Prevalence and Characteristics of Pruritus and Association With Quality of Life in People Living With HIV: A Cross-Sectional Study

HIV: Inflammatory dermatoses

Patients living with HIV may experience a variety of inflammatory dermatoses, ranging from exacerbations of underlying conditions to those triggered by HIV infection itself. This article presents a current literature review on the etiology, diagnosis and management of atopic dermatitis, psoriasis, pityriasis rubra pilaris, lichen planus, seborrheic dermatitis, eosinophilic folliculitis, pruritic papular eruption and pruritus, in patients living with HIV.

How to get rid of itching

Itch is an unpleasant sensation arising from a variety of dermatologic, neuropathic, systemic, and psychogenic etiologies. Various itch pathways are implicated according to the underlying etiology. A variety of pruritogens, or itch mediators, as well as receptors have been identified and provide potential therapeutic targets. Recent research has primarily focused on targeting inflammatory cytokines and Janus kinase signaling, protease-activated receptors, substance P and neurokinin, transient receptor potential-vanilloid ion channels, Mas-related G-protein-coupled receptors (MRGPRX2 and MRGPRX4), the endogenous opioid and cannabinoid balance, and phosphodiesterase 4. Periostin, a newly identified pruritogen, should be further explored with clinical trials. Drugs targeting neural sensitization including the gabergic system and P2X3 are other potential drugs for chronic itch. There is a need for more targeted therapies to improve clinical outcomes and reduce side effects.

Itch in Adult Population with Type 2 Diabetes Mellitus: Clinical Profile, Pathogenesis and Disease-Related Burden in a Cross-Sectional Study

BACKGROUND

Despite growing interest in itch, data regarding itch in type 2 diabetes mellitus (DM2) are still limited, and mostly based on outdated studies. This study aimed to evaluate the clinical characteristics of itch in the adult population with DM2 and explore potential underlying causes.

METHODS

The study group consisted of 109 adult patients with DM2. Standardized questionnaires were completed in order to assess the itch intensity [Numerical Rating Scale (three days, 24hours) (NRS)] and the Four-item Itch Questionnaire (4IIQ) and to assess the psychological impact of itch [ItchyQoL, Six-Item Stigmatization Scale (6-ISS), Hospital Anxiety and Depression Scale (HADS)]. Skin dryness was evaluated clinically and by non-invasive assessment of epidermis moisturizing. Neuropathy was assessed using the clinical Katzenwadel neuropathy scale.

RESULTS

Itch occurred in 35.8% of adult patients with DM2, with NRSmax three days 6.31 ± 2.16 and 8.1 ± 3.5 points in 4IIQ. Itchy patients have had significantly higher FPG levels compared with the non-itchy population (p = 0.01). Patients with itch had a significantly higher possibility of neuropathy compared with non-itchy subjects (p < 0.01). Skin xerosis was significantly more advanced in patients with itch compared to those without (p < 0.01). The mean ItchyQol score was assessed as 41.2 ± 13.4 points, indicating mild life quality impairment and correlated positively with itch intensity. Itchy subjects had significantly higher scores in both anxiety and depression dimensions of HADS (in each p < 0.01).

CONCLUSIONS

We suggest that the primary cause of itch is prolonged poor diabetes control with altered glucose and insulin levels, subsequently causing skin dryness and neuropathy in long-lasting DM2.

Hallazgos en piel en pacientes con infección por VIH en Bogotá

Objetivo Describir los hallazgos en piel y las características sociodemográficas de pacientes VIH positivos atendidos en un centro de remisión en Bogotá. Métodos Se realizó un estudio observacional descriptivo, incluyendo adultos con infección por VIH atendidos en el Hospital Universitario San Ignacio de Bogotá, entre abril de 2019 y febrero de 2020. A partir de un interrogatorio, un examen físico y la revisión de historias clínicas, se registraron hallazgos en piel, datos de terapia antirre- troviral recibida, conteo de linfocitos CD4+ y carga viral para VIH, así como pruebasmicológicas e histopatológicas (cuando fueron necesarias). Resultados Se evaluó un total de 168 pacientes que, en su mayoría, eran hombres (88,7%), en la cuarta década de la vida, de orientación HSH (77,4%), con fototipos del II al IV (97%) y manejados con terapia antirretroviral (94,6%). Se encontraron hallazgos en piel en el 97,6% de los pacientes, siendo más frecuentes las infecciones (43,8%), específicamente los condilomas anogenitales, principalmente en pacientes con <200 linfocitos CD4+/mm3, seguidas por las condiciones inflamatorias (35,4%), principalmente dermatitis seborreica y acné. Este último, más frecuente en pacientes con >200 linfocitos CD4+/mm3. Conclusiones Los hallazgos más frecuentes en piel fueron: dermatitis seborreica, condilomas anogenitales, verrugas virales, moluscos contagiosos y micosis superficiales, que se asemeja a lo reportado en poblaciones con buen control inmunovirológico de la enfermedad. La alta prevalencia de condilomas anogenitales nos invita a imple- mentar estrategias de tamización para VPH, así como de educación en infecciones de transmisión sexual.

A qualitative research study on the illness perception of chronic pruritus in older Asian adults based on the Common-Sense Model of self-regulation

Background

Chronic pruritus (CP), itch lasting more than 6 weeks, is common in community‐dwelling older adults. Understanding their illness perception allows the attending physician to develop a personalised care plan to mitigate CP.

Aim

This study explores the illness perception of CP among older Asian adults in an urban community.

Design

Qualitative research was conducted, framed by the Common‐Sense Model of self‐regulation (CSM). Through in‐depth interviews (IDIs), qualitative data were gathered from Asian patients with CP, and then a thematic analysis was carried out. The emergent themes were grouped according to the five domains of CSM: ‘identity’, ‘cause’, ‘time’, ‘controllability’ and ‘consequence’.

Setting and Patients

IDIs were conducted in a Singapore public primary care clinic before the data were saturated.

Results

The CSM domains illustrate the illness perception of CP. CP was identified as a ‘problem’ rather than a disease and was often described in metaphor. Patients' perception of the cause was diverse due to the lack of provision of a clear explanation by their physicians. They opined that CP continued indefinitely. Without definite time to resolution, patients adapted their help‐ and health‐seeking behaviours to control it. The consequences included therapeutic experimentation, alternative therapy, self‐isolation, avoidance behaviours, emotional disturbance and dermatological complications.

Conclusion and Patient Contribution

Patients provided information on their perception of CP, which aligned with the CSM. A multipronged approach is needed to deliver holistic and personalised care to patients with CP, providing clarity on its natural progression, to set their expectations on its timeline, treatment effectiveness and undertake appropriate behaviour modification to adapt to its chronicity.

Emerging drugs for the treatment of chronic pruritic diseases

INTRODUCTION

Chronic pruritus is non-histaminergic and mediated through a complex interplay of peripheral and central immune and neural pathways. Significant developments in the understanding of chronic pruritus have emerged and paved the way for new, emerging therapies.

AREAS COVERED

This review details the emerging drug landscape for chronic pruritus treatment, focusing on monoclonal antibody agents that target key cytokines and their receptors as well as small molecule agents that inhibit mediators of the immune and neural pathways. The article provides background regarding the currently available therapies and the rationale for the development of new agents based on the current market and recent scientific developments.

EXPERT OPINION

Identification of new targets along neuroimmune itch pathways has allowed for the development of targeted drugs which can be utilized for effective therapy. As we enter a new era of chronic itch treatments, we face exciting prospects and challenges.