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Brooks SG, Yosipovitch G. Adjunctive Management of Itch in Atopic Dermatitis. Dermatol Clin 2024; 42:577-589. [PMID: 39278711 DOI: 10.1016/j.det.2024.04.008] [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] [Indexed: 09/18/2024]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin condition that can be difficult to treat due to a complex etiology and diverse clinical presentations. Itch is the most common symptom associated with AD with profound negative impact on quality of life. Thus, the adjunctive management of itch in patients with AD is needed to control and reduce disease burden. Supplemental treatment options are continuously emerging and undergoing testing in clinical trials. This article summarizes the latest data on topical and systemic adjunctive therapies for AD safety and efficacy in reducing itch.
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Affiliation(s)
- Sarah G Brooks
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, 5555 Ponce de Leon Boulevard, Coral Gables, FL 33146, USA
| | - Gil Yosipovitch
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, 5555 Ponce de Leon Boulevard, Coral Gables, FL 33146, USA.
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Tanaka A, Igawa K, Takahashi H, Shimizu R, Kataoka Y, Torisu-Itakura H, Morisaki Y, Montmayeur S, Katoh N. Lebrikizumab Combined with Topical Corticosteroids Improves Patient-reported Outcomes in Japanese Patients with Moderate-to-severe Atopic Dermatitis. Acta Derm Venereol 2024; 104:adv34375. [PMID: 39248292 PMCID: PMC11403364 DOI: 10.2340/actadv.v104.34375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 07/18/2024] [Indexed: 09/10/2024] Open
Abstract
Lebrikizumab has previously demonstrated efficacy in Phase 3 trials: ADvocate1 and ADvocate2 (as monotherapy), ADhere, and ADhere-J (in combination with topical corticosteroids). Here, the impact of lebrikizumab combined with low- to mid-potency topical corticosteroids on patient-reported outcomes at 16 weeks in Japanese patients with moderate-to-severe atopic dermatitis is evaluated. Eligible patients (n = 286) were randomized 2:2:3 to receive placebo+ topical corticosteroids, 250 mg lebrikizumab every 4 weeks (LEBQ4W+topical corticosteroids, 500 mg loading dose at baseline), or 250 mg lebrikizumab every 2 weeks (LEBQ2W+ topical corticosteroids, 500 mg loading dose at baseline and Week 2) by subcutaneous injection. All PRO endpoints for the study were met; patients in the lebrikizumab in combination with topical corticosteroids groups demonstrated statistically significant and clinically meaningful improvements compared with placebo in combination with topical corticosteroids in Skin Pain NRS, DLQI, POEM, WPAI-AD, and SCORAD scales. Lebrikizumab combined with topical corticosteroids compared with placebo+topical corticosteroids improved patient-reported outcomes in Japanese patients with moderate-to-severe atopic dermatitis.
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Affiliation(s)
- Akio Tanaka
- Department of Dermatology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ken Igawa
- Dokkyo Medical University, Dokkyo, Japan
| | | | | | | | | | | | | | - Norito Katoh
- Kyoto Prefectural University of Medicine, Kyoto, Japan
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Labib A, Yosipovitch G. An evaluation of abrocitinib for moderate-to-severe atopic dermatitis. Expert Rev Clin Immunol 2022; 18:1107-1118. [PMID: 36173402 DOI: 10.1080/1744666x.2022.2126353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Atopic dermatitis (AD) is a common itchy inflammatory skin condition that affects many individuals. For many years, the landscape of AD treatment remained unchanged; however, there has been developing therapies that directly target the underlying immunological mechanism of AD. Janus kinase (JAK) inhibitors are small molecules that have shown anti-inflammatory and anti-itch effects in AD. Recently, abrocitinib, an oral JAK 1 inhibitor, was approved by the Food and Drug Administration for atopic dermatitis. AREAS COVERED By downregulating the immune cascade, abrocitinib has demonstrated the ability to curb symptoms of AD, including rapidly reducing pruritus in 2-3 days, and is safe and well-tolerated overall despite a low increased risk in infection. The data discussed was obtained from a comprehensive literature review utilizing PubMed. EXPERT OPINION Abrocitinib has strong efficacy, likely due to its broader mechanism of action provided by the inhibition of key regulatory molecule, JAK. Results have demonstrated that it is more efficacious at curbing symptoms of AD than dupilumab, the current treatment of choice for refractory, moderate-to-severe AD. While abrocitinib provides a great alternative treatment, particularly for non-responders and AD subtypes, it also demonstrates a stronger side effect profile that must be considered.
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Affiliation(s)
- Angelina Labib
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery and Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Gil Yosipovitch
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery and Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
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Son B, Lee H. Acupuncture treatment for tinea pedis of the foot in a Korean military hospital: a case report. Acupunct Med 2022; 40:493-495. [PMID: 35670052 DOI: 10.1177/09645284221086290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Byunwoo Son
- Department of Korean Medicine, VII Corps, Icheon-si, Republic of Korea
| | - Hyeonhoon Lee
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
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Lipman ZM, Labib A, Yosipovitch G. Current Clinical Options for the Management of Itch in Atopic Dermatitis. Clin Cosmet Investig Dermatol 2021; 14:959-969. [PMID: 34377004 PMCID: PMC8349193 DOI: 10.2147/ccid.s289716] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/13/2021] [Indexed: 12/16/2022]
Abstract
Pruritus is the most burdensome and prevalent symptom in patients suffering from atopic dermatitis. Treating atopic itch has historically been a challenge due to multiple underlying mechanisms within its pathogenesis and an incomplete understanding of them. In recent years, our understanding of these mechanisms have increased tremendously and subsequently, new treatments have reached the market that target the pathophysiology of atopic itch from different angles. In addition, there are several promising new treatments currently in development and trials. In the current article, we discuss these currently available treatment options, their available evidence and efficacy, and highlight some of the more recent advancements in the field.
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Affiliation(s)
- Zoe M Lipman
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery and Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Angelina Labib
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery and Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Gil Yosipovitch
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery and Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
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Guttman-Yassky E, Blauvelt A, Eichenfield LF, Paller AS, Armstrong AW, Drew J, Gopalan R, Simpson EL. Efficacy and Safety of Lebrikizumab, a High-Affinity Interleukin 13 Inhibitor, in Adults With Moderate to Severe Atopic Dermatitis: A Phase 2b Randomized Clinical Trial. JAMA Dermatol 2020; 156:411-420. [PMID: 32101256 PMCID: PMC7142380 DOI: 10.1001/jamadermatol.2020.0079] [Citation(s) in RCA: 207] [Impact Index Per Article: 51.8] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Question Is lebrikizumab, a novel, high-affinity, monoclonal antibody targeting interleukin 13 that selectively inhibits interleukin 13 signaling, efficacious and safe in adults with moderate to severe atopic dermatitis? Findings Among 280 patients with moderate to severe atopic dermatitis in this phase 2b, placebo-controlled randomized clinical trial, lebrikizumab statistically significantly improved measures of clinical manifestations of atopic dermatitis, pruritus, and quality of life in a dose-dependent manner vs placebo during 16 weeks of treatment. Meaning Lebrikizumab was efficacious for adults with moderate to severe atopic dermatitis, was generally well tolerated, and had a favorable safety profile consistent with previous lebrikizumab studies; these data support the central role of interleukin 13 in the pathophysiology of atopic dermatitis. Importance Interleukin 13 (IL-13) is a central pathogenic mediator driving multiple features of atopic dermatitis (AD) pathophysiology. Objective To evaluate the efficacy and safety of lebrikizumab, a novel, high-affinity, monoclonal antibody targeting IL-13 that selectively prevents formation of the IL-13Rα1/IL-4Rα heterodimer receptor signaling complex, in adults with moderate to severe AD. Design, Setting, and Participants A phase 2b, double-blind, placebo-controlled, dose-ranging randomized clinical trial of lebrikizumab injections every 4 weeks or every 2 weeks was conducted from January 23, 2018, to May 23, 2019, at 57 US centers. Participants were adults 18 years or older with moderate to severe AD. Interventions Patients were randomized 2:3:3:3 to placebo every 2 weeks or to subcutaneous injections of lebrikizumab at the following doses: 125 mg every 4 weeks (250-mg loading dose [LD]), 250 mg every 4 weeks (500-mg LD), or 250 mg every 2 weeks (500-mg LD at baseline and week 2). Main Outcomes and Measures The primary end point was percentage change in the Eczema Area and Severity Index (EASI) (baseline to week 16). Secondary end points for week 16 included proportion of patients achieving Investigator’s Global Assessment score of 0 or 1 (IGA 0/1); EASI improvement of at least 50%, 75%, or 90% from baseline; percentage change in the pruritus numeric rating scale (NRS) score; and pruritus NRS score improvement of at least 4 points. Safety assessments included treatment-emergent adverse events. Results A total of 280 patients (mean [SD] age, 39.3 [17.5] years; 166 [59.3%] female) were randomized to placebo (n = 52) or to lebrikizumab at doses of 125 mg every 4 weeks (n = 73), 250 mg every 4 weeks (n = 80), or 250 mg every 2 weeks (n = 75). Compared with placebo (EASI least squares mean [SD] percentage change, −41.1% [56.5%]), lebrikizumab groups showed dose-dependent, statistically significant improvement in the primary end point vs placebo at week 16: 125 mg every 4 weeks (−62.3% [37.3%], P = .02), 250 mg every 4 weeks (−69.2% [38.3%], P = .002), and 250 mg every 2 weeks (−72.1% [37.2%], P < .001). Differences vs placebo-treated patients (2 of 44 [4.5%]) in pruritus NRS improvement of at least 4 points were seen as early as day 2 in the high-dose lebrikizumab group (9 of 59 [15.3%]). Treatment-emergent adverse events were reported in 24 of 52 placebo patients (46.2%) and in lebrikizumab patients as follows: 42 of 73 (57.5%) for 125 mg every 4 weeks, 39 of 80 (48.8%) for 250 mg every 4 weeks, and 46 of 75 (61.3%) for 250 mg every 2 weeks; most were mild to moderate and did not lead to discontinuation. Low rates of injection-site reactions (1 of 52 [1.9%] in the placebo group vs 13 of 228 [5.7%] in all lebrikizumab groups), herpesvirus infections (2 [3.8%] vs 8 [3.5%]), and conjunctivitis (0% vs 6 [2.6%]) were reported. Conclusions and Relevance During 16 weeks of treatment, lebrikizumab provided rapid, dose-dependent efficacy across a broad range of clinical manifestations in adult patients with moderate to severe AD and demonstrated a favorable safety profile. These data support the central role of IL-13 in AD pathophysiology. If these findings replicate in phase 3 studies, lebrikizumab may meaningfully advance the standard of care for moderate to severe AD. Trial Registration ClinicalTrials.gov Identifier: NCT03443024
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Affiliation(s)
- Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Andrew Blauvelt
- Principal Investigator and President, Oregon Medical Research Center, Portland
| | - Lawrence F Eichenfield
- Department of Dermatology, University of California, San Diego.,Department of Pediatrics, University of California, San Diego.,Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, California
| | - Amy S Paller
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - April W Armstrong
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles
| | | | | | - Eric L Simpson
- Department of Dermatology, Oregon Health & Science University, Portland
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Rietcheck H, Maghfour J, Rundle C, Husayn S, Presley C, Sillau S, Liu Y, Leehey M, Dunnick C, Dellavalle R. A Review of the Current Evidence Connecting Seborrheic Dermatitis and Parkinson’s Disease and the Potential Role of Oral Cannabinoids. Dermatology 2020; 237:872-877. [DOI: 10.1159/000512189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/13/2020] [Indexed: 11/19/2022] Open
Abstract
Parkinson’s disease (PD) is a neurodegenerative disorder associated with multiple comorbidities, including seborrheic dermatitis (SD), which develops in more than half of PD patients. SD in patients with PD can be severe and frequently intractable by traditional topical therapy. Cannabinoids possess anti-inflammatory and neuromodulatory properties working within the intrinsic endocannabinoid system, the activation of which may alleviate the motor symptoms of PD. The effect of cannabinoids on SD is unknown. Here we explore the pathophysiological mechanisms and possible therapeutic role of oral cannabinoids in PD patients with SD, and review speculative mechanisms underlying the association of PD and SD. Current data supporting the use of cannabinoids in both PD and SD, as well as oral cannabinoid safety and tolerability, are presented. Cannabinoids may provide the possibility of simultaneous treatment of both SD and PD. Specific SD studies and additional safety data on oral cannabinoids are needed.
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Misery L, Belloni Fortina A, El Hachem M, Chernyshov P, Kobyletzki L, Heratizadeh A, Marcoux D, Aoki V, Zaniboni M, Stalder J, Eichenfield L. A position paper on the management of itch and pain in atopic dermatitis from the International Society of Atopic Dermatitis (ISAD)/Oriented Patient‐Education Network in Dermatology (OPENED) task force. J Eur Acad Dermatol Venereol 2020; 35:787-796. [DOI: 10.1111/jdv.16916] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/21/2020] [Indexed: 02/06/2023]
Affiliation(s)
- L. Misery
- Department of Dermatology and Expert Center on Pruritus University Hospital of Brest Brest France
| | | | - M. El Hachem
- Dermatology Unit Bambino Gesù Children's HospitalIRCCS Rome Italy
| | - P. Chernyshov
- Department of Dermatology and Venereology National Medical University Kiev Ukraine
| | - L. Kobyletzki
- Department of Medical Research Lund University Malmö Sweden
- Centre for Clinical Research Örebro University Örebro Sweden
| | - A. Heratizadeh
- Department of Dermatology and Allergy Hannover Medical School Hannover Germany
| | - D. Marcoux
- Division of Dermatology Department of Pediatrics University of MontrealSte‐Justine Hospital Montreal QC Canada
| | - V. Aoki
- Department of Dermatology University of Sao Paulo Medical School Sao Paulo Brazil
| | - M.C. Zaniboni
- Department of Dermatology University of Sao Paulo Medical School Sao Paulo Brazil
| | - J.‐F. Stalder
- Department of Dermatology University Hospital of Nantes Nantes France
| | - L.F. Eichenfield
- Departments of Dermatology and Pediatrics University of California San Diego CA USA
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10
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Abstract
Atopic dermatitis (AD) is a chronic pruritic inflammatory skin disease in which management with topical anti-inflammatory agents during exacerbations remains the mainstay of treatment. With no cure in sight, a significant proportion of patients elect to incorporate complementary and alternative medicine (CAM) as an adjunct to conventional treatment. Many clinicians find it difficult to provide recommendations as the field covers an extensive number of very disparate therapies, with limited quality evidence to indicate efficacy. Since publication of the last review on this topic in the Journal that compiled and analyzed randomized controlled trials (RCTs) on CAMs in 2015, several new studies have surfaced. This update aims to aggregate and review these new data. A literature search was conducted in the PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Global Resource for EczemA Trials (GREAT) databases for RCTs on complementary and alternative therapies in AD from March 2015 through May 2018, resulting in 15 studies being included in this review. The preliminary results for many treatments such as vitamin E, East Indian Sandalwood Oil (EISO), melatonin, L-histidine, and Manuka honey show positive clinical effects, but there is currently not enough evidence to recommend their use in AD therapy. Future investigative efforts should focus on reproducing some of these studies with a larger sample size whose clinical characteristics and demographics are more reflective of the general AD population, and standardizing the process to produce reliable data.
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Manway M, Blackburn S, Barr J, Hull E, Averitte R, Ahn Y. Effects of acupuncture on chronic idiopathic pruritus: an uncontrolled pilot study evaluating inflammatory changes with treatment. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2018; 16:/j/jcim.ahead-of-print/jcim-2018-0021/jcim-2018-0021.xml. [PMID: 30391935 DOI: 10.1515/jcim-2018-0021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 10/04/2018] [Indexed: 11/15/2022]
Abstract
Background Conduct a pilot study addressing the efficacy of acupuncture in the treatment of chronic idiopathic pruritus to aid in the design of a larger clinical trial. Routine laboratory tests to assess systemic inflammation in addition to subjective patient surveys were performed provide documentation of efficacy of treatment. Methods Patients with chronic pruritus who did not respond to standard treatment were recruited to participate. After exclusion of systemic or known reversible causes, each patient received up to 10 treatments which were performed approximately one week apart. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured before and after a series of acupuncture treatments to evaluate levels of inflammation and pre- and post-treatment surveys were conducted to evaluate levels of perceived itch. Results Only one of the ten patients in this study possessed an elevation of ESR before treatment. This patient's ESR value returned to normal range after treatment and this participant reported subjective relief of her pruritus. Conclusions Future studies on the efficacy of acupuncture in the treatment of chronic idiopathic pruritus should focus on those patients with measurable levels of inflammation at the initiation of the study or utilize alternative and more comprehensive values to monitor disease response.
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Affiliation(s)
- Mitchell Manway
- Affiliated Dermatology & Affiliated Laboratories, Midwestern University Osteopathic Postdoctoral Training Institute, Scottsdale, AZ, USA
| | - Stephanie Blackburn
- Affiliated Dermatology & Affiliated Laboratories, Midwestern University Osteopathic Postdoctoral Training Institute, Scottsdale, AZ, USA
| | - Jason Barr
- Affiliated Dermatology & Affiliated Laboratories, Midwestern University Osteopathic Postdoctoral Training Institute, Scottsdale, AZ, USA
| | - Elizabeth Hull
- Biomedical Sciences Program, College of Graduate Studies, Midwestern University, 19555 N 59Avenue, Glendale, AZ 85308, USA
| | - Richard Averitte
- Affiliated Dermatology & Affiliated Laboratories, Midwestern University Osteopathic Postdoctoral Training Institute, Scottsdale, AZ, USA
| | - Yang Ahn
- Medical Acupuncture, Ahn Clinic, Scottsdale, AZ, USA
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Itch induced by peripheral mu opioid receptors is dependent on TRPV1-expressing neurons and alleviated by channel activation. Sci Rep 2018; 8:15551. [PMID: 30341332 PMCID: PMC6195532 DOI: 10.1038/s41598-018-33620-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 09/28/2018] [Indexed: 12/16/2022] Open
Abstract
Opioids remain the gold standard for the treatment of moderate to severe pain. However, their analgesic properties come with important side effects, including pruritus, which occurs frequently after systemic or neuraxial administration. Although part of the opioid-induced itch is mediated centrally, recent evidence shows that the opioid receptor system in the skin also modulates itch. The goal of our study was to identify the peripherally located transducer mechanisms involved in opioid-induced pruritus. Scratching behaviors in response to an intradermal injection of the mu-opioid receptor (MOR) agonist [D-Ala2, N-MePhe4, Gly-ol]-enkephalin (DAMGO) was quantified in mast cell-, PAR2- and TRPV1-deficient mice or following ablation of TRPV1+ sensory neurons. We found that mast cells−/−, PAR-2−/−, or TRPV1−/− mice still exhibit DAMGO-induced itch responses. However, we show that ablation of TRPV1+ neurons or acute TRPV1 activation by capsaicin abolishes DAMGO-induced itch. Overall, our work shows that peripheral DAMGO-induced itch is dependent on the presence of TRPV1-expressing pruriceptors, but not the TRPV1 channel itself. Activation of these fibers by capsaicin prevents the opioid-induced itch.
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Barbiturates enhance itch-associated scratching in atopic dermatitis mice: A possible clue to understanding nocturnal pruritus in atopic dermatitis. Eur J Pharmacol 2018; 836:57-66. [PMID: 30125561 DOI: 10.1016/j.ejphar.2018.08.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/07/2018] [Accepted: 08/14/2018] [Indexed: 11/20/2022]
Abstract
In chronic pruritic diseases such as atopic dermatitis, pruritus is exacerbated during nocturnal sleep; however, the underlying mechanism remains unclear. We previously demonstrated that acute administration of the sedative-hypnotics ethanol markedly enhanced itch-associated spontaneous scratching in a diet-induced mouse model of atopic dermatitis. In the present study, to expand our previous finding and provide a general mechanism for the central modulation of chronic itch, we examined whether other hypnotic drugs, such as barbiturates and benzodiazepines, also enhance scratching, and further investigated the underlying mechanism. Barbiturates markedly enhanced spontaneous scratching in the atopic dermatitis model but not controls. However, unexpectedly, benzodiazepines only slightly increased scratching, and the selective γ-aminobutyric acid type A (GABAA) receptor agonist, muscimol, had no effect. Local injection studies have demonstrated that barbiturates act at the supraspinal level to enhance scratching. Barbiturate-induced scratching was inhibited not only by GABAA receptor antagonists but also by an L-type voltage-dependent calcium channel (L-VDCC) agonist and an α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) glutamate receptor agonist. An intracisternally injected AMPA receptor antagonist alone or in combination with an L-VDCC antagonist sufficiently enhanced scratching. Barbiturate-induced scratching enhancement was observed in another atopic dermatitis model, NC/Nga, but not in histamine-induced acute itch model in normal healthy mice. Overall, our results suggest that a synergistic effect among AMPA receptor inhibition, GABAA receptor activation, and L-VDCC inhibition in the brain mediates barbiturate-induced scratching in atopic dermatitis mice. This observation may provide a novel clue to understanding a supraspinal itch mechanism in chronic diseases such as atopic dermatitis.
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Zhi WI, Ingram E, Li SQ, Chen P, Piulson L, Bao T. Acupuncture for Bortezomib-Induced Peripheral Neuropathy: Not Just for Pain. Integr Cancer Ther 2018; 17:1079-1086. [PMID: 30027756 PMCID: PMC6247555 DOI: 10.1177/1534735418788667] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: Bortezomib-induced peripheral neuropathy (BIPN) is a
common and debilitating side effect. Our pilot study demonstrated that
acupuncture is safe and can decrease total neuropathic symptoms. However, there
is lack of knowledge in which individual BIPN symptoms benefited from
acupuncture. Purpose: To characterize individual symptoms reduced
by acupuncture in patients with BIPN. Methods: Patients with
multiple myeloma treated with bortezomib who developed BIPN grade 2 or above,
based on National Cancer Institute Common Terminology Criteria for Adverse
Events (NCI CTCAE), were enrolled and received 10 acupuncture treatments over 10
weeks. Self-reported BIPN-associated symptoms assessments were collected weekly
at baseline, during, and after acupuncture treatment using the Neuropathy Pain
Scale (NPS) and the Functional Assessment of Cancer Therapy/Gynecologic Oncology
Group–Neurotoxicity (FACT/GOG-Ntx) questionnaires. Changes in individual
symptoms were analyzed based on FACT/GOG-Ntx and NPS scores.
Results: There were statistically significant reductions in
individual symptoms in both NPS and FACT/GOG-Ntx. The FACT/GOG-Ntx reductions
were most pronounced in hand/feet numbness/tingling, discomfort, and trouble
walking. The sensory symptoms, such as tingling and numbness, especially in the
feet, reduced the most (P < .0001), and motor dysfunction
also reduced significantly (P = .0001). Both hearing and
dysfunction scores were also statistically significantly increased, indicating
improved symptoms. The NPS scores showed significant symptom relief in all 10
items from the NPS assessment, particularly in cold sensitivity and an
unpleasant feeling. Conclusions: Acupuncture can improve multiple
symptoms associated with BIPN, particularly numbness and tingling in hands and
feet, cold sensitivity, and an unpleasant feeling. Further randomized control
trials are warranted to confirm our findings.
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Affiliation(s)
- W Iris Zhi
- 1 Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Susan Qing Li
- 1 Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Patricia Chen
- 1 Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lauren Piulson
- 1 Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ting Bao
- 1 Memorial Sloan Kettering Cancer Center, New York, NY, USA
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