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Huang X, Xie J, Yang Y, Dai X, Lu L, Li N, Li Y, Wang S, Zhang L. Brain network mechanism of acupuncture for chronic spontaneous urticaria: a functional magnetic resonance imaging study protocol. Front Neurol 2023; 14:1263753. [PMID: 37920832 PMCID: PMC10619855 DOI: 10.3389/fneur.2023.1263753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/18/2023] [Indexed: 11/04/2023] Open
Abstract
Introduction Chronic spontaneous urticaria (CSU) is a common skin condition that can significantly impact patients' quality of life. Although studies have demonstrated the efficacy of acupuncture in treating CSU, the underlying mechanisms remain unclear. Dysfunction within the brain's default mode network (DMN) represents a fundamental characteristic of central pathological changes associated with CSU. Therefore, it is hypothesized that improving brain network dysfunction could serve as a key mechanism through which acupuncture exerts its therapeutic effects. This study aims to provide evidence supporting this hypothesis. Methods and analysis This study, a parallel, randomized, sham-controlled functional neuroimaging investigation will be conducted in China. We aim to enroll 50 patients with CSU and 25 healthy controls, distributing them evenly between the acupuncture and sham acupuncture groups in a 1:1 ratio. The total observation period will span 6 weeks, including 2 weeks designated for the baseline phase and 4 weeks allocated for the clinical treatment phase. Prior to treatment, all participants will undergo magnetic resonance scanning, clinical index detection, and microbiota collection. Following treatment, the patients with CSU will be retested for these indicators. Using resting-state functional connectivity (rsFC) analysis, dynamic Functional Connection (dFC) analysis, and brain microstate extraction technology combined with correlation analysis of microbiota and clinical indicators, the regulatory mechanism of acupuncture on the brain network of CSU will be evaluated from multiple dimensions. Ethics and dissemination This trial was approved by the Biomedical Ethics Review Committee of the West China Hospital, Sichuan University (No. 2022-1255). Each participant will provide written informed consent to publish any potentially identifiable images or data.Clinical trial registrationhttps://www.chictr.org.cn/, identifier: ChiCTR2200064563.
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Affiliation(s)
- Xianhao Huang
- Division of Internal Medicine, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Xie
- Chengdu Xinjin District Hospital of Traditional Chinese Medicine, Chengdu, China
| | - Yang Yang
- Division of Internal Medicine, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xuechun Dai
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Lingyun Lu
- Division of Internal Medicine, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Ning Li
- Division of Internal Medicine, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Li
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Song Wang
- Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology and Huaxi MR Research Center (HMRRC), West China Hospital, Sichuan University, Chengdu, China
| | - Leixiao Zhang
- Division of Internal Medicine, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
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2
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Kim HJ, Lee EH, Lim YH, Jeong D, Na HS, Jung Y. Pathophysiological Role of TLR4 in Chronic Relapsing Itch Induced by Subcutaneous Capsaicin Injection in Neonatal Rats. Immune Netw 2022; 22:e20. [PMID: 35573151 PMCID: PMC9066010 DOI: 10.4110/in.2022.22.e20] [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: 09/03/2021] [Revised: 12/24/2021] [Accepted: 12/27/2021] [Indexed: 12/01/2022] Open
Abstract
Despite the high prevalence of chronic dermatitis and the accompanied intractable itch, therapeutics that specifically target itching have low efficacy. Increasing evidence suggests that TLRs contribute to immune activation and neural sensitization; however, their roles in chronic itch remain elusive. Here, we show that the RBL-2H3 mast cell line expresses TLR4 and that treatment with a TLR4 antagonist opposes the LPS dependent increase in mRNA levels of Th2 and innate cytokines. The pathological role of TLR4 activation in itching was studied in neonate rats that developed chronic itch due to neuronal damage after receiving subcutaneous capsaicin injections. Treatment with a TLR4 antagonist protected these rats with chronic itch against scratching behavior and chronic dermatitis. TLR4 antagonist treatment also restored the density of cutaneous nerve fibers and inhibited the histopathological changes that are associated with mast cell activation after capsaicin injection. Additionally, the expression of IL-1β, IL-4, IL-5, IL-10, and IL-13 mRNA in the lesional skin decreased after TLR4 antagonist treatment. Based on these data, we propose that inhibiting TLR4 alleviated itch in a rat model of chronic relapsing itch, and the reduction in the itch was associated with TLR4 signaling in mast cells and nerve fibers.
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Affiliation(s)
- Hee Joo Kim
- Department of Dermatology, Gachon Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
- Lee Gil Ya Cancer and Diabetes Institute, Gachon University College of Medicine, Incheon, Korea
| | - Eun-Hui Lee
- Lee Gil Ya Cancer and Diabetes Institute, Gachon University College of Medicine, Incheon, Korea
- Department of Microbiology, Gachon University College of Medicine, Incheon, Korea
| | - Yoon Hee Lim
- Lee Gil Ya Cancer and Diabetes Institute, Gachon University College of Medicine, Incheon, Korea
- Department of Microbiology, Gachon University College of Medicine, Incheon, Korea
| | - Dongil Jeong
- Department of Dermatology, Gachon Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Heung Sik Na
- Department of Physiology, Korea University College of Medicine, Seoul, Korea
| | - YunJae Jung
- Lee Gil Ya Cancer and Diabetes Institute, Gachon University College of Medicine, Incheon, Korea
- Department of Microbiology, Gachon University College of Medicine, Incheon, Korea
- Department of Health Science and Technology, Gachon Advanced Institute for Health Science & Technology, Gachon University, Incheon, Korea
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3
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Lu PH, Tai YC, Yu MC, Lin IH, Kuo KL. Western and complementary alternative medicine treatment of uremic pruritus: A literature review. Tzu Chi Med J 2021; 33:350-358. [PMID: 34760630 PMCID: PMC8532575 DOI: 10.4103/tcmj.tcmj_151_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/10/2020] [Accepted: 09/18/2020] [Indexed: 12/28/2022] Open
Abstract
Uremic pruritus (UP), also called chronic kidney disease-associated pruritus (CKD-aP), is a bothersome symptom that causes sleep disturbance, anxiety, depression, and reduced quality of life. Pruritus often occurs in patients with end-stage renal disease. There is still no definite treatment for UP due to its unclear pathogenesis. We searched electronic databases (PubMed and Google Scholar) and gathered the latest clinical trials and pilot studies of Western and complementary alternative medicine (CAM) therapies for UP in English. These UP studies were separated into three main groups: systemic, topical, and others and CAM. Gabapentin, nalfurafine, acupuncture, and Chinese herbal bath therapy (CHBT) show antipruritic effects, with higher evidence grades in the meta-analysis. Emollients with additive compounds are more effective for reducing itch than emollients without additives. Supplements for deficient elements, such as zinc, omega-3, and omega-6, also show benefits for pruritus improvement. CAM therapies such as acupuncture, herbs, and herbal baths or creams all have good results for UP treatment. We summarize the treatments and suggest a treatment algorithm for UP according to severity. Some UP therapies are already supported by large-scale clinical evidence, and some new treatments can provide patients with new hope and treatment options. However, these new methods still need large population studies and further exploration.
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Affiliation(s)
- Ping-Hsun Lu
- Department of Chinese Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.,School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yu-Chih Tai
- Department of Chinese Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Min-Chien Yu
- Department of Chinese Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - I-Hsin Lin
- School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan
| | - Ko-Lin Kuo
- Division of Nephrology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
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4
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Satoh T, Yokozeki H, Murota H, Tokura Y, Kabashima K, Takamori K, Shiohara T, Morita E, Aiba S, Aoyama Y, Hashimoto T, Katayama I. 2020 guidelines for the diagnosis and treatment of cutaneous pruritus. J Dermatol 2021; 48:e399-e413. [PMID: 34288036 DOI: 10.1111/1346-8138.16066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 11/27/2022]
Abstract
The mechanisms underlying itch are not fully understood. Physicians usually encounter difficulty controlling itch in generalized pruritus. Since only a small percentage of patients with generalized pruritus respond to antihistamines (H1 receptor antagonists), a variety of itch mediators and mechanisms other than histaminergic signals are considered to be involved in itch for these non-responsive patients. In 2012, we created guidelines for generalized pruritus. Those guidelines have been updated and revised to make some of the definitions, diagnostic terms, and classifications more applicable to daily clinical practice. Cutaneous pruritus as designated in these guidelines is a disease characterized by itch without an observable rash. Generalized pruritus (without skin inflammation) is defined as the presence of itch over a wide area, and not localized to a specific part of the body. This entity includes idiopathic pruritus, pruritus in the elderly, symptomatic pruritus, pregnancy-associated pruritus, drug-induced pruritus, and psychogenic pruritus. Localized pruritus (without skin inflammation) represents fixed itch localized to a specific part of the body, and includes anogenital pruritus, scalp pruritus, notalgia paresthetica, and brachioradial pruritus. These guidelines outline the current concepts and specify the diagnostic methods/treatments for cutaneous pruritus.
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Affiliation(s)
- Takahiro Satoh
- Department of Dermatology, National Defense Medical College, Tokorozawa, Japan
| | - Hiroo Yokozeki
- Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroyuki Murota
- Department of Dermatology, School of Medical Sciences, Nagasaki University, Nagasaki, Japan
| | - Yoshiki Tokura
- Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kenji Kabashima
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kenji Takamori
- Juntendo Itch Research Center, Institute for Environmental and Gender-specific Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tetsuo Shiohara
- Department of Dermatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Eishin Morita
- Department of Dermatology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Setsuya Aiba
- Department of Dermatology, Tohoku University School of Medicine, Sendai, Japan
| | - Yumi Aoyama
- Department of Dermatology, Kawasaki Medical School, Kurashiki, Japan
| | - Takashi Hashimoto
- Department of Dermatology, National Defense Medical College, Tokorozawa, Japan
| | - Ichiro Katayama
- Department of Dermatology, Course of Integrated Medicine Graduate School of Medicine, Osaka University, Suita, Japan
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5
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Mast Cell Mediators as Pain Triggers in Migraine: Comparison of Histamine and Serotonin in the Activation of Primary Afferents in the Meninges in Rats. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s11055-020-00983-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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6
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Abstract
Antihistamines are common and readily available medications for primary care patients and those seeking over-the-counter treatments. This article provides an overview of available antihistamines, their mechanisms of action, safety concerns in specific populations, and their therapeutic uses in several common conditions.
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7
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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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8
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Ala S, Alvandipour M, Saeedi M, Seyedein S, Monajati M, Koulaeinejad N. Evaluation of Cholestyramine 15% Ointment in Relieving Pruritus and Burning After Ileostomy: A Rrandomized, Double-Blind Placebo-Controlled Clinical Trial. J INVEST SURG 2019; 33:795-802. [PMID: 30892108 DOI: 10.1080/08941939.2019.1578442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose/Aims: Skin irritation is a common ileostomy problem that causes burning and pruritus among patients due to the leakage of intestinal discharge around the stoma. This clinical trial was performed to evaluate the efficacy of topical cholestyramine (15%) on the reduction of the levels of burning and pruritus after an ileostomy. Material and methods: The patients were randomly divided into two groups of treatment and control (n = 15). The intervention group was subjected to one fingertip of cholestyramine, whereas the other group received the placebo ointment (approximately 0.5 g) on the skin immediately after the surgery and twice a day for 2 months. The primary outcome measure was the severity of burning and pruritus measured by a visual analog scale at different times after an ileostomy. Results: Out of 34 patients, four cases were excluded due to the inappropriate completion of the questionnaire (n = 2) and unwillingness to attend the follow-up visits (n = 2). Therefore, 30 patients were included in the study. The levels of burning among patients in the cholestyramine were lower in weeks 3, 4, and 8 compared to the placebo group. Moreover, lower levels of pruritus were observed among patients in the treatment group in weeks 4 and 8 after an ileostomy. No side effects were reported among the patients. Conclusions: Topical cholestyramine was found to be effective in the management of burning and pruritus resulting from an ileostomy among the population under study.
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Affiliation(s)
- Shahram Ala
- Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mina Alvandipour
- Department of Surgery, Imam Khomeini General Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Majid Saeedi
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Sarvenaz Seyedein
- Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahila Monajati
- Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Neda Koulaeinejad
- Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
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9
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Min S, Kim KW, Jung WM, Lee MJ, Kim YK, Chae Y, Lee H, Park HJ. Acupuncture for Histamine-Induced Itch: Association With Increased Parasympathetic Tone and Connectivity of Putamen-Midcingulate Cortex. Front Neurosci 2019; 13:215. [PMID: 30914919 PMCID: PMC6423085 DOI: 10.3389/fnins.2019.00215] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 02/25/2019] [Indexed: 12/19/2022] Open
Abstract
Previous studies have suggested that acupuncture is effective for ameliorating itch intensity. However, factors associated with the antipruritic effects of acupuncture have yet to be clarified. In a randomized, sham-controlled, crossover trial, we investigated the antipruritic effects of acupuncture against histamine-induced itch in healthy volunteers. Autonomic changes using heart rate variability (HRV) and brain connectivity using functional magnetic resonance imaging (fMRI) were also assessed to identify physiological factors associated with the acupuncture response. Acupuncture significantly reduced itch intensity and skin blood perfusion as assessed by laser Doppler perfusion imaging compared to sham control, indicating the antipruritic effects of acupuncture. In responder and non-responder analysis, the power of normalized high frequency (HF norm) was significantly higher, while the power of normalized low frequency (LF norm) and LF/HF ratio were significantly lower in responders compared to non-responders, suggesting the acupuncture response involved parasympathetic activation. In fMRI analysis, the putamen and the posterior part of the midcingulate cortex (pMCC) were positively connected to itch and negatively correlated with itch intensity in responders. These results suggest that parasympathetic activity and functional connectivity of the putamen and pMCC could be associated with antipruritic response to acupuncture.
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Affiliation(s)
- Seorim Min
- Department of Science in Korean Medicine, Graduate School, College of Korean Medicine, Kyung Hee University, Seoul, South Korea.,Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea
| | - Koh-Woon Kim
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Kyung Hee University, Seoul, South Korea.,East-West Medical Research Institute, Kyung Hee University, Seoul, South Korea
| | - Won-Mo Jung
- Department of Science in Korean Medicine, Graduate School, College of Korean Medicine, Kyung Hee University, Seoul, South Korea.,Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea
| | - Min-Jung Lee
- Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea
| | - Yu-Kang Kim
- Department of Science in Korean Medicine, Graduate School, College of Korean Medicine, Kyung Hee University, Seoul, South Korea.,Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea
| | - Younbyoung Chae
- Department of Science in Korean Medicine, Graduate School, College of Korean Medicine, Kyung Hee University, Seoul, South Korea.,Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea
| | - Hyangsook Lee
- Department of Science in Korean Medicine, Graduate School, College of Korean Medicine, Kyung Hee University, Seoul, South Korea.,Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea
| | - Hi-Joon Park
- Department of Science in Korean Medicine, Graduate School, College of Korean Medicine, Kyung Hee University, Seoul, South Korea.,Acupuncture and Meridian Science Research Center, Kyung Hee University, Seoul, South Korea
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10
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Weng CH, Hsu CW, Hu CC, Yen TH, Chan MJ, Huang WH. Blood lead level is a positive predictor of uremic pruritus in patients undergoing hemodialysis. Ther Clin Risk Manag 2017; 13:717-723. [PMID: 28652758 PMCID: PMC5476754 DOI: 10.2147/tcrm.s135470] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Although uremic pruritus (UP) is a common and annoying symptom for end-stage renal disease patients on hemodialysis (HD) and peritoneal dialysis, its pathogenesis is poorly understood. However, systemic inflammation is one of the possible pathogenesis of UP, and blood lead level (BLL) has been noted to be associated with inflammation and nutritional status in long-term HD patients. There might be an interaction or association, therefore, between BLL and UP through systemic inflammation. We analyzed cross-sectional data among 866 participants. All of the 866 patients in this study were stratified into groups with low-normal (<10 μg/dL), high-normal (10-20 μg/dL), and abnormal BLLs (>20 μg/dL). The associations between UP and BLL and the clinical data were analyzed. Multivariate logistic regression demonstrated that HD duration, non-anuria, log ferritin, serum low-density lipoprotein, log BLL, high-normal BLL, and high BLL were associated with UP. In conclusion, BLL was positively associated with UP.
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Affiliation(s)
- Cheng-Hao Weng
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Linkou Medical Center.,Department of Medicine, Chang Gung University College of Medicine, Taoyuan
| | - Ching-Wei Hsu
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Linkou Medical Center.,Department of Medicine, Chang Gung University College of Medicine, Taoyuan
| | - Ching-Chih Hu
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan.,Department of Hepatogastroenterology and Liver Research Unit, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Linkou Medical Center.,Department of Medicine, Chang Gung University College of Medicine, Taoyuan
| | - Ming-Jen Chan
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Linkou Medical Center.,Department of Medicine, Chang Gung University College of Medicine, Taoyuan
| | - Wen-Hung Huang
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Linkou Medical Center.,Department of Medicine, Chang Gung University College of Medicine, Taoyuan
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11
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Ibrahim IM, Elsaie ML, Almohsen AM, Mohey-Eddin MH. Effectiveness of topical clove oil on symptomatic treatment of chronic pruritus. J Cosmet Dermatol 2017; 16:508-511. [PMID: 28382655 DOI: 10.1111/jocd.12342] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2017] [Indexed: 11/28/2022]
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12
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Rungsiprakarn P, Laopaiboon M, Sangkomkamhang US, Lumbiganon P. Pharmacological interventions for generalised itching (not caused by systemic disease or skin lesions) in pregnancy. Cochrane Database Syst Rev 2016; 2:CD011351. [PMID: 26891962 PMCID: PMC8665832 DOI: 10.1002/14651858.cd011351.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Generalised itching is one of the most common dermatological symptoms in pregnant women. Having itchy skin during pregnancy may be very frustrating and can lead to poor sleep, exhaustion and impaired quality of life. There is a need for a systematic review to evaluate the effectiveness and safety of pharmacological interventions for treating itching in pregnancy. OBJECTIVES To assess the effectiveness and safety of pharmacological interventions for treating generalised itching (not caused by systemic diseases or skin lesions) in pregnancy. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (28 January 2016) and the reference list of the one identified study. SELECTION CRITERIA All published, unpublished and ongoing randomised controlled trials (RCTs) evaluating interventions for itching in pregnancy.Quasi-RCTs, cluster-RCTs, RCTs using a cross-over design, and studies reported in abstract form (without full text) were not eligible for inclusion. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the one trial report that was identified from the search strategy and this was subsequently excluded. MAIN RESULTS There are no included studies as we did not identify any relevant trials. AUTHORS' CONCLUSIONS Generalised itching (not caused by systemic disease or skin lesions) is quite a common symptom in pregnancy. However, there is no evidence from randomised controlled trials to guide practice in terms of the effectiveness and safety of pharmacological interventions for treating this condition.Well-designed randomised controlled trials are needed in order to evaluate the effectiveness of topical and systemic pharmacological interventions as well as any adverse effects of the interventions. Such studies should consider important outcomes such as relief of itching, women's satisfaction, sleep disturbance, and adverse effects.
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Affiliation(s)
| | - Malinee Laopaiboon
- Khon Kaen UniversityDepartment of Biostatistics and Demography, Faculty of Public Health123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
| | - Ussanee S Sangkomkamhang
- Khon Kaen HospitalDepartment of Obstetrics and GynaecologySrichan RoadMaungKhon KaenThailand40000
| | - Pisake Lumbiganon
- Khon Kaen UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
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13
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Metz M, Wahn U, Gieler U, Stock P, Schmitt J, Blume-Peytavi U. Chronic pruritus associated with dermatologic disease in infancy and childhood: update from an interdisciplinary group of dermatologists and pediatricians. Pediatr Allergy Immunol 2013; 24:527-39. [PMID: 23980845 DOI: 10.1111/pai.12115] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2013] [Indexed: 01/08/2023]
Abstract
An effective treatment strategy for chronic pruritus in children with dermatologic disorders should consider the multidimensional aspects of pruritus, the unique challenges associated with treating pruritic skin disorders in the pediatric population, and evidence-based therapies with demonstrated antipruritic benefits and clinically relevant effects on patient/family quality of life (QoL). The Course of Advanced Learning for the Management of ITch (CALM-IT) Task Force is an interdisciplinary group of experts specializing in core aspects of pruritus treatment, integrating pediatrics, dermatology, psychotherapy, pruritus management, and sleep. CALM-IT recently convened to provide updated guidance on managing chronic pruritus associated with dermatologic diseases in pediatric patients, with a special focus on atopic dermatitis (AD) and chronic spontaneous urticaria (csU). This review highlights the updated concepts and best practices, which were built upon international PRACTALL consensus and modified for children and infants with AD and csU. CALM-IT supports the routine use of basic skin therapy and the escalation of topical medications, according to severity and focused on rapid itch control. Anti-inflammatory agents should be appropriate for infants and children (i.e., with an optimized therapeutic index) and have proven antipruritic properties, such as those demonstrated by methylprednisolone aceponate. New experimental findings do not support the use of non-sedating oral antihistamines as adjuvant antipruritic therapy for AD. In csU, oral H1 -antihistamine use is justified, consistent with the distinct pathophysiologic mechanisms of itch underlying AD and csU. All encompassing QoL assessments should consider the burden of both patient and caregiver and should address outstanding unmet clinical needs of pediatric patients. Future research areas include integrated QoL assessments and multidisciplinary treatment programs with pediatric-targeted pruritic therapies providing rapid itch control.
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Affiliation(s)
- Martin Metz
- Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany
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14
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Pfab F, Schalock PC, Napadow V, Athanasiadis GI, Yosipovitch G, Ring J. Complementary integrative approach for treating pruritus. Dermatol Ther 2013; 26:149-56. [DOI: 10.1111/dth.12031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - P. C. Schalock
- Department of Dermatology; Massachusetts General Hospital; Harvard Medical School; Boston; Massachusetts; USA
| | | | - G. I. Athanasiadis
- Department of Dermatology and Allergy; Technische Universität München; Munich; Germany
| | - G. Yosipovitch
- Department of Dermatology, Neurobiology & Anatomy; Regenerative Medicine Wake Forest University Health Sciences; Winston-Salem; North Carolina; USA
| | - J. Ring
- Department of Dermatology and Allergy; Technische Universität München; Munich; Germany
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15
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Pfab F, Valet M, Tölle T, Behrendt H, Ring J, Darsow U. Recent progress in unraveling central nervous system processing of itch sensation. World Allergy Organ J 2013; 1:168-73. [PMID: 23282675 PMCID: PMC3651029 DOI: 10.1097/wox.0b013e318187ff70] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Itch is the major symptom of many allergic or inflammatory skin diseases, yet it is still difficult to measure objectively. This article shows and updates the development and approaches of central nervous system investigation of itch. Human neuroimaging studies on the physiology and pathophysiology of itch sensation have been hampered by the lack of a reproducible "on-off" stimulus. Short-term alternating temperature modulation of histamine-induced itch has recently been shown to provide on-off characteristics. Recent studies with functional magnetic resonance imaging demonstrate that itch sensation in healthy volunteers is processed by a network of brain regions contributing to the encoding of sensory, emotional, attentional, evaluative, and motivational aspects of itch.
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Affiliation(s)
- Florian Pfab
- From the *Department of Dermatology and Allergy, Technische Universität München; §Division of Environmental Dermatology and Allergy, Helmholtz Zentrum München/TUM, ZAUM-Center for Allergy and Environment; and ‡Department of Neurology, Klinikum r.d. Isar, Technische Universität München, Munich, Germany
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Sekine R, Satoh T, Takaoka A, Saeki K, Yokozeki H. Anti pruritic effects of topical crotamiton, capsaicin, and a corticosteroid on pruritogen-induced scratching behavior. Exp Dermatol 2012; 21:201-4. [PMID: 22379965 DOI: 10.1111/j.1600-0625.2011.01433.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Itch accompanies various skin diseases. As a number of mediators other than histamine can be involved in the itch sensation, H1 receptor antagonists are not necessarily effective in treating itch. External application of antipruritic drugs is occasionally used as an alternative therapy for pruritic skin conditions, such as pruritus on primary non-diseased, non-inflamed skin. Even so, the actual effects of these drugs on the itch sensation have yet to be studied in detail. To verify the antipruritic effects of crotamiton, capsaicin, and a corticosteroid on the itch sensation, we examined the inhibitory effects of these drugs on various pruritogen-induced scratching behaviors in mice. Topical application of 10% crotamiton moderately inhibited histamine-, serotonin-, and PAR-2 agonist-induced scratching behaviors. Topical capsaicin (0.025%) also exerted a moderate suppressive effect on histamine-, substance P-, and PAR-2 agonist-induced itch responses. Notably, topical corticosteroid (0.05% clobetasol propionate) remarkably inhibited the scratching behaviors induced by all of the pruritogenic agents tested. Therapeutic effects of capsaicin on substance P-induced pruritus did not seem to be mediated by desensitization of the TRPV1 (+) C fibers and/or by altered responsiveness of the mast cells. In addition, the antipruritic effects of crotamiton and corticosteroid appear to be, at least partly, associated with a TRPV1-independent pathway. This study examined the itch responses to pruritogens and demonstrated the mode of action of the externally applied antipruritic drugs.
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Affiliation(s)
- Rika Sekine
- Department of Dermatology, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
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Pfab F, Kirchner MT, Huss-Marp J, Schuster T, Schalock PC, Fuqin J, Athanasiadis GI, Behrendt H, Ring J, Darsow U, Napadow V. Acupuncture compared with oral antihistamine for type I hypersensitivity itch and skin response in adults with atopic dermatitis: a patient- and examiner-blinded, randomized, placebo-controlled, crossover trial. Allergy 2012; 67:566-73. [PMID: 22313287 DOI: 10.1111/j.1398-9995.2012.02789.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2011] [Indexed: 12/14/2022]
Abstract
BACKGROUND Itch is the major symptom of atopic dermatitis (AD). Acupuncture has been shown to exhibit a significant effect on experimental itch in AD. Our study evaluated acupuncture and antihistamine itch therapy (cetirizine) on type I hypersensitivity itch and skin reaction in AD using a patient and examiner-blinded, randomized, placebo-controlled, crossover trial. METHODS Allergen-induced itch was evaluated in 20 patients with AD after several interventions in separate sessions: preventive (preceding) and abortive (concurrent) verum acupuncture (VAp and VAa), cetirizine (10 mg, VC), corresponding placebo interventions (preventive, PAp, and abortive, PAa, placebo acupuncture; placebo cetirizine pill, PC) and a no-intervention control (NI). Itch was induced on the forearm and temperature modulated over 20 min, using our validated model. Outcome parameters included itch intensity, wheal and flare size and the D2 attention test. RESULTS Mean itch intensity (SE: 0.31 each) was significantly lower following VAa (31.9) compared with all other groups (PAa: 36.5; VC: 36.8; VAp: 37.6; PC: 39.8; PAp: 39.9; NI: 45.7; P < 0.05). There was no significant difference between VAp and VC (P > 0.1), although both therapies were significantly superior to their respective placebo interventions (P < 0.05). Flare size following VAp was significantly smaller (P = 0.034) than that following PAp. D2 attention test score was significantly lower following VC compared with all other groups (P < 0.001). CONCLUSIONS Both VA and cetirizine significantly reduced type I hypersensitivity itch in patients with AD, compared with both placebo and NI. Timing of acupuncture application was important, as VAa had the most significant effect on itch, potentially because of counter-irritation and/or distraction. Itch reduction following cetirizine coincided with reduced attention.
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Affiliation(s)
| | - M.-T. Kirchner
- Division of Environmental Dermatology and Allergy; Helmholtz Zentrum München/TUM; ZAUM-Center for Allergy and Environment; Munich; Germany
| | | | - T. Schuster
- Institute for Medical Statistics and Epidemiology; Technische Universität München; Munich; Germany
| | - P. C. Schalock
- Department of Dermatology; Harvard Medical School; Massachusetts General Hospital; Boston; MA; USA
| | | | - G. I. Athanasiadis
- Department of Dermatology and Allergy; Technische Universität München; Munich; Germany
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Júnior WSF, Ladio AH, Albuquerque UPD. Resilience and adaptation in the use of medicinal plants with suspected anti-inflammatory activity in the Brazilian Northeast. JOURNAL OF ETHNOPHARMACOLOGY 2011; 138:238-52. [PMID: 21963566 DOI: 10.1016/j.jep.2011.09.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 09/09/2011] [Accepted: 09/16/2011] [Indexed: 05/05/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE This study uses the utilitarian redundancy model as a basis to investigate issues related to the preference for plants native to the Caatinga used as anti-inflammatories by respondents from the community of Carão in rural Pernambuco, Brazil. MATERIALS AND METHODS For this purpose, 49 respondents and 24 native plants used as anti-inflammatories were selected from a database built by previous studies in this study area. Interviews with respondents were conducted by applying the checklist-interview technique and by presenting photographs of plants, which were ordered according to plant preference for each type of inflammation mentioned. After elaborating each list of preferences, we inquired as to the criteria used for the construction of the lists. A salience index was calculated to determine the most- and least-preferred species, and principal component analysis (PCA) was used to identify the most significant criteria used by the respondents to indicate the preferred plants for anti-inflammatory use. RESULTS We identified 37 subcategories or inflammatory conditions, most of which were associated with disorders of the genitourinary (8 conditions), digestive (7) and respiratory (4) systems. Subcategories with the highest level of redundancy include "wound" (79.1% of species), "cut" (66.6%) and "uterus" (66.6%), and five non-redundant conditions were identified (only one species). We obtained approximately 300 lists and 18 choice criteria. PCA analysis showed that seven species were most preferred by the respondents, as they showed the highest salience values, and that the preferred criterion was "treatment effectiveness". CONCLUSIONS These results indicate that inflammation is a complex collection of disorders consisting of several subcategories. Furthermore, respondents preferred different treatments for different inflammatory conditions, which pose a challenge for future pharmacological studies that aim to assess the biological activity of anti-inflammatory plants. Preferences were very specific, focused on a small number of species and mainly related to therapeutic effectiveness.
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Liang J, Xiao G, Ji W. Capsaicin induces reflex scratching in inflamed skin. Pharmacology 2011; 88:82-7. [PMID: 21846999 DOI: 10.1159/000330094] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Accepted: 06/01/2011] [Indexed: 01/27/2023]
Abstract
We investigated whether capsaicin induces itching in skin with existing inflammation. We induced skin inflammation by intradermal injection of complete Freund's adjuvant (CFA) in the neck of mice. Four days later, we injected capsaicin in the same area and counted the number of scratching bouts for 30 min. We examined potential effects on pain in parallel experiments in which CFA and capsaicin were intradermally injected into hind paws. We used the time spent licking the hind paws during the 15 min after capsaicin injection as an estimate of pain. Capsaicin injection into the skin pretreated with CFA, but not into healthy skin, induced scratching. The scratching behavior was reduced by pretreatment with naloxone or capsazepine, selective antagonists for transient receptor potential vanilloid receptor-1 (TRPV1), but not morphine or mepyramine, selective antagonists for histamine 1 receptor. In animals injected with capsaicin into the hind paws, licking behavior was significantly inhibited via a μ-receptor-dependent mechanism. Our results show that TRPV1 activation, which normally induces pain, evokes an itch-related response in the presence of inflammation. This model may be interesting for future studies to explore the mechanism of a painful stimuli-induced itch observed under pathological conditions.
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Affiliation(s)
- Jiexian Liang
- Department of Anesthesiology, Guangdong Institute of Cardiovascular Disease, Guangzhou, PR China
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Pfab F, Athanasiadis GI, Huss-Marp J, Fuqin J, Heuser B, Cifuentes L, Brockow K, Schober W, Konstantinow A, Irnich D, Behrendt H, Ring J, Ollert M. Effect of Acupuncture on Allergen-Induced Basophil Activation in Patients with Atopic Eczema:A Pilot Trial. J Altern Complement Med 2011; 17:309-14. [DOI: 10.1089/acm.2009.0684] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Florian Pfab
- Department of Dermatology and Allergy, Technische Universität München, Munich, Germany
- Division of Environmental Dermatology and Allergy, Helmholtz Zentrum München/TUM, ZAUM-Center for Allergy and Environment, Munich, Germany
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Georgios I. Athanasiadis
- Department of Dermatology and Allergy, Technische Universität München, Munich, Germany
- Clinical Research Division of Molecular and Clinical Allergotoxicology, Technische Universität München, Munich, Germany
| | - Johannes Huss-Marp
- Department of Dermatology and Allergy, Technische Universität München, Munich, Germany
- Division of Environmental Dermatology and Allergy, Helmholtz Zentrum München/TUM, ZAUM-Center for Allergy and Environment, Munich, Germany
| | - Jiang Fuqin
- Department of Dermatology and Allergy, Technische Universität München, Munich, Germany
| | - Beate Heuser
- Clinical Research Division of Molecular and Clinical Allergotoxicology, Technische Universität München, Munich, Germany
| | - Liliana Cifuentes
- Department of Dermatology and Allergy, Technische Universität München, Munich, Germany
- Division of Environmental Dermatology and Allergy, Helmholtz Zentrum München/TUM, ZAUM-Center for Allergy and Environment, Munich, Germany
| | - Knut Brockow
- Department of Dermatology and Allergy, Technische Universität München, Munich, Germany
- Division of Environmental Dermatology and Allergy, Helmholtz Zentrum München/TUM, ZAUM-Center for Allergy and Environment, Munich, Germany
| | - Wolfgang Schober
- Division of Environmental Dermatology and Allergy, Helmholtz Zentrum München/TUM, ZAUM-Center for Allergy and Environment, Munich, Germany
| | | | - Dominik Irnich
- Department of Anesthesiology, Ludwig-Maximilians Universität München, Munich, Germany
| | - Heidrun Behrendt
- Division of Environmental Dermatology and Allergy, Helmholtz Zentrum München/TUM, ZAUM-Center for Allergy and Environment, Munich, Germany
| | - Johannes Ring
- Department of Dermatology and Allergy, Technische Universität München, Munich, Germany
| | - Markus Ollert
- Department of Dermatology and Allergy, Technische Universität München, Munich, Germany
- Clinical Research Division of Molecular and Clinical Allergotoxicology, Technische Universität München, Munich, Germany
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Pfab F, Huss-Marp J, Gatti A, Fuqin J, Athanasiadis GI, Irnich D, Raap U, Schober W, Behrendt H, Ring J, Darsow U. Influence of acupuncture on type I hypersensitivity itch and the wheal and flare response in adults with atopic eczema - a blinded, randomized, placebo-controlled, crossover trial. Allergy 2010; 65:903-10. [PMID: 20002660 DOI: 10.1111/j.1398-9995.2009.02284.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Itch is a major symptom of allergic skin disease. Acupuncture has been shown to exhibit a significant effect on histamine-induced itch in healthy volunteers. We investigated the effect of acupuncture on type I hypersensitivity itch and skin reaction in a double-blind, randomized, placebo-controlled, crossover trial. METHODS An allergen stimulus (house dust mite or grass pollen skin prick) was applied to 30 patients with atopic eczema before (direct effect) and after (preventive effect) two experimental approaches or control observation: acupuncture at points Quchi and Xuehai [verum acupuncture (VA), dominant side], 'placebo-point' acupuncture (PA, dominant side), no acupuncture (NA). Itch intensity was recorded on a visual analogue scale. After 10 min, wheal and flare size and skin perfusion (via LASER-Doppler) were measured at the stimulus site, and the validated Eppendorf Itch Questionnaire (EIQ) was answered. RESULTS Mean itch intensity was significantly lower in VA (35.7 +/- 6.4) compared to NA (45.9 +/- 7.8) and PA (40.4 +/- 5.8) regarding the direct effect; and significantly lower in VA (34.3 +/- 7.1) and PA (37.8 +/- 5.6) compared to NA (44.6 +/- 6.2) regarding the preventive effect. In the preventive approach, mean wheal and flare size were significantly smaller in VA (0.38 +/- 0.12 cm(2)/8.1 +/- 2.0 cm(2)) compared to PA (0.54 +/- 0.13 cm(2)/13.5 +/- 2.8 cm(2)) and NA (0.73 +/- 0.28 cm(2)/15.1 +/- 4.1 cm(2)), and mean perfusion in VA (72.4 +/- 10.7) compared to NA (84.1 +/- 10.7). Mean EIQ ratings were significantly lower in VA compared to NA and PA in the treatment approach; and significantly lower in VA and PA compared to NA in the preventive approach. CONCLUSIONS Acupuncture at the correct points showed a significant reduction in type I hypersensitivity itch in patients with atopic eczema. With time the preventive point-specific effect diminished with regard to subjective itch sensation, whereas it increased in suppressing skin-prick reactions.
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Affiliation(s)
- F Pfab
- Department of Dermatology and Allergy, Technische Universität München, Munich, Germany.
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Kido M, Takeuchi S, Esaki H, Hayashida S, Furue M. Scratching behavior does not necessarily correlate with epidermal nerve fiber sprouting or inflammatory cell infiltration. J Dermatol Sci 2010; 58:130-5. [PMID: 20399618 DOI: 10.1016/j.jdermsci.2010.03.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 03/05/2010] [Accepted: 03/09/2010] [Indexed: 12/18/2022]
Abstract
BACKGROUND Increased sprouting of epidermal nerve fibers of lesional skin are thought to be associated with persistent pruritus in chronic inflammatory dermatitis such as atopic dermatitis as supported by a murine study using tacrolimus (or FK506: FK) which was shown to inhibit both epidermal sprouting of nerves and scratching behavior or by immunohistochemical observations of lesional skin in the patients with atopic dermatitis or prurigo, etc. OBJECTIVES To examine a mitogen-activated protein kinase/extracellular signal-regulated kinase kinase 1/2 (MEK1/2) inhibitor (CX-659S: CX) for a possible anti-pruritic property in vivo since some MEK1/2 inhibitors have been reported to inhibit neurite growth in vitro. METHODS CX, FK and corticosteroids (betamethasone valerate: BV) were topically applied on inflamed skin in a mouse model of chronic dermatitis using repetitive hapten painting to examine anti-pruritic property and anti-inflammatory effects. Scratching behaviors were assessed using MicroAct automatic measuring system, and epidermal sprouting of nerves and skin inflammation was assessed histologically. RESULTS FK significantly decrease scratching behavior, but CX and BV failed to do so despite of their ability to significantly inhibit epidermal nerve fiber sprouting and skin inflammation, respectively. In addition, CX+BV mixture synergistically inhibited epidermal nerve fiber sprouting and skin inflammation even more potently than FK without decreasing scratching behavior. CONCLUSIONS These findings suggest that the scratching behavior does not necessarily correlate with epidermal nerve fiber sprouting or inflammatory cell infiltration.
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Affiliation(s)
- Makiko Kido
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Fukuoka 812-8582, Japan
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Pfab F, Valet M, Sprenger T, Huss-Marp J, Athanasiadis GI, Baurecht HJ, Konstantinow A, Zimmer C, Behrendt H, Ring J, Tölle TR, Darsow U. Temperature modulated histamine-itch in lesional and nonlesional skin in atopic eczema - a combined psychophysical and neuroimaging study. Allergy 2010; 65:84-94. [PMID: 19804445 DOI: 10.1111/j.1398-9995.2009.02163.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Itch is the major symptom of many allergic diseases; yet it is still difficult to measure objectively. The aim of this study was to use an evaluated itch stimulus model in lesional (LS) and nonlesional (NLS) atopic eczema (AE) skin and to characterize cerebral responses using functional magnetic resonance imaging (fMRI). METHODS Thermal modulation was performed on a histamine stimulus in randomized order on LS or NLS in rapid alternating order from 32 degrees C (warm) to 25 degrees C (cold). Subjective itch ratings were recorded. Additionally, fMRI measurements were used to analyze the cerebral processing (n = 13). Healthy skin (HS) of age-matched volunteers served as control (n = 9). RESULTS Mean VAS itch intensity was significantly (P < 0.0001) higher during the relative cold [55.2 +/- 8.3% (LS); 48.6 +/- 8.2% (NLS)] compared to the relative warm blocks [36.0 +/- 7.3% (LS); 33.7 +/- 7.6% (NLS)]. Compared to HS, the itch response was delayed in LS and NLS. Itch intensity was perceived highest in LS, followed by NLS and HS. For NLS, fMRI revealed at the beginning of the itch provocation a cerebral deactivation pattern in itch processing structures (thalamus, prefrontal, cingulate, insular, somatosensory and motor cortex). During the course of stimulation, the cerebral deactivation was reduced with time and instead an activation of the basal ganglia occurred. In contrast LS showed an activation instead of deactivation pattern already at the beginning of the stimulation in the above mentioned structures. CONCLUSIONS Moderate short-term temperature modulation led to a reproducible, significant enhancement of histamine-induced itch with the strongest effect in LS. The differences in itch perception and itch kinetics between healthy volunteers and NLS in patients point towards an ongoing central inhibitory activity patients with AE, especially at the beginning of the itch provocation.
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Affiliation(s)
- F Pfab
- Department of Dermatology and Allergy Biederstein, Technische Universität München, Munich, Germany
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Abstract
This article examines the physiological changes that occur in the skin with advancing age that make it more prone to skin problems. Examples of common skin disorders that may affect older people are provided. Intrinsic factors such as a genetic tendency to eczema, and extrinsic factors such as the effects of sun damage and general poor health can both affect the skin of older people. The management of dry skin conditions in this age group is investigated and the value of emollient therapy, involving the use of bath emollients, soap substitutes and leave-on emollient lotions, creams or ointments, is discussed.
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Proksch E. The role of emollients in the management of diseases with chronic dry skin. Skin Pharmacol Physiol 2008; 21:75-80. [PMID: 18187966 DOI: 10.1159/000112957] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2007] [Accepted: 07/23/2007] [Indexed: 11/19/2022]
Abstract
Dry skin is a common skin condition as well as a key aspect of a number of diseases such as atopic dermatitis and psoriasis but also of other diseases and systemic conditions. Dry skin has an impact on the patient in terms of discomfort, pruritus and impaired quality of life. Within the overall treatment regimen for these diseases, the use of emollients to manage dry skin plays a considerable role in managing skin conditions. In atopic dermatitis and psoriasis, emollients help to improve skin condition and to reduce pruritus alongside more potent pharmacological agents. It is important to choose an emollient that not only soothes and rehydrates the skin but also offers numerous other dermatological supporting roles, especially induction of proper epidermal differentiation. This review will explain the role of emollients within the management of diseases with dry skin as a major symptom and the components of an ideal emollient.
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Affiliation(s)
- E Proksch
- Department of Dermatology, University of Kiel, Kiel, Germany.
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Valet M, Pfab F, Sprenger T, Wöller A, Zimmer C, Behrendt H, Ring J, Darsow U, Tölle TR. Cerebral processing of histamine-induced itch using short-term alternating temperature modulation--an FMRI study. J Invest Dermatol 2007; 128:426-33. [PMID: 17657239 DOI: 10.1038/sj.jid.5701002] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Human neuroimaging studies on the physiology of itch have been hampered by the lack of reproducible "on-off" stimuli. Using a previously established biphasic temperature stimulus model, we investigated the cerebral activation pattern of itch processing in 12 healthy volunteers with functional magnetic resonance imaging. Itch was provoked on the right forearm with skin prick application of 1% histamine-dihydrochloride. Local temperature modulation allowed reproducible itch provocation above scratch threshold (defined as 33/100 on a visual analogue scale) during 25 degrees C, whereas itch declined below scratch threshold during the 32 degrees C stimulation period. No itch sensation was reported using 0.9% saline with temperature modulation. Itch sensation above scratch threshold was associated with increased activation of the thalamus, presupplementary motor area, anterior insular, inferior parietal, and dorsolateral prefrontal cortex, and decreased activation of the orbitofrontal, medial frontal, mid-cingulate, and primary motor cortex in comparison to saline. The biphasic temperature model allows rapid modulation of histamine-induced itch. The evoked itch sensation above scratch threshold is processed by a network of brain regions contributing to the encoding of sensory, emotional, attention-dependent, cognitive-evaluative and motivational aspects of itch.
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Affiliation(s)
- Michael Valet
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
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27
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Pfab F, Valet M, Sprenger T, Toelle TR, Athanasiadis GI, Behrendt H, Ring J, Darsow U. Short-Term Alternating Temperature Enhances Histamine-Induced Itch: A Biphasic Stimulus Model. J Invest Dermatol 2006; 126:2673-8. [PMID: 17008877 DOI: 10.1038/sj.jid.5700577] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Itch is the major symptom of many allergic or inflammatory skin diseases; yet it is still difficult to measure objectively. Human studies on the physiology and pathophysiology of the itch sensation (e.g. functional magnetic resonance imaging studies) have been hampered by the lack of an efferent and manageable "on-off" stimulus. Here, a short-term temperature-modulated human histamine itch model is presented. In nine healthy right-handed male volunteers (age 29+/-2.6 years), 1% histamine dihydrochloride was used in the skin prick model as standard itch stimulus on the right forearm with subsequent thermal modulation of the target skin area using a Medoc TSA II NeuroSensory Analyzer thermode. Modulation occurred in rapid alternating order from 32 degrees C (neutral) to 25 degrees C (slight cold) and vice versa; each temperature block lasted 20 seconds. Subjective itch ratings were recorded using a computerized visual analog scale (VAS) and - for qualitative assessment - the Eppendorf Itch Questionnaire (EIQ). All subjects reported localized itch sensations without pain; mean VAS itch intensity was 50.6+/-3.5% during the 25 degrees C blocks and 33.8+/-3.9% during the 32 degrees C blocks (P<0.0001). Also, mean EIQ ratings were significantly higher related to the 25 degrees C blocks. In spite of the common knowledge that intensive cold can inhibit itch sensation, a reproducible, significant enhancement of histamine-induced itch by short-term moderate temperature decrease could be shown. This effect might be explained by peripheral and central adaptation processes triggered by alternating afferent activity patterns and might be used - owing to its "on/off" characteristics-in future itch physiology studies such as functional magnetic resonance imaging.
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Affiliation(s)
- Florian Pfab
- Department of Dermatology and Allergy, Technische Universität München, Munich, Germany
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28
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Abstract
Pruritus is a major disorder among the skin derangements in advanced renal failure. Its prevalence seems to be diminishing perhaps because of improvements in dialysis treatment. Recent information suggests that interactions between dermal mast cells and distal ends of nonmyelinated C fibers may be important in the precipitation and regulation of the sensory stimuli. The knowledge as to the control of pruritus transmission to cortex areas is still incomplete but endogenous opioid and opioid receptors may have a role in this regard. A recent classification was proposed for pruritus based on the level of its origin. Uremic pruritus, however, seems to be too complex to fit perfectly in any of the suggested modalities. Inflammation and malnutrition are recognized risk factors for cardiovascular death in end-stage renal disease patients, which may be related to the genesis of pruritus. Consistent with this concept, lower serum levels of albumin and higher serum levels of ferritin were found in pruritic patients when compared to nonpruritic ones. Newer treatments for this difficult clinical problem are being developed and tested.
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Affiliation(s)
- Jocemir R Lugon
- Nephrology Division, Department of Medicine, Universidade Federal Fluminense, Niteroi-RJ, Brazil.
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Proksch E, Lachapelle JM. The management of dry skin with topical emollients - recent perspectives. Behandlung der trockenen Haut mit topischen Emulsionen - neue Entwicklungen. J Dtsch Dermatol Ges 2005; 3:768-74. [PMID: 16194154 DOI: 10.1111/j.1610-0387.2005.05068.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Dry skin (xerosis) is a common symptom of a number of chronic skin diseases, such as atopic dermatitis, but can also be caused by environmental factors, such as cold weather and frequent showering. The condition can cause unsightliness of the skin, discomfort, itching, and can have a negative impact on patients' quality of life. This article will cover recent developments in the understanding of xerosis and its management with emollients. The stratum corneum consists of corneocytes and lipid-enriched intercellular bilayers. These are both produced from keratinocytes in a process called epidermal differentiation. Disturbed epidermal differentiation, resulting in the impairment of stratum corneum intercellular lipid bilayers and natural moisturizing factor, is the root cause of xerosis. The constituent ingredients of emollients should, therefore, address the different factors that contribute to dry skin and, most importantly, attempt to restore epidermal differentiation. The use of lipids, physiological lipids, humectants and antipruritics will help to restore the lipid lamellae, improve skin hydration, skin elasticity and prevent itching. The ideal emollient will include these ingredients plus an agent to support epidermal differentiation. Selecting the correct emollient product and using it regularly are vital factors in the management of xerosis.
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Affiliation(s)
- Ehrhardt Proksch
- Klinik für Dermatologie, Venerologie und Allergologie, Universitäts-Hautklinik Kiel.
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Hossen MA, Fujii Y, Ogawa M, Takubo M, Tsumuro T, Kamei C. Effect of loratadine on mouse models of atopic dermatitis associated pruritus. Int Immunopharmacol 2005; 5:1331-6. [PMID: 15914337 DOI: 10.1016/j.intimp.2005.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2004] [Revised: 01/07/2005] [Accepted: 02/09/2005] [Indexed: 10/25/2022]
Abstract
To confirm the effectiveness of loratadine for relieving pruritus in atopic dermatitis, we examined the effect of this drug using animal models of atopic dermatitis associated pruritus in ICR and hairless mice. As for the results, in ICR mice, single oral administration of loratadine at a dose of 5 or 10 mg/kg significantly inhibited the dorsal scratching behavior induced by histamine or an antigen, and the effect of loratadine was more potent than that of fexofenadine and chlorpheniramine. In hairless mice, oral administration of loratadine at a dose of 10 mg/kg for 6 days significantly inhibited the facial scratching behavior induced by the feeding of a low magnesium diet. Furthermore, oral administration of loratadine at a dose of 10 mg/kg for 7 days also significantly inhibited the histamine-induced scratching behavior in the same animals. These results indicate that loratadine may be effective in preventing pruritus associated with atopic dermatitis.
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Affiliation(s)
- Maria Alejandra Hossen
- Department of Pharmacology, Faculty of Pharmaceutical Sciences, Okayama University, Tsushima-naka 1-1-1, Okayama 700-8530, Japan
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Kim BM, Lee SH, Shim WS, Oh U. Histamine-induced Ca2+ influx via the PLA2/lipoxygenase/TRPV1 pathway in rat sensory neurons. Neurosci Lett 2004; 361:159-62. [PMID: 15135918 DOI: 10.1016/j.neulet.2004.01.019] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Histamine is known to excite a subset of C-fibers and cause itch sensation. Despite its well-defined excitatory action on sensory neurons, intracellular signaling mechanisms are not understood. Previously, we demonstrated that bradykinin excited sensory neurons by activating TRPV1 via the phospholipase A(2) (PLA(2)) and lipoxygenase (LO) pathway. We, thus, hypothesized that histamine excited sensory neurons via the PLA(2)/LO/TRPV1 pathway. Application of histamine elicited a rapid increase in intracellular Ca(2+) ([Ca(2+)](i)) that desensitized slowly in cultured dorsal root ganglion neurons. Histamine-induced [Ca(2+)](i) was dependent on extracellular Ca(2+) and inhibited by capsazepine and by SC0030, competitive antagonists of TRPV1. Quinacrine and nordihydroguaiaretic acid, a PLA(2) and an LO inhibitor, respectively, blocked the histamine-induced Ca(2+) influx in sensory neurons, while indomethacin (a cyclooxygenase inhibitor) did not. We thus conclude that histamine activates TRPV1 after stimulating the PLA(2)/LO pathway, leading to the excitation of sensory neurons. These results further provide an idea for potential use of TRPV1 antagonists as anti-itch drugs.
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Affiliation(s)
- Byung Moon Kim
- Sensory Research Center, National Creative Research Initiatives, College of Pharmacy, Seoul National University, San 56-1, Shinlim, Kwanak-Gu, Seoul 151-742, South Korea
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