1
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Biazus Soares G, Hashimoto T, Yosipovitch G. Atopic Dermatitis Itch: Scratching for an Explanation. J Invest Dermatol 2024; 144:978-988. [PMID: 38363270 DOI: 10.1016/j.jid.2023.10.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/20/2023] [Accepted: 10/31/2023] [Indexed: 02/17/2024]
Abstract
Chronic pruritus is a cardinal symptom of atopic dermatitis (AD). The mechanisms underlying atopic itch involve intricate crosstalk among skin, immune components, and neural components. In this review, we explore these mechanisms, focusing on key players and interactions that induce and exacerbate itch. We discuss the similarities and differences between pruritus and pain in patients with AD as well as the relationship between pruritus and factors such as sweat and the skin microbiome. Furthermore, we explore novel targets that could provide significant itch relief in these patients as well as exciting future research directions to better understand atopic pruritus in darker skin types.
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Affiliation(s)
- Georgia Biazus Soares
- Miami Itch Center, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Takashi Hashimoto
- Department of Dermatology, National Defense Medical College, Tokorozawa, Japan
| | - Gil Yosipovitch
- Miami Itch Center, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
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2
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Tang Y, Cheng S, Wang J, Jin Y, Yang H, Lin Q, Xu S, Hui L, Yin Q, Yang Y, Wu X. Acupuncture for the Treatment of Itch: Peripheral and Central Mechanisms. Front Neurosci 2022; 15:786892. [PMID: 35431769 PMCID: PMC9005788 DOI: 10.3389/fnins.2021.786892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/13/2021] [Indexed: 11/21/2022] Open
Abstract
Despite the widespread clinical use of acupuncture in the treatment of pruritus caused by psoriasis, urticaria, uremic, and other diseases, insights into the mechanism of action of acupuncture are still emerging. For the above reasons, a beneficial effect of acupuncture on pruritus was not recommended or reported in recent clinical practice guidelines. Acupuncture is a kind of physical stimulation, which has the characteristics of multi-channel and multi-target effects. The biomechanical stimulation signal of acupuncture needling can be transformed into bioelectric and chemical signals; interfere with kinds of cells and nerve fibers in the skin and muscle; alter signaling pathways and transcriptional activity of cells, mediators, and receptors; and result in inhibition of peripheral and central transmission of pruritus. Available mechanistic data give insights into the biological regulation potency of acupuncture for pruritus and provide a basis for more in-depth and comprehensive mechanism research.
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3
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Li S, Ding M, Wu Y, Xue S, Ji Y, Zhang P, Zhang Z, Cao Z, Zhang F. Histamine Sensitization of the Voltage-Gated Sodium Channel Nav1.7 Contributes to Histaminergic Itch in Mice. ACS Chem Neurosci 2022; 13:700-710. [PMID: 35157443 DOI: 10.1021/acschemneuro.2c00012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Itch, a common clinical symptom of many skin diseases, severely impairs the life quality of patients. Nav1.7, a subtype of voltage-gated sodium channels mainly expressed in primary sensory neurons, is responsible for the amplification of threshold currents that trigger action potential (AP) generation. Gain-of-function mutation of Nav1.7 leads to paroxysmal itch, while pharmacological inhibition of Nav1.7 alleviates histamine-dependent itch. However, the crosstalk between histamine and Nav1.7 that leads to itch is unclear. In the present study, we demonstrated that in the dorsal root ganglion (DRG) neurons from histamine-dependent itch model mice induced by compound 48/80, tetrodotoxin-sensitive (TTX-S) but not TTX-resistant Na+ currents were activated at more hyperpolarized membrane potentials compared to those on DRG neurons from vehicle-treated mice. Meanwhile, bath application of histamine shifted the activation voltages of TTX-S Na+ currents to the hyperpolarized direction, increased the AP frequency, and reduced the current threshold required to elicit APs. Further mechanistic studies demonstrated that selective activation of H1 but not H2 and H4 receptors mimicked histamine effect on TTX-S Na+ channels in DRG neurons. The protein kinase C (PKC) inhibitor GO 8963, but not the PKA inhibitor H89, normalized histamine-sensitized TTX-S Na+ channels. We also demonstrated that histamine shifted the activation voltages of Na+ currents to the hyperpolarized direction in Chinese hamster ovary (CHO) cells expressing Nav1.7. Importantly, selective inhibition of Nav1.7 by PF-05089771 significantly relieved the scratching frequency in a histamine-dependent itch model induced by compound 48/80. Taken together, these data suggest that activation of H1 receptors by histamine sensitizes Nav1.7 channels through the PKC pathway in DRG neurons that contributes to histamine-dependent itch.
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Affiliation(s)
- Shaoheng Li
- State Key Laboratory of Natural Medicines and Jiangsu Provincial Key Laboratory for TCM Evaluation and Translational Development, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu 211198, China
| | - Meihuizi Ding
- State Key Laboratory of Natural Medicines and Jiangsu Provincial Key Laboratory for TCM Evaluation and Translational Development, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu 211198, China
| | - Ying Wu
- State Key Laboratory of Natural Medicines and Jiangsu Provincial Key Laboratory for TCM Evaluation and Translational Development, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu 211198, China
| | - Shuwen Xue
- State Key Laboratory of Natural Medicines and Jiangsu Provincial Key Laboratory for TCM Evaluation and Translational Development, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu 211198, China
| | - Yunyun Ji
- State Key Laboratory of Natural Medicines and Jiangsu Provincial Key Laboratory for TCM Evaluation and Translational Development, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu 211198, China
| | - Pinhui Zhang
- State Key Laboratory of Natural Medicines and Jiangsu Provincial Key Laboratory for TCM Evaluation and Translational Development, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu 211198, China
| | - Zhuang Zhang
- State Key Laboratory of Natural Medicines and Jiangsu Provincial Key Laboratory for TCM Evaluation and Translational Development, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu 211198, China
| | - Zhengyu Cao
- State Key Laboratory of Natural Medicines and Jiangsu Provincial Key Laboratory for TCM Evaluation and Translational Development, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu 211198, China
| | - Fan Zhang
- State Key Laboratory of Natural Medicines and Jiangsu Provincial Key Laboratory for TCM Evaluation and Translational Development, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu 211198, China
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4
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Misery L, Brenaut E, Pierre O, Le Garrec R, Gouin O, Lebonvallet N, Abasq-Thomas C, Talagas M, Le Gall-Ianotto C, Besner-Morin C, Fluhr JW, Leven C. Chronic itch: emerging treatments following new research concepts. Br J Pharmacol 2021; 178:4775-4791. [PMID: 34463358 DOI: 10.1111/bph.15672] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 11/29/2022] Open
Abstract
Until recently, itch pathophysiology was poorly understood and treatments were poorly effective in relieving itch. Current progress in our knowledge of the itch processing, the numerous mediators and receptors involved has led to a large variety of possible therapeutic pathways. Currently, inhibitors of IL-31, IL-4/13, NK1 receptors, opioids and cannabinoids, JAK, PDE4 or TRP are the main compounds involved in clinical trials. However, many new targets, such as Mas-related GPCRs and unexpected new pathways need to be also explored.
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Affiliation(s)
- Laurent Misery
- LIEN, Univ Brest, Brest, France.,Department of Dermatology, University Hospital of Brest, Brest, France
| | - Emilie Brenaut
- LIEN, Univ Brest, Brest, France.,Department of Dermatology, University Hospital of Brest, Brest, France
| | | | | | - Olivier Gouin
- LIEN, Univ Brest, Brest, France.,INSERM UMR 1163, Laboratory of Genetic Skin Diseases, Imagine Institute, Paris, France.,University of Paris, Paris, France
| | | | - Claire Abasq-Thomas
- LIEN, Univ Brest, Brest, France.,Department of Dermatology, University Hospital of Brest, Brest, France
| | - Matthieu Talagas
- LIEN, Univ Brest, Brest, France.,Department of Dermatology, University Hospital of Brest, Brest, France
| | | | - Catherine Besner-Morin
- LIEN, Univ Brest, Brest, France.,Department of Dermatology, University Hospital of Brest, Brest, France.,Division of Dermatology, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
| | - Joachim W Fluhr
- LIEN, Univ Brest, Brest, France.,Department of Dermatology, University Hospital of Brest, Brest, France.,Department of Dermatology, Charité Universitätsmedizin, Berlin, Germany
| | - Cyril Leven
- LIEN, Univ Brest, Brest, France.,EA3878, FCRIN INNOVTE, groupe d'étude thrombose Bretagne Occidentale, Brest, France.,Department of Biochemistry and Pharmaco-Toxicology, University Hospital of Brest, Brest, France
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5
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Kim HS, Hashimoto T, Fischer K, Bernigaud C, Chosidow O, Yosipovitch G. Scabies itch: an update on neuroimmune interactions and novel targets. J Eur Acad Dermatol Venereol 2021; 35:1765-1776. [PMID: 33960033 DOI: 10.1111/jdv.17334] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/23/2021] [Indexed: 12/14/2022]
Abstract
Frequently described as 'the worst itch' one can ever experience scabies itch is the hallmark of Sarcoptes scabiei mite infestation. Notably, the itchiness often persists for weeks despite scabicides therapy. The mechanism of scabies itch is not yet fully understood, and effective treatment modalities are still missing which can severely affect the quality of life. The aim of this review is to provide an overview of the scope of itch in scabies and highlight candidate mechanisms underlying this itch. We herein discuss scabies itch, with a focus on the nature, candidate underlying mechanisms and treatment options. We also synthesize this information with current understanding of the mechanisms contributing to non-histaminergic itch in other conditions. Itch is a major problem in scabies and can lead to grave consequences. We provide the latest insights on host-mite interaction, secondary microbial infection and neural sensitization with special emphasis on keratinocytes and mast cells to better understand the mechanism of itch in scabies. Also, the most relevant current modalities remaining under investigation that possess promising perspectives for scabies itch (i.e. protease-activated receptor-2 (PAR-2) inhibitor, Mas-related G protein-coupled receptor X2 (MRGPRX2) antagonist) are discussed. Greater understanding of these diverse mechanisms may provide a rational basis for the development of improved and targeted approaches to control itch in individuals with scabies.
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Affiliation(s)
- H S Kim
- Dr Philip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, Miller School of Medicine, University of Miami, Miami, FL, USA.,Department of Dermatology, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - T Hashimoto
- Department of Dermatology, National Defense Medical College, Saitama, Japan
| | - K Fischer
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - C Bernigaud
- Faculté de Santé de Créteil et Service de Dermatologie, APHP, Hôpital Henri-Mondor, Université Paris-Est, Créteil, France.,Research Group Dynamic, EA7380, Faculté de Santé de Créteil, Ecole Nationale Vétérinaire d'Alfort, USC ANSES, Université Paris-Est Créteil, Créteil, France
| | - O Chosidow
- Faculté de Santé de Créteil et Service de Dermatologie, APHP, Hôpital Henri-Mondor, Université Paris-Est, Créteil, France.,Research Group Dynamic, EA7380, Faculté de Santé de Créteil, Ecole Nationale Vétérinaire d'Alfort, USC ANSES, Université Paris-Est Créteil, Créteil, France
| | - G Yosipovitch
- Dr Philip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, Miller School of Medicine, University of Miami, Miami, FL, USA
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6
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Najafi P, Misery L, Carré JL, Ben Salem D, Dufor O. Itch Matrixes. Front Med (Lausanne) 2021; 8:636904. [PMID: 33718409 PMCID: PMC7943862 DOI: 10.3389/fmed.2021.636904] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/25/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Peyman Najafi
- Univ Brest, LIEN, Brest, France.,Paris-Saclay Institute of Neuroscience, Centre National de la Recherche Scientifique/Université Paris-Saclay, Gif-sur-Yvette, France
| | - Laurent Misery
- Univ Brest, LIEN, Brest, France.,University Hospital of Brest, Department of Dermatology, Brest, France
| | | | - Douraied Ben Salem
- Univ Brest, LATIM, INSERM UMR, Brest, France.,University Hospital of Brest, Department of Radiology, Brest, France
| | - Olivier Dufor
- Univ Brest, LIEN, Brest, France.,L@bISEN Yncréa Ouest, ISEN, Brest, France
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7
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Misery L. Pruriplastic Itch-A Novel Pathogenic Concept in Chronic Pruritus. Front Med (Lausanne) 2021; 7:615118. [PMID: 33553207 PMCID: PMC7854543 DOI: 10.3389/fmed.2020.615118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/22/2020] [Indexed: 11/24/2022] Open
Abstract
The International Association for the Study of Pain (IASP) defined three descriptors for pain: nociceptive pain is “pain that arises from actual or threatened damage to non neural tissue and is due to the activation of nociceptors”; neuropathic pain is “pain caused by a lesion or disease of the somatosensory nervous system”; and nociplastic pain is “pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain.” Based on clinical and pathophysiological arguments, a similar definition of “pruriplastic pruritus” should be made. Pruriplastic pruritus would include psychogenic pruritus, as well as some cases of pruritus ani, vulvar pruritus, sensitive skin or other poorly understood cases of pruritus. This new descriptor of itch could serve as systematic screening for altered pruriceptive function in patients who suffer from chronic itch and it may also help in defining better tailored treatment by identifying patients who are likely to respond better to centrally rather than to peripherally targeted therapies.
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8
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Mueller SM, Carruthers HR, Navarini AA, Goldust M, Gysin S, Itin PH. Pruritic and antipruritic colors: An exploratory pilot study. Dermatol Ther 2020; 33:e13447. [DOI: 10.1111/dth.13447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/20/2020] [Indexed: 01/24/2023]
Affiliation(s)
- Simon M. Mueller
- Department of Dermatology University Hospital Basel Basel Switzerland
| | | | | | - Mohamad Goldust
- Department of Dermatology University Hospital Basel Basel Switzerland
- University of Rome G. Marconi Rome Italy
- Department of Dermatology University Medical Center Mainz Mainz Germany
| | - Stefan Gysin
- Department of Dermatology University Hospital Basel Basel Switzerland
- Institute of Primary and Community Care Lucerne Switzerland
- Department of Health Sciences and Health Policy University of Lucerne Lucerne Switzerland
| | - Peter H. Itin
- Department of Dermatology University Hospital Basel Basel Switzerland
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9
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The Skin Microbiota and Itch: Is There a Link? J Clin Med 2020; 9:jcm9041190. [PMID: 32331207 PMCID: PMC7230651 DOI: 10.3390/jcm9041190] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 02/07/2023] Open
Abstract
Itch is an unpleasant sensation that emanates primarily from the skin. The chemical mediators that drive neuronal activity originate from a complex interaction between keratinocytes, inflammatory cells, nerve endings and the skin microbiota, relaying itch signals to the brain. Stress also exacerbates itch via the skin–brain axis. Recently, the microbiota has surfaced as a major player to regulate this axis, notably during stress settings aroused by actual or perceived homeostatic challenge. The routes of communication between the microbiota and brain are slowly being unraveled and involve neurochemicals (i.e., acetylcholine, histamine, catecholamines, corticotropin) that originate from the microbiota itself. By focusing on itch biology and by referring to the more established field of pain research, this review examines the possible means by which the skin microbiota contributes to itch.
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10
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Hashimoto T, Yosipovitch G. Itchy body: Topographical difference of itch and scratching and C Nerve fibres. Exp Dermatol 2019; 28:1385-1389. [DOI: 10.1111/exd.14054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/24/2019] [Accepted: 11/01/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Takashi Hashimoto
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery and Miami Itch Center Miller School of Medicine University of Miami Miami FL USA
| | - Gil Yosipovitch
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery and Miami Itch Center Miller School of Medicine University of Miami Miami FL USA
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11
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Yosipovitch G, Rosen JD, Hashimoto T. Itch: From mechanism to (novel) therapeutic approaches. J Allergy Clin Immunol 2019; 142:1375-1390. [PMID: 30409247 DOI: 10.1016/j.jaci.2018.09.005] [Citation(s) in RCA: 187] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/27/2018] [Accepted: 09/07/2018] [Indexed: 12/13/2022]
Abstract
Itch is a common sensory experience that is prevalent in patients with inflammatory skin diseases, as well as in those with systemic and neuropathic conditions. In patients with these conditions, itch is often severe and significantly affects quality of life. Itch is encoded by 2 major neuronal pathways: histaminergic (in acute itch) and nonhistaminergic (in chronic itch). In the majority of cases, crosstalk existing between keratinocytes, the immune system, and nonhistaminergic sensory nerves is responsible for the pathophysiology of chronic itch. This review provides an overview of the current understanding of the molecular, neural, and immune mechanisms of itch: beginning in the skin, proceeding to the spinal cord, and eventually ascending to the brain, where itch is processed. A growing understanding of the mechanisms of chronic itch is expanding, as is our pipeline of more targeted topical and systemic therapies. Our therapeutic armamentarium for treating chronic itch has expanded in the last 5 years, with developments of topical and systemic treatments targeting the neural and immune systems.
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Affiliation(s)
- Gil Yosipovitch
- Department of Dermatology and Cutaneous Surgery and Miami Itch Center Miller School of Medicine University of Miami, Miami, Fla.
| | - Jordan Daniel Rosen
- Department of Dermatology and Cutaneous Surgery and Miami Itch Center Miller School of Medicine University of Miami, Miami, Fla
| | - Takashi Hashimoto
- Department of Dermatology and Cutaneous Surgery and Miami Itch Center Miller School of Medicine University of Miami, Miami, Fla
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12
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Mueller SM, Mueller F, Reinhardt J, Itin P, Navarini A, Stippich C, Borgwardt S. Assessment of the impact of sex in intensity, skin flares and central processing of histaminergic itch—A pilot study. Exp Dermatol 2019; 28:1493-1500. [DOI: 10.1111/exd.14021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/25/2019] [Accepted: 08/07/2019] [Indexed: 12/21/2022]
Affiliation(s)
| | - Felix Mueller
- Department of Psychiatry University of Basel Basel Switzerland
| | - Julia Reinhardt
- Division of Diagnostic and Interventional Neuroradiology Department of Radiology University Hospital Basel University of Basel Basel Switzerland
- Department of Neuroradiology Clinical Neuroscience Center University Hospital Zurich University of Zurich Zurich Switzerland
| | - Peter Itin
- Department of Dermatology University of Basel Basel Switzerland
| | | | - Christoph Stippich
- Division of Diagnostic and Interventional Neuroradiology Department of Radiology University Hospital Basel University of Basel Basel Switzerland
- Department of Neuroradiology Clinical Neuroscience Center University Hospital Zurich University of Zurich Zurich Switzerland
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13
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Roberts CA, Giesbrecht T, Stancak A, Fallon N, Thomas A, Kirkham TC. Where Is Itch Represented in the Brain, and How Does it Differ from Pain? An Activation Likelihood Estimation Meta-Analysis of Experimentally-Induced Itch. J Invest Dermatol 2019; 139:2245-2248.e3. [PMID: 31054845 DOI: 10.1016/j.jid.2019.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 04/10/2019] [Accepted: 04/12/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Carl A Roberts
- Department of Psychological Sciences, University of Liverpool, United Kingdom.
| | | | - Andrej Stancak
- Department of Psychological Sciences, University of Liverpool, United Kingdom
| | - Nicholas Fallon
- Department of Psychological Sciences, University of Liverpool, United Kingdom
| | | | - Tim C Kirkham
- Department of Psychological Sciences, University of Liverpool, United Kingdom
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14
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Jafferany M, Davari ME. Itch and psyche: psychiatric aspects of pruritus. Int J Dermatol 2018; 58:3-23. [PMID: 29917231 DOI: 10.1111/ijd.14081] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 04/07/2018] [Accepted: 05/16/2018] [Indexed: 01/02/2023]
Abstract
Itch, also referred to as pruritus, is an unpleasant cutaneous sensation provoking the desire to scratch. It is often an uncomfortable, subjective sensation responsible for decreased quality of life in a variety of psychodermatological conditions. Comorbid psychiatric conditions, including depression and anxiety, are frequently associated with itch and scratch cycle. The reciprocal and intricate relationship between the psyche and itch has been widely studied. The neurobiology of itch involves the complexity of specific mediators, itch-related neuronal pathways, and central processing of itch. The connection between itch and the psyche can be grouped under three headings: pruritic diseases with psychosocial sequelae, pruritic diseases aggravated by psychosocial factors, and psychiatric disorders causing pruritus. Itch and pain modulation go together in most circumstances and involve various substances including histamine, interleukins, protease-activated receptors, transient receptor potential receptors, opioids, and cannabinoids. The close interaction between keratinocytes and nerve endings modulating pain and itch also play a major role. Management of itch associated with its psychosomatic components is directed at an underlying cause and adopting a holistic approach to address not only dermatologic and somatosensory aspects, but also the cognitive, emotional, and psychosocial components. An integrated multidisciplinary team consisting of a dermatologist, psychiatrist, psychologist, and social worker is vital in addressing the multifaceted aspects of pruritus.
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15
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Misery L, Dutray S, Chastaing M, Schollhammer M, Consoli SG, Consoli SM. Psychogenic itch. Transl Psychiatry 2018; 8:52. [PMID: 29491364 PMCID: PMC5830411 DOI: 10.1038/s41398-018-0097-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/06/2017] [Accepted: 11/01/2017] [Indexed: 11/09/2022] Open
Abstract
Psychogenic itch can be defined as "an itch disorder where itch is at the center of the symptomatology and where psychological factors play an evident role in the triggering, intensity, aggravation, or persistence of the pruritus." The disorder is poorly known by both psychiatrists and dermatologists and this review summarizes data on psychogenic itch. Because differential diagnosis is difficult, the frequency is poorly known. The burden is huge for people suffering from this disorder but a management associating psychological and pharmacological approach could be very helpful. Classification, psychopathology, and physiopathology are still debating. New data from brain imaging could be very helpful. Psychological factors are known to modulate itch in all patients, but there is a specific diagnosis of psychogenic itch that must be proposed cautiously. Neurophysiological and psychological theories are not mutually exclusive and can be used to better understand this disorder. Itch can be mentally induced. Opioids and other neurotransmitters, such as acetylcholine and dopamine, are probably involved in this phenomenon.
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Affiliation(s)
- Laurent Misery
- French Psychodermatology Group, French Society of Dermatology, Paris, France. .,Department of Dermatology, University Hospital of Brest, Brest, France. .,Laboratory of Neurosciences of Brest, University of Western Brittany, Brest, France.
| | - Sabine Dutray
- French Psychodermatology Group, French Society of Dermatology, Paris, France ,0000 0004 0472 3249grid.411766.3Department of Dermatology, University Hospital of Brest, Brest, France
| | - Myriam Chastaing
- French Psychodermatology Group, French Society of Dermatology, Paris, France ,0000 0001 2188 0893grid.6289.5Laboratory of Neurosciences of Brest, University of Western Brittany, Brest, France ,Department of Psychiatry and Medical Psychology, Unit of Liaison Psychiatry, Brest, France
| | - Martine Schollhammer
- French Psychodermatology Group, French Society of Dermatology, Paris, France ,0000 0004 0472 3249grid.411766.3Department of Dermatology, University Hospital of Brest, Brest, France
| | - Sylvie G. Consoli
- French Psychodermatology Group, French Society of Dermatology, Paris, France
| | - Silla M. Consoli
- French Psychodermatology Group, French Society of Dermatology, Paris, France ,0000 0004 1788 6194grid.469994.fDepartment of Consultation Liaison Psychiatry, Paris-Descartes University, Sorbonne Paris Cité, Paris, France
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16
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Schut C, Mochizuki H, Grossman SK, Lin AC, Conklin CJ, Mohamed FB, Gieler U, Kupfer J, Yosipovitch G. Brain Processing of Contagious Itch in Patients with Atopic Dermatitis. Front Psychol 2017; 8:1267. [PMID: 28790959 PMCID: PMC5524890 DOI: 10.3389/fpsyg.2017.01267] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/11/2017] [Indexed: 11/13/2022] Open
Abstract
Several studies show that itch and scratching cannot only be induced by pruritogens like histamine or cowhage, but also by the presentation of certain (audio-) visual stimuli like pictures on crawling insects or videos showing other people scratching. This phenomenon is coined "Contagious itch" (CI). Due to the fact that CI is more profound in patients with the chronic itchy skin disease atopic dermatitis (AD), we believe that it is highly relevant to study brain processing of CI in this group. Knowledge on brain areas involved in CI in AD-patients can provide us with useful hints regarding non-invasive treatments that AD-patients could profit from when they are confronted with itch-inducing situations in daily life. Therefore, this study investigated the brain processing of CI in AD-patients. 11 AD-patients underwent fMRI scans during the presentation of an itch inducing experimental video (EV) and a non-itch inducing control video (CV). Perfusion based brain activity was measured using arterial spin labeling functional MRI. As expected, the EV compared to the CV led to an increase in itch and scratching (p < 0.05). CI led to a significant increase in brain activity in the supplementary motor area, left ventral striatum and right orbitofrontal cortex (threshold: p < 0.001; cluster size k > 50). Moreover, itch induced by watching the EV was by trend correlated with activity in memory-related regions including the temporal cortex and the (pre-) cuneus as well as the posterior operculum, a brain region involved in itch processing (threshold: p < 0.005; cluster size k > 50). These findings suggest that the fronto-striatal circuit, which is associated with the desire to scratch, might be a target region for non-invasive treatments in AD patients.
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Affiliation(s)
- Christina Schut
- Institute of Medical Psychology, Justus-Liebig-UniversityGiessen, Germany
| | - Hideki Mochizuki
- Department of Dermatology, Lewis Katz School of Medicine at Temple University, PhiladelphiaPA, United States
- Department of Dermatology and Cutaneous Surgery and Miami Itch Center, Miller School of Medicine, University of Miami, MiamiFL, United States
| | - Shoshana K. Grossman
- Department of Dermatology, Lewis Katz School of Medicine at Temple University, PhiladelphiaPA, United States
| | - Andrew C. Lin
- Department of Dermatology, Lewis Katz School of Medicine at Temple University, PhiladelphiaPA, United States
| | - Christopher J. Conklin
- Department of Radiology, Jefferson Integrated Magnetic Resonance Imaging Center, Thomas Jefferson University, PhiladelphiaPA, United States
| | - Feroze B. Mohamed
- Department of Radiology, Jefferson Integrated Magnetic Resonance Imaging Center, Thomas Jefferson University, PhiladelphiaPA, United States
| | - Uwe Gieler
- Department of Dermatology, University Hospital of Giessen and MarburgGiessen, Germany
| | - Joerg Kupfer
- Institute of Medical Psychology, Justus-Liebig-UniversityGiessen, Germany
| | - Gil Yosipovitch
- Department of Dermatology and Cutaneous Surgery and Miami Itch Center, Miller School of Medicine, University of Miami, MiamiFL, United States
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18
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Mueller SM, Hogg S, Mueller JM, McKie S, Itin P, Reinhardt J, Griffiths CE, Kleyn CE. Functional magnetic resonance imaging in dermatology: The skin, the brain and the invisible. Exp Dermatol 2017; 26:845-853. [DOI: 10.1111/exd.13305] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2017] [Indexed: 01/05/2023]
Affiliation(s)
- Simon M. Mueller
- Department of Dermatology; University Hospital Basel; Basel Switzerland
- Dermatology Centre; The Manchester Academic Health Science Centre; The University of Manchester; Manchester UK
| | - Samuel Hogg
- Department of Dermatology; University Hospital Basel; Basel Switzerland
| | - Jannis M. Mueller
- Department of Neurology; Kantonsspital Muensterlingen; Muensterlingen Switzerland
| | - Shane McKie
- Neuroscience and Psychiatry Unit; The Manchester Academic Health Science Centre; The University of Manchester; Manchester UK
| | - Peter Itin
- Dermatology Centre; The Manchester Academic Health Science Centre; The University of Manchester; Manchester UK
| | - Julia Reinhardt
- Division of Diagnostic & Interventional Neuroradiology; University Hospital Basel; Basel Switzerland
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Mochizuki H, Schut C, Nattkemper LA, Yosipovitch G. Brain mechanism of itch in atopic dermatitis and its possible alteration through non-invasive treatments. Allergol Int 2017; 66:14-21. [PMID: 27688121 DOI: 10.1016/j.alit.2016.08.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 08/30/2016] [Indexed: 01/19/2023] Open
Abstract
Atopic dermatitis (AD) is a common chronic skin disease that is characterized by intense pruritus and has high impairment of quality of life. AD is often described as "the itch that rashes, rather than the rash that itches". Several studies suggest that mechanisms of central modulation play an important role in the development and maintenance of chronic itch. Therefore, treating the neurosensory aspects of itch is an important part in the management of chronic itch. However, little attention has been paid to the role of the central nervous system in the processing of itch in AD. Targeting itch-related anatomical structures in the brain with non-invasive treatments such as psychological interventions and transcranial Direct Current Stimulation (tDCS) could have an antipruritic effect in AD. Therefore, in this review article, we discuss the current progress in brain imaging research of itch, as well as the efficacy of non-invasive interventions for itch relief in this patient group.
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Affiliation(s)
- Hideki Mochizuki
- Department of Dermatology, Lewis Katz School of Medicine, Philadelphia, PA, USA; Temple Itch Center, Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Christina Schut
- Institute of Medical Psychology, Justus-Liebig-University, Giessen, Germany
| | - Leigh A Nattkemper
- Department of Dermatology, Lewis Katz School of Medicine, Philadelphia, PA, USA; Temple Itch Center, Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Gil Yosipovitch
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, USA.
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