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Affiliation(s)
- Young-Won Kim
- Department of Physiology, Chung-Ang University College of Medicine, Seoul 06974, Korea
| | - Tong Zhou
- Department of Physiology and Cell Biology, University of Nevada, Reno School of Medicine, Reno, NV 89557, USA
| | - Eun-A Ko
- Department of Physiology and Cell Biology, University of Nevada, Reno School of Medicine, Reno, NV 89557, USA
| | - Seongtae Kim
- Department of Physiology, Chung-Ang University College of Medicine, Seoul 06974, Korea
| | - Donghee Lee
- Department of Physiology, Chung-Ang University College of Medicine, Seoul 06974, Korea
| | - Yelim Seo
- Department of Physiology, Chung-Ang University College of Medicine, Seoul 06974, Korea
| | - Nahee Kwon
- Department of Medicine, Chung-Ang University College of Medicine, Seoul 06974, Korea
| | - Taeyeon Choi
- Department of Medicine, Chung-Ang University College of Medicine, Seoul 06974, Korea
| | - Heejung Lim
- Department of Medicine, Chung-Ang University College of Medicine, Seoul 06974, Korea
| | - Sungvin Cho
- Department of Medicine, Chung-Ang University College of Medicine, Seoul 06974, Korea
| | - Gwanhui Bae
- Department of Medicine, Chung-Ang University College of Medicine, Seoul 06974, Korea
| | - Yuseong Hwang
- Department of Medicine, Chung-Ang University College of Medicine, Seoul 06974, Korea
| | - Dojin Kim
- Department of Medicine, Chung-Ang University College of Medicine, Seoul 06974, Korea
| | - Hyewon Park
- Department of Medicine, Chung-Ang University College of Medicine, Seoul 06974, Korea
| | - Minjae Lee
- Department of Medicine, Chung-Ang University College of Medicine, Seoul 06974, Korea
| | - Eunkyung Jang
- Department of Medicine, Chung-Ang University College of Medicine, Seoul 06974, Korea
| | - Jeongyoon Choi
- Department of Physiology, Chung-Ang University College of Medicine, Seoul 06974, Korea
| | - Hyemi Bae
- Department of Physiology, Chung-Ang University College of Medicine, Seoul 06974, Korea
| | - Inja Lim
- Department of Physiology, Chung-Ang University College of Medicine, Seoul 06974, Korea
| | - Hyoweon Bang
- Department of Physiology, Chung-Ang University College of Medicine, Seoul 06974, Korea
| | - Jae-Hong Ko
- Department of Physiology, Chung-Ang University College of Medicine, Seoul 06974, Korea
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190
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Riccio D, Andersen HH, Arendt-Nielsen L. Antipruritic effects of transient heat stimulation on histaminergic and nonhistaminergic itch. Br J Dermatol 2019; 181:786-795. [PMID: 30802929 DOI: 10.1111/bjd.17825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Chronic itch is notoriously difficult to treat. Counterstimuli are able to inhibit itch, but this principle is difficult to apply in clinical practice, and the mechanisms behind counterstimulation-induced itch suppression in humans are unclear. OBJECTIVES Firstly, to analyse the stimulus-response effects of transient heat stimuli on histaminergic and nonhistaminergic itch, and secondly, to investigate whether the antipruritic effect depends on homotopic (peripheral mediation) or heterotopic (central mediation) counterstimulation relative to the itch provocation site. METHODS Eighteen healthy volunteers participated (eight female, mean age 25·7 ± 0·8 years). Itch was evoked on premarked areas of the volar forearms, by either histamine (1% solution) or cowhage (35-40 spicules). In addition to the itch provocations (experiment 1), 5-s homotopic heat stimuli at 32, 40, 45 or 50 °C were applied. In experiment 2, heat stimuli were applied either homotopically, intrasegmentally (next to the provocation site) or extrasegmentally (dorsal forearm). Itch intensity was evaluated throughout the procedures using a digital visual analogue scale. RESULTS Homotopic counterstimuli inhibited histaminergic itch by 41·3% at 45 °C (P < 0·01) and by 76·7% at 50 °C (P < 0·001). Cowhage-induced itch was less prone to counterstimulation and was significantly diminished only at 50 °C, by 43·6% (P = 0·009). Counterstimulations applied heterotopically were not able to inhibit itch significantly. CONCLUSIONS Itch pathway-specific effects of counterstimuli were observed between homo- and heterotopic stimulation. Histaminergic itch was robustly inhibited by short-term homotopic noxious heat stimuli for up to 10 min. Nonhistaminergic itch was only weakly inhibited. The inhibitory effects exerted by the short-term heat stimuli only occurred following homotopic counterstimulation.
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Affiliation(s)
- D Riccio
- Center for Neuroplasticity and Pain (CNAP), Aalborg University, Aalborg, Denmark.,Laboratory for Experimental Cutaneous Pain and Itch Research, SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - H H Andersen
- Laboratory for Experimental Cutaneous Pain and Itch Research, SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - L Arendt-Nielsen
- Center for Neuroplasticity and Pain (CNAP), Aalborg University, Aalborg, Denmark.,Laboratory for Experimental Cutaneous Pain and Itch Research, SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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191
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Schnitzler C, Rosen J, Szepietowski J, Reich A, Yosipovitch G, Reszke R, Nattkemper L, Osada N, Pihan D, Ständer S, Zeidler C. Validation of ‘ItchApp©’ in Poland and in the USA: multicentre validation study of an electronical diary for the assessment of pruritus. J Eur Acad Dermatol Venereol 2019; 33:398-404. [DOI: 10.1111/jdv.15300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/01/2018] [Indexed: 11/29/2022]
Affiliation(s)
- C. Schnitzler
- Center for Chronic Pruritus Department of Dermatology; University Hospital Münster; Münster Germany
| | - J. Rosen
- Department of Dermatology and Cutaneous Surgery; Miami Itch Center; University of Miami; Miami FL USA
| | - J.C. Szepietowski
- Department of Dermatology, Venereology and Allergology; Medical University Wroclaw; Wroclow Poland
| | - A. Reich
- Department of Dermatology; University of Rzeszow; Rzeszów Poland
| | - G. Yosipovitch
- Department of Dermatology and Cutaneous Surgery; Miami Itch Center; University of Miami; Miami FL USA
| | - R. Reszke
- Department of Dermatology, Venereology and Allergology; Medical University Wroclaw; Wroclow Poland
| | - L.A. Nattkemper
- Department of Dermatology and Cutaneous Surgery; Miami Itch Center; University of Miami; Miami FL USA
| | - N. Osada
- Center for Chronic Pruritus Department of Dermatology; University Hospital Münster; Münster Germany
| | - D. Pihan
- Arone; Saint-Maur-des-Fossés France
| | - S. Ständer
- Center for Chronic Pruritus Department of Dermatology; University Hospital Münster; Münster Germany
| | - C. Zeidler
- Center for Chronic Pruritus Department of Dermatology; University Hospital Münster; Münster Germany
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192
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Meixiong J, Vasavda C, Green D, Zheng Q, Qi L, Kwatra SG, Hamilton JP, Snyder SH, Dong X. Identification of a bilirubin receptor that may mediate a component of cholestatic itch. eLife 2019; 8:44116. [PMID: 30657454 PMCID: PMC6368403 DOI: 10.7554/elife.44116] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 01/17/2019] [Indexed: 12/31/2022] Open
Abstract
Various pathologic conditions result in jaundice, a yellowing of the skin due to a buildup of bilirubin. Patients with jaundice commonly report experiencing an intense non-histaminergic itch. Despite this association, the pruritogenic capacity of bilirubin itself has not been described, and no bilirubin receptor has been identified. Here, we demonstrate that pathophysiologic levels of bilirubin excite peripheral itch sensory neurons and elicit pruritus through MRGPRs, a family of G-protein coupled receptors expressed in primary sensory neurons. Bilirubin binds and activates two MRGPRs, mouse MRGPRA1 and human MRGPRX4. In two mouse models of pathologic hyperbilirubinemia, we show that genetic deletion of either Mrgpra1 or Blvra, the gene that encodes the bilirubin-producing enzyme biliverdin reductase, attenuates itch. Similarly, plasma isolated from hyperbilirubinemic patients evoked itch in wild-type animals but not Mrgpra1-/- animals. Removing bilirubin decreased the pruritogenic capacity of patient plasma. Based on these data, targeting MRGPRs is a promising strategy for alleviating jaundice-associated itch. Jaundice causes the skin to yellow as a result of a build-up of a pigment called bilirubin. Normally, bilirubin is made in the liver and removed from the body in digestive fluid called bile, but people with liver or gallbladder problems may end up with too much bilirubin that accumulates in their blood and skin. One side effect of jaundice is intense and uncontrollable itching. Researchers are not sure what causes this itching, and there are few treatments that help to relieve it. At the molecular level, itching sensations occur when compounds bind to particular receptors on the surface of nerve cells. One family of receptors that can trigger itch is called the Mas-related G-protein Coupled Receptor (MRGPR). Could one of these receptors trigger jaundice-related itching? Now, Meixiong, Vasavda et al. show that bilirubin binds to and activates MRGPRs to cause itch in mice. Whereas injecting bilirubin into normal mice causes them to scratch, mice that have been genetically engineered to lack MRGPRs do not itch when their own bilirubin levels rise, or when they are injected with bilirubin or with plasma from patients who experience jaundice-related itching. Furthermore, removing bilirubin from the plasma of patients before it was injected into normal mice reduced the amount of itching that the mice felt. Overall, the results reported by Meixiong, Vasavda et al. suggest that drugs that prevent bilirubin from attaching to MRGPRs might help to alleviate jaundice-related itching. However, researchers must first verify that bilirubin interacts with MRGPRs in people to cause itch. If bilirubin causes itch in people like in mice, scientists could then evaluate existing drugs or make new ones to prevent bilirubin from attaching to the MRGPRs.
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Affiliation(s)
- James Meixiong
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Chirag Vasavda
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Dustin Green
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Qin Zheng
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Lijun Qi
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Shawn G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, United States
| | - James P Hamilton
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Solomon H Snyder
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, United States.,Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, United States.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Xinzhong Dong
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, United States.,Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, United States.,Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, United States.,Howard Hughes Medical Institute, Johns Hopkins University School of Medicine, Baltimore, United States
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193
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Scalp Pruritus: Review of the Pathogenesis, Diagnosis, and Management. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1268430. [PMID: 30766878 PMCID: PMC6350598 DOI: 10.1155/2019/1268430] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 01/03/2019] [Indexed: 12/19/2022]
Abstract
Scalp pruritus is a frequent problem encountered in dermatological practice. This disorder is caused by various underlying diseases and is a diagnostic and therapeutic challenge. Scalp pruritus may be localized to the scalp or extended to other body areas. It is sometimes not only associated with skin diseases or specific skin changes, but also associated with lesions secondary to rubbing or scratching. Moreover, scalp pruritus may be difficult to diagnose and manage and may have a great impact on the quality of life of patients. It can be classified as dermatologic, neuropathic, systemic, and psychogenic scalp pruritus based on the potential underlying disease. A thorough evaluation of patients presenting with scalp pruritus is important. Taking history and performing physical examination and further investigations are essential for diagnosis. Therapeutic strategy comprises removal of the aggravating factors and appropriate treatment of the underlying condition. All treatments should be performed considering an individual approach. This review article focuses on the understanding of the pathophysiology and the diagnostic and therapeutic management of scalp pruritus.
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Steinke S, Zeidler C, Riepe C, Bruland P, Soto-Rey I, Storck M, Augustin M, Bobko S, Garcovich S, Legat FJ, Lvov A, Misery L, Osada N, Reich A, Şavk E, Serra-Baldrich E, Streit M, Szepietowski JC, Weger W, Dugas M, Ständer S. Humanistic burden of chronic pruritus in patients with inflammatory dermatoses: Results of the European Academy of Dermatology and Venereology Network on Assessment of Severity and Burden of Pruritus (PruNet) cross-sectional trial. J Am Acad Dermatol 2019; 79:457-463.e5. [PMID: 30119869 DOI: 10.1016/j.jaad.2018.04.044] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/17/2018] [Accepted: 04/20/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Chronic pruritus is a multifactorial, challenging symptom of global relevance. OBJECTIVE The European Academy of Dermatology and Venereology Network on Assessment of Severity and Burden of Pruritus (PruNet) investigation aimed to analyze the severity and humanistic burden of chronic pruritus in patients suffering from inflammatory dermatoses across Europe. METHODS Prospectively collected routine data on 552 patients (with atopic dermatitis, contact dermatitis, prurigo nodularis, psoriasis vulgaris, lichen planus, or mycosis fungoides [pruritus numeric rating scale score ≥3]) from 9 European centers (in Austria, France, Germany, Italy, Poland, Russia, Spain, Switzerland, and Turkey) were analyzed by univariate and multivariate variance analyses of various itch characteristics and quality of life (as measured by the Dermatology Life Quality Index and the ItchyQoL). RESULTS Duration, frequency, and intensity of pruritus (according to a numeric rating scale and visual analog scale) and related impairment of quality of life differed between European centers and dermatologic diagnoses (P < .05). The country in which the center was located had a greater impact on how patients evaluated pruritus intensity and quality of life than diagnosis did (P < .001). LIMITATIONS One center per country was included. CONCLUSION The humanistic burden of chronic pruritus in patients with inflammatory dermatoses is high. European cross-cultural factors may have a stronger influence than a specific dermatologic diagnosis on how patients rate intensity of pruritus and quality of life.
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Affiliation(s)
- Sabine Steinke
- Center for Chronic Pruritus, Department of Dermatology, University Hospital of Münster, Münster, Germany; Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Claudia Zeidler
- Center for Chronic Pruritus, Department of Dermatology, University Hospital of Münster, Münster, Germany
| | - Claudia Riepe
- Center for Chronic Pruritus, Department of Dermatology, University Hospital of Münster, Münster, Germany
| | - Philipp Bruland
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Iñaki Soto-Rey
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Michael Storck
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Svetlana Bobko
- Department of Dermatology, University Hospital Moscow, Moscow, Russia
| | - Simone Garcovich
- Department of Dermatology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Franz J Legat
- Department of Dermatology, Medical University of Graz, Graz, Austria; Das Kurhaus-Bad Gleichenberg, Bad Gleichenberg, Austria
| | - Andrey Lvov
- Department of Dermatology, University Hospital Moscow, Moscow, Russia
| | - Laurent Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - Nani Osada
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Adam Reich
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland; Department of Dermatology, University of Rzeszow, Rzeszow, Poland
| | - Ekin Şavk
- Department of Dermatology, Adnan Menderes University, Aydın, Turkey
| | - Esther Serra-Baldrich
- Cutaneous Allergy Unit, Department of Dermatology, Hospital Sant Pau, Universitat Autònoma Barcelona, Barcelona, Spain
| | - Markus Streit
- Department of Dermatology, Kantonsspital Aarau, Aarau, Switzerland
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Wolfgang Weger
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Martin Dugas
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Sonja Ständer
- Center for Chronic Pruritus, Department of Dermatology, University Hospital of Münster, Münster, Germany
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Kilic A, Harder A, Reich H, Knie U, Masur C, Abels C. Efficacy of hydrophilic or lipophilic emulsions containing Echinacea purpurea extract in treatment of different types of pruritus. Clin Cosmet Investig Dermatol 2018; 11:591-602. [PMID: 30538520 PMCID: PMC6251459 DOI: 10.2147/ccid.s172518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Pruritus reduces quality of life and may occur at different sites of the body. To alleviate pruritus, lipid replenishing and rehydration of the skin is often unsatisfactory. Thus, products with additional antipruritic effects are needed. Objectives Antipruritic effects and cosmetic properties of two different emulsions, water-in-oil (w/o) or oil-in-water (o/w), and a shampoo containing a lipophilic Echinacea purpurea root extract (Ec.-extract) were assessed in adults suffering from pruritus. Methods Adults (n = 55) with pruritus of the body applied a w/o emulsion for 2 weeks. In a separate study, adults (n = 33) with a pruritic scalp applied an o/w-emulsion for 4 weeks. In a third study, shampoo (n = 34) was applied for 4 weeks. Objective (erythema, dryness, and papules) and subjective (intensity, duration, and burden of pruritus) parameters were assessed. Results Treatment with the w/o emulsion significantly reduced erythema and dryness (P < 0.0001) as well as pruritus (in 93% of participants) on the body. Treatment with the o/w-emulsion on the scalp significantly (P < 0.0001) reduced objective (erythema in 61% and dryness in 85% of participants) and subjective (85% of participants had reduced pruritus) parameters. Similar results in reduction of dryness (76% of participants) and pruritus (70 % of participants) were seen after 4 weeks of shampoo use. Conclusion Independent from the type of emulsion (w/o or o/w), cosmetic products containing a proprietary Ec.-extract significantly reduced objective and subjective parameters in adults suffering from acute or chronic pruritus exhibiting excellent tolerability.
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Affiliation(s)
- Ana Kilic
- Dr. August Wolff GmbH & Co. KG Arzneimittel, Bielefeld, Germany,
| | - Anastasia Harder
- Dr. August Wolff GmbH & Co. KG Arzneimittel, Bielefeld, Germany,
| | - Hubert Reich
- Dr. August Wolff GmbH & Co. KG Arzneimittel, Bielefeld, Germany,
| | - Ulrich Knie
- Dr. August Wolff GmbH & Co. KG Arzneimittel, Bielefeld, Germany,
| | - Clarissa Masur
- Dr. August Wolff GmbH & Co. KG Arzneimittel, Bielefeld, Germany,
| | - Christoph Abels
- Dr. August Wolff GmbH & Co. KG Arzneimittel, Bielefeld, Germany,
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196
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Pereira MP, Mittal A, Ständer S. Current treatment strategies in refractory chronic pruritus. Curr Opin Pharmacol 2018; 46:1-6. [PMID: 30530232 DOI: 10.1016/j.coph.2018.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/12/2018] [Accepted: 11/26/2018] [Indexed: 02/07/2023]
Abstract
Chronic pruritus is a highly prevalent, debilitating disease, which is often refractory to conventional therapies. A step-wise, guideline-driven approach should be adopted in the management of these patients. Emollients as well as topical corticosteroids if appropriate should be initiated whilst looking for the cause underlying the pruritus. If these measures fail, and the origin of the pruritus remains unknown, cannot be treated or does not respond to therapy, systemic therapies as for example gabapentinoids, antidepressants, mu-opioid-receptor antagonists or, in case of inflammatory conditions, immunosuppressive drugs should be recommended. Novel agents, especially systemic monoclonal antibodies, neurokinin-1 receptor antagonists and opioid receptor modulators, are promising in providing relief in refractory cases.
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Affiliation(s)
- Manuel Pedro Pereira
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany.
| | - Asit Mittal
- Department of Dermatology, Venereology and Leprology, RNT Medical College, Udaipur, Rajasthan, India
| | - Sonja Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
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197
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Pereira MP, Ständer S. Novel drugs for the treatment of chronic pruritus. Expert Opin Investig Drugs 2018; 27:981-988. [DOI: 10.1080/13543784.2018.1548606] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Manuel P. Pereira
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Sonja Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
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Andrade Miranda A, Franco JVA, Sanclemente G, Kuah CY, Yu AM, Shpadaruk V, Roqué i Figuls M, Martin-Lopez JE, Chua S. Interventions for pruritus of unknown cause. Hippokratia 2018. [DOI: 10.1002/14651858.cd013128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Andrea Andrade Miranda
- Hospital Italiano de Buenos Aires; Department of Dermatology; Tte. Peron 4230 Buenos Aires Argentina 1199
- Instituto Universitario Hospital Italiano; Argentine Cochrane Centre; Potosi 4234 Buenos Aires Buenos Aires Argentina C1199ACL
| | - Juan VA Franco
- Instituto Universitario Hospital Italiano; Argentine Cochrane Centre; Potosi 4234 Buenos Aires Buenos Aires Argentina C1199ACL
- Hospital Italiano de Buenos Aires; Family and Community Medicine Service; Tte. Gral. Juan Domingo Perón 4190 Buenos Aires Buenos Aires Argentina C1199ABB
| | - Gloria Sanclemente
- Universidad de Antioquia; Grupo de Investigación Dermatológica (GRID); Carrera 25 A #1 A Sur 45, Of 2026 Torre Medica El Tesoro Medellín Colombia
| | - Chii Yang Kuah
- Southend University Hospital NHS Foundation Trust; Department of Oncology; Prittlewell Chase Southend-on-sea Westcliff-on-Sea UK SS0 0RY
| | - Ashley M Yu
- University of Ottawa; Faculty of Medicine; 451 Smyth Road Ottawa ON Canada K1H 8L1
| | - Volha Shpadaruk
- University Hospitals of Leicester; Dermatology; Leicester Royal Infirmary OPD3 Balmoral Building Leicester UK LE1 5WW
| | - Marta Roqué i Figuls
- CIBER Epidemiología y Salud Pública (CIBERESP); Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau); Sant Antoni Maria Claret 171 Edifici Casa de Convalescència Barcelona Catalunya Spain 08041
| | - Juliana Esther Martin-Lopez
- Andalusian Health Technology Assessment Agency (AETSA); Department of Research; 27 Calle Laurel Dos Hermanas Seville Spain 41089
| | - Sean Chua
- urong East St21 Blk288A #03-358 Singapore Singapore 601288
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Akarsu S, Ozbagcivan O, Ilknur T, Semiz F, Inci BB, Fetil E. Xerosis cutis and associated co-factors in women with prurigo nodularis. An Bras Dermatol 2018; 93:671-679. [PMID: 30156616 PMCID: PMC6106662 DOI: 10.1590/abd1806-4841.20187127] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 08/20/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Current data regarding the associated factors of prurigo nodularis are still uncertain, except for atopic predisposition. OBJECTIVES The purposes of this study were to (1) determine the frequencies of xerosis and other accompanying diseases of female patients with prurigo nodularis; (2) compare the demographic, clinical and accompanying disease characteristics by grouping these patients according to whether they have associated xerosis (who were subsequently subgrouped as atopic or non-atopic) or not. METHODS In this retrospective descriptive study, 80 females with PN were categorized according to the accompanying diseases (dermatological, systemic, neurological, psychogenic, mixed, or undetermined origin). RESULTS A total of 45 associated co-factors including dermatological in 63 (78.8%), systemic in 57 (71.3%), psychological in 33 (41.3%) and neurological co-factors in 14 (17.5%) of all patients with prurigo nodularis were detected. Xerosis was observed in 48 (60%) patients (non-atopic co-factors in 66.7% of them). The ratio of patients with mixed co-factors, dermatological+systemic co-factors and dermatological+systemic+psychological co-factors were found to be significantly higher in patients with xerosis compared to those without xerosis. STUDY LIMITATIONS Our study has certain limitations such as the absence of an age-matched control group, absence of follow-up data and the fact that the diagnosis of xerosis has not been based on objective methods. CONCLUSIONS Xerosis has been identified in more than half of the patients with PN and it has been determined that in most patients xerosis is associated especially with diabetes mellitus and other conditions related to prurigo nodularis.
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Affiliation(s)
- Sevgi Akarsu
- Department of Dermatology, Faculty of Medicine, Dokuz Eylul
University, Izmir, Turkey
| | - Ozlem Ozbagcivan
- Department of Dermatology, Faculty of Medicine, Dokuz Eylul
University, Izmir, Turkey
| | - Turna Ilknur
- Department of Dermatology, Faculty of Medicine, Dokuz Eylul
University, Izmir, Turkey
| | - Fatma Semiz
- Department of Dermatology, Faculty of Medicine, Dokuz Eylul
University, Izmir, Turkey
| | - Burcu Bahar Inci
- Department of Dermatology, Faculty of Medicine, Dokuz Eylul
University, Izmir, Turkey
| | - Emel Fetil
- Department of Dermatology, Faculty of Medicine, Dokuz Eylul
University, Izmir, Turkey
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Ständer S, Zeidler C, Augustin M, Bayer G, Kremer AE, Legat FJ, Maisel P, Mettang T, Metz M, Nast A, Niemeier V, Raap U, Schneider G, Ständer HF, Staubach P, Streit M, Weisshaar E. S2k Guidelines for the diagnosis and treatment of chronic pruritus - update - short version. J Dtsch Dermatol Ges 2018; 15:860-872. [PMID: 28763584 DOI: 10.1111/ddg.13304] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Associated with a host of different diseases, pruritus is a cardinal symptom that poses an interdisciplinary diagnostic and therapeutic challenge. Over time, that symptom may progress independently of the initial cause, thus losing its function as a warning sign and turning into a clinically relevant disease of its own. In Germany, approximately 13.5 % of the general population are affected by chronic pruritus, with an incidence of 7 %. All forms of chronic pruritus require targeted treatment consisting of (a) diagnosis and management of the underlying disease, (b) dermatological treatment of primary or secondary (for example, dry skin, scratch lesions) symptoms, (c) symptomatic antipruritic treatment, and (d) psychological/psychotherapeutic treatment in case of an underlying or associated psychological or psychosomatic condition. Medical care of patients with chronic pruritus should therefore include an interdisciplinary approach, in particular with respect to diagnosis and therapy of the underlying disease as well as in terms of the management of treatment and adverse events. The objective of the present interdisciplinary guidelines is to define and standardize diagnostic and therapeutic procedures in patients with chronic pruritus. This is a short version of the current S2 guidelines on chronic pruritus. The long version may be found at www.awmf.org.
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Affiliation(s)
- Sonja Ständer
- Center for Chronic Pruritus (KCP) and Department of Dermatology, University Medical Center, Münster, Germany
| | - Claudia Zeidler
- Center for Chronic Pruritus (KCP) and Department of Dermatology, University Medical Center, Münster, Germany
| | - Matthias Augustin
- Institute for Health Care Research in Dermatology and Nursing (IVDP), Competence Center for Nursing Research in Dermatology (CVderm), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gudrun Bayer
- Institute of General Medicine, Charité - University Medical Center, Berlin, Germany
| | - Andreas E Kremer
- Department of Medicine I, Gastroenterology, Pulmonology, and Endocrinology, University of Erlangen-Nuremberg, Germany
| | - Franz J Legat
- Department of Dermatology, Venereology, Graz Medical University, Graz, Austria
| | - Peter Maisel
- Center for General Medicine, Medical Faculty, University of Münster, Germany
| | - Thomas Mettang
- Department of Nephrology, DKD Helios Klinik, Wiesbaden, Germany
| | - Martin Metz
- Allergy Center Charité, Department of Dermatology, Venereology, and Allergology, Charité - University Medical Center, Berlin, Germany
| | - Alexander Nast
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology, and Allergology, Charité - University Medical Center, Berlin, Germany
| | - Volker Niemeier
- Department of Dermatology, Venereology, and Allergology, University Medical Center Giessen and Marburg (Giessen site) and Practice for Dermatology, Psychotherapy, and Psychoanalysis, Giessen, Germany
| | - Ulrike Raap
- Department of Dermatology, Allergology Faculty of Medicine and Health Science, University of Oldenburg, Klinikum Oldenburg AöR, Oldenburg, Germany
| | - Gudrun Schneider
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Cener, Münster, Germany
| | - Hartmut F Ständer
- Dermatology Bad Bentheim, Dermatology Practice at Paulinenkrankenhaus Bad Bentheim and Department of Dermatology Medical Center Dortmund gGmbH, Dortmund, Germany
| | - Petra Staubach
- Clinical Research Center, Department of Dermatology, University Medical Center, Mainz, Germany
| | - Markus Streit
- Department of Dermatology, Aarau Canton Hospital, Aarau, Switzerland
| | - Elke Weisshaar
- Department of Clinical Social Medicine, Occupational and Environmental Dermatology, University Medical Center, Heidelberg, Germany
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