1
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Ding H, Zhou L, Zhou J, Feng J. Peripheral Mechanisms of Mechanical Itch. J Invest Dermatol 2024; 144:1449-1453. [PMID: 38206270 DOI: 10.1016/j.jid.2023.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/25/2023] [Accepted: 10/31/2023] [Indexed: 01/12/2024]
Abstract
Mechanical itch, which is defined as an itch sensation caused by innocuous mechanical force, may warn of the potential risk in the skin. The increased mechanosensitivity in sensory neurons may cause scratch-induced itch and promote the transition from acute itch to chronic itch. Recent studies have not only expanded our knowledge about the neuronal circuits in the CNS but have also highlighted the importance of the peripheral epithelia-immune-neuronal crosstalk in the development of mechanical itch. In this review, we will summarize related findings about the molecular and cellular mechanisms of mechanical itch in the skin.
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Affiliation(s)
- Huijuan Ding
- School of Chinese Materia Medica, Nanjing University of Chinese Medicine, Nanjing, China
| | - Liqin Zhou
- State Key Laboratory of Chemical Biology, Shanghai Institute of Materia Medica, Chinese Academy of Science, Shanghai, China; University of Chinese Academy of Sciences, Beijing, China
| | - Jiaying Zhou
- School of Chinese Materia Medica, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jing Feng
- School of Chinese Materia Medica, Nanjing University of Chinese Medicine, Nanjing, China; State Key Laboratory of Chemical Biology, Shanghai Institute of Materia Medica, Chinese Academy of Science, Shanghai, China; University of Chinese Academy of Sciences, Beijing, China.
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2
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Pereira MP, Metz M. [Neuropathy in pruritus medicine : Recommended diagnostics and therapy]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024:10.1007/s00105-024-05374-z. [PMID: 38869846 DOI: 10.1007/s00105-024-05374-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/22/2024] [Indexed: 06/14/2024]
Abstract
Chronic itch is a frequent and debilitating condition that greatly affects the quality of life of those affected. In a subset of patients, damage to the peripheral or central nervous system constitutes the cause of the itch. Small-fiber neuropathy, nerve compression syndromes, post-herpetic neuralgia, scars and burns are possible conditions affecting the peripheral nervous system potentially causing itch, whereas space-occupying lesions affecting the spinal cord and stroke are examples of conditions that may induce central itch. Neuropathic itch starts on normal appearing skin, is often accompanied by pain sensations and other dysesthesias, and usually relieved by local cold application. Its distribution depends on the affected site of the somatosensory system. A comprehensive medical history is paramount to reach the diagnosis, while complementary diagnostics with skin biopsies for the investigation of cutaneous neuromorphological alterations or medical imaging to rule out nerve impingement may be advised in selected cases. Topical agents such as capsaicin or local anesthetics as well as systemic drugs such as gabapentinoids, antidepressants and opioid receptor modulators are used in the treatment of neuropathic itch. This review article provides an overview of the clinical features, underlying causes, diagnostic workup and therapeutic approach in neuropathic itch.
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Affiliation(s)
- Manuel P Pereira
- Institut für Allergieforschung, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 27, 12203, Berlin, Deutschland.
- Immunologie und Allergologie, Fraunhofer Institut für Translationale Medizin und Pharmakologie ITMP, Berlin, Deutschland.
| | - Martin Metz
- Institut für Allergieforschung, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 27, 12203, Berlin, Deutschland
- Immunologie und Allergologie, Fraunhofer Institut für Translationale Medizin und Pharmakologie ITMP, Berlin, Deutschland
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3
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Yook HJ, Lee JH. Prurigo Nodularis: Pathogenesis and the Horizon of Potential Therapeutics. Int J Mol Sci 2024; 25:5164. [PMID: 38791201 PMCID: PMC11121340 DOI: 10.3390/ijms25105164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/18/2024] [Accepted: 04/18/2024] [Indexed: 05/26/2024] Open
Abstract
Chronic pruritus that lasts for over 6 weeks can present in various forms, like papules, nodules, and plaque types, with prurigo nodularis (PN) being the most prevalent. The pathogenesis of PN involves the dysregulation of immune cell-neural circuits and is associated with peripheral neuropathies, possibly due to chronic scratching. PN is a persistent and challenging condition, involving complex interactions among the skin, immune system, and nervous system. Lesional skin in PN exhibits the infiltration of diverse immune cells like T cells, eosinophils, macrophages, and mast cells, leading to the release of inflammatory cytokines and itch-inducing substances. Activated sensory nerve fibers aggravate pruritus by releasing neurotransmitters, perpetuating a vicious cycle of itching and scratching. Traditional treatments often fail, but recent advancements in understanding the inflammatory and itch transmission mechanisms of PN have paved the way for innovative therapeutic approaches, which are explored in this review.
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Affiliation(s)
| | - Ji Hyun Lee
- Department of Dermatology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, #222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
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4
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Biazus Soares G, Hashimoto T, Yosipovitch G. Atopic Dermatitis Itch: Scratching for an Explanation. J Invest Dermatol 2024; 144:978-988. [PMID: 38363270 DOI: 10.1016/j.jid.2023.10.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/20/2023] [Accepted: 10/31/2023] [Indexed: 02/17/2024]
Abstract
Chronic pruritus is a cardinal symptom of atopic dermatitis (AD). The mechanisms underlying atopic itch involve intricate crosstalk among skin, immune components, and neural components. In this review, we explore these mechanisms, focusing on key players and interactions that induce and exacerbate itch. We discuss the similarities and differences between pruritus and pain in patients with AD as well as the relationship between pruritus and factors such as sweat and the skin microbiome. Furthermore, we explore novel targets that could provide significant itch relief in these patients as well as exciting future research directions to better understand atopic pruritus in darker skin types.
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Affiliation(s)
- Georgia Biazus Soares
- Miami Itch Center, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Takashi Hashimoto
- Department of Dermatology, National Defense Medical College, Tokorozawa, Japan
| | - Gil Yosipovitch
- Miami Itch Center, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
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5
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Zhao Q, Tominaga M, Toyama S, Komiya E, Tobita T, Morita M, Zuo Y, Honda K, Kamata Y, Takamori K. Effects of Psychological Stress on Spontaneous Itch and Mechanical Alloknesis of Atopic Dermatitis. Acta Derm Venereol 2024; 104:adv18685. [PMID: 38566405 PMCID: PMC11000660 DOI: 10.2340/actadv.v104.18685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 02/15/2024] [Indexed: 04/04/2024] Open
Abstract
Atopic dermatitis (AD), a chronic inflammatory skin disease, manifests as an intractable itch. Psychological stress has been suggested to play a role in the onset and worsening of AD symptoms. However, the pathophysiological relationships between psychological stressors and cutaneous manifestations remain unclear. To elucidate the mechanisms underlying the stress-related exacerbation of itch, we investigated the effects of water stress, restraint stress and repeated social defeat stress on itch-related scratching behaviour, mechanical alloknesis and dermatitis in male NC/Nga mice with AD-like symptoms induced by the repeated application of ointment containing Dermatophagoides farina body. NC/Nga mice with AD-like symptoms were subjected to water stress, restraint stress and repeated social defeat stress, and their scratching behaviour, sensitivity to mechanical stimuli (mechanical alloknesis) and severity of dermatitis were evaluated. Social defeat stress+ Dermatophagoides farina body-treated mice exposed to stress showed slower improvements in or the exacerbation of AD-like symptoms, including dermatitis and itch. In the mechanical alloknesis assay, the mechanical alloknesis scores of social defeat stress+ Dermatophagoides farina body-treated mice exposed to stress were significantly higher than those of non-exposed social defeat stress+ Dermatophagoides farina body- and social defeat stress-treated mice. These results suggest that psychological stress delays improvements in dermatitis by exacerbating itch hypersensitivity in AD.
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Affiliation(s)
- Qiaofeng Zhao
- Juntendo Itch Research Center (JIRC), Institute for Environmental and Gender-Specific Medicine, Juntendo University Graduate School of Medicine, Chiba, Japan
| | - Mitsutoshi Tominaga
- Juntendo Itch Research Center (JIRC), Institute for Environmental and Gender-Specific Medicine, Juntendo University Graduate School of Medicine, Chiba, Japan
| | - Sumika Toyama
- Juntendo Itch Research Center (JIRC), Institute for Environmental and Gender-Specific Medicine, Juntendo University Graduate School of Medicine, Chiba, Japan
| | - Eriko Komiya
- Juntendo Itch Research Center (JIRC), Institute for Environmental and Gender-Specific Medicine, Juntendo University Graduate School of Medicine, Chiba, Japan
| | - Tomohiro Tobita
- Juntendo Itch Research Center (JIRC), Institute for Environmental and Gender-Specific Medicine, Juntendo University Graduate School of Medicine, Chiba, Japan
| | - Motoki Morita
- Juntendo Itch Research Center (JIRC), Institute for Environmental and Gender-Specific Medicine, Juntendo University Graduate School of Medicine, Chiba, Japan
| | - Ying Zuo
- Juntendo Itch Research Center (JIRC), Institute for Environmental and Gender-Specific Medicine, Juntendo University Graduate School of Medicine, Chiba, Japan
| | - Kotaro Honda
- Juntendo Itch Research Center (JIRC), Institute for Environmental and Gender-Specific Medicine, Juntendo University Graduate School of Medicine, Chiba, Japan
| | - Yayoi Kamata
- Juntendo Itch Research Center (JIRC), Institute for Environmental and Gender-Specific Medicine, Juntendo University Graduate School of Medicine. Chiba, Japan
| | - Kenji Takamori
- Juntendo Itch Research Center (JIRC), Institute for Environmental and Gender-Specific Medicine, Juntendo University Graduate School of Medicine, Chiba, Japan; Department of Dermatology, Juntendo University Urayasu Hospital, Chiba, Japan..
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6
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Zhu J, Hassler C, Villena FB, Papadopoulou A, Navarini AA, Mueller SM. Reverse underwear sign as an indicator of alloknesis. J Dtsch Dermatol Ges 2024; 22:574-575. [PMID: 38368270 DOI: 10.1111/ddg.15320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/03/2023] [Indexed: 02/19/2024]
Affiliation(s)
- Jie Zhu
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Caterina Hassler
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | | | | | | | - Simon M Mueller
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
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7
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Zhu J, Hassler C, Villena FB, Papadopoulou A, Navarini AA, Müller S. „Reverse underwear sign“ als Indikator für Alloknesis. J Dtsch Dermatol Ges 2024; 22:574-576. [PMID: 38574006 DOI: 10.1111/ddg.15320_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/03/2023] [Indexed: 04/06/2024]
Affiliation(s)
- Jie Zhu
- Abteilung für Dermatologie, Universitätsspital Basel, Basel, Schweiz
| | - Caterina Hassler
- Abteilung für Dermatologie, Universitätsspital Basel, Basel, Schweiz
| | | | | | | | - Simon Müller
- Abteilung für Dermatologie, Universitätsspital Basel, Basel, Schweiz
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8
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Yeo H, Ahn SS, Ou S, Yun SJ, Lim Y, Koh D, Lee YH, Shin SY. The EGR1-Artemin Axis in Keratinocytes Enhances the Innervation of Epidermal Sensory Neurons during Skin Inflammation Induced by House Dust Mite Extract from Dermatophagoidesfarinae. J Invest Dermatol 2024:S0022-202X(24)00090-3. [PMID: 38302010 DOI: 10.1016/j.jid.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 02/03/2024]
Abstract
Epidermal hyperinnervation is a critical feature of pruritus during skin inflammation. However, the mechanisms underlying epidermal hyperinnervation are unclear. This study investigates the role of the transcription factor EGR1 in epidermal innervation by utilizing wild-type (Egr1+/+) and Egr1-null (Egr1‒/‒) mice topically applied Dermatophagoides farinae extract from dust mite. Our findings revealed that Egr1‒/‒ mice exhibited reduced scratching behaviors and decreased density of epidermal innervation compared with Egr1+/+ mice. Furthermore, we identified artemin, a neurotrophic factor, as an EGR1 target responsible for Dermatophagoides farinae extract-induced hyperinnervation. It has been demonstrated that Dermatophagoides farinae extract stimulates toll-like receptors in keratinocytes. To elucidate the cellular mechanism, we stimulated keratinocytes with Pam3CSK4, a toll-like receptor 1/2 ligand. Pam3CSK4 triggered a toll-like receptor 1/2-mediated signaling cascade involving IRAK4, IκB kinase, MAPKs, ELK1, EGR1, and artemin, leading to increased neurite outgrowth and neuronal migration. In addition, increased expression of EGR1 and artemin was observed in the skin tissues of patients with atopic dermatitis. These findings highlight the significance of the EGR1-artemin axis in keratinocytes, promoting the process of epidermal innervation and suggesting it as a potential therapeutic target for alleviating itch and pain associated with house dust mite-induced skin inflammation.
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Affiliation(s)
- Hyunjin Yeo
- Department of Biological Sciences, Sang-huh College of Life Science, Konkuk University, Seoul, Republic of Korea
| | - Sung Shin Ahn
- Department of Biological Sciences, Sang-huh College of Life Science, Konkuk University, Seoul, Republic of Korea
| | - Sukjin Ou
- Department of Biological Sciences, Sang-huh College of Life Science, Konkuk University, Seoul, Republic of Korea
| | - Sook Jung Yun
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Yoongho Lim
- Division of Bioscience and Biotechnology, Konkuk University, Seoul, Republic of Korea
| | - Dongsoo Koh
- Department of Applied Chemistry, Dongduk Women's University, Seoul, Republic of Korea
| | - Young Han Lee
- Department of Biological Sciences, Sang-huh College of Life Science, Konkuk University, Seoul, Republic of Korea; Cancer and Metabolism Institute, Konkuk University, Seoul, Republic of Korea
| | - Soon Young Shin
- Department of Biological Sciences, Sang-huh College of Life Science, Konkuk University, Seoul, Republic of Korea; Cancer and Metabolism Institute, Konkuk University, Seoul, Republic of Korea.
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9
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Xu Z, Wang Y, Jiang C, Wang Z, Cheng Y, Fan M. The regulation of the PD-1/PD-L1 pathway in imiquimod-induced chronic psoriasis itch and itch sensitization in mouse. Mol Pain 2024; 20:17448069241252384. [PMID: 38631843 PMCID: PMC11069332 DOI: 10.1177/17448069241252384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 04/19/2024] Open
Abstract
PD-1/PD-L1 inhibitors have been demonstrated to induce itch in both humans and experimental animals. However, whether the PD-1/PD-L1 pathway is involved in the regulation of chronic psoriatic itch remains unclear. This study aimed to investigate the role of the PD-1/PD-L1 pathway in imiquimod-induced chronic psoriatic itch. The intradermal injection of PD-L1 in the nape of neck significantly alleviated chronic psoriatic itch in imiquimod-treated skin. Additionally, we observed that spontaneous scratching behavior induced by imiquimod disappeared on day 21. Still, intradermal injection of PD-1/PD-L1 inhibitors could induce more spontaneous scratching for over a month, indicating that imiquimod-treated skin remained in an itch sensitization state after the spontaneous scratching behavior disappeared. During this period, there was a significant increase in PD-1 receptor expression in both the imiquimod-treated skin and the spinal dorsal horn in mice, accompanied by significant activation of microglia in the spinal dorsal horn. These findings suggest the potential involvement of the peripheral and central PD-1/PD-L1 pathways in regulating chronic itch and itch sensitization induced by imiquimod.
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Affiliation(s)
- Zhehao Xu
- Department of Pharmacology, Clinic Medical College, Anhui Medical University, Hefei, China
| | - Yue Wang
- Department of Pharmacology, Clinic Medical College, Anhui Medical University, Hefei, China
- Department of Science and Education, Hefei BOE Hospital, Hefei, China
| | - Changcheng Jiang
- Department of Pharmacology, Clinic Medical College, Anhui Medical University, Hefei, China
| | - Zhengwei Wang
- Department of Pharmacology, Clinic Medical College, Anhui Medical University, Hefei, China
| | - YongFeng Cheng
- Department of Pharmacology, Clinic Medical College, Anhui Medical University, Hefei, China
| | - Manli Fan
- Department of Pharmacy, Fuyang Hospital, Anhui Medical University, Fuyang, China
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10
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Cameron S, Donnelly A, Broderick C, Arichi T, Bartsch U, Dazzan P, Elberling J, Godfrey E, Gringras P, Heathcote LC, Joseph D, Wood TC, Pariante C, Rubia K, Flohr C. Mind and skin: Exploring the links between inflammation, sleep disturbance and neurocognitive function in patients with atopic dermatitis. Allergy 2024; 79:26-36. [PMID: 37469218 DOI: 10.1111/all.15818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/06/2023] [Accepted: 07/02/2023] [Indexed: 07/21/2023]
Abstract
Atopic dermatitis (AD) is a chronic, pruritic and inflammatory, dry skin condition with many known comorbidities. These include airway disease, food allergies, atopic eye disease and autoimmune conditions. Furthermore, there is often significant sleep disturbance as well as increased psychological distress and mental health problems. Severe AD therefore often has a significant impact on the quality of life of both patients and their families. In this review we discuss recent findings on the putative links between AD, its association with itch, sleep disturbance and neuropsychiatric morbidity, including the role of inflammation in these conditions. Itch was thought to predominantly drive sleep disruption in AD. We now understand changes in sleep influence immune cell distribution and the associated inflammatory cytokines, which suggests a bidirectional relationship between AD and sleep. We also increasingly recognize inflammation as a key driver in psychological symptoms and disorders. The link between cutaneous, systemic and possible brain inflammation could at least in part be driven by the sleep deprivation and itch-driven neuronal proliferation seen in AD.
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Affiliation(s)
- Shona Cameron
- St John's Institute of Dermatology, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ali Donnelly
- St John's Institute of Dermatology, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Conor Broderick
- St John's Institute of Dermatology, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Tomoki Arichi
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ullrich Bartsch
- Surrey Sleep Research Centre, Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College London and University of Surrey, Guildford, UK
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jesper Elberling
- Depart of Dermatology and Allergy, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Emma Godfrey
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paul Gringras
- Paediatric Sleep Department, Evelina Children's Hospital, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Lauren C Heathcote
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Desaline Joseph
- Paediatric Sleep Department, Evelina Children's Hospital, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Tobias C Wood
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Carmine Pariante
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College London and University of Surrey, Guildford, UK
| | - Katya Rubia
- UK Dementia Research Institute, Care Research & Technology Centre, Imperial College London and University of Surrey, Guildford, UK
| | - Carsten Flohr
- St John's Institute of Dermatology, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
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11
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Deng L, Costa F, Blake KJ, Choi S, Chandrabalan A, Yousuf MS, Shiers S, Dubreuil D, Vega-Mendoza D, Rolland C, Deraison C, Voisin T, Bagood MD, Wesemann L, Frey AM, Palumbo JS, Wainger BJ, Gallo RL, Leyva-Castillo JM, Vergnolle N, Price TJ, Ramachandran R, Horswill AR, Chiu IM. S. aureus drives itch and scratch-induced skin damage through a V8 protease-PAR1 axis. Cell 2023; 186:5375-5393.e25. [PMID: 37995657 PMCID: PMC10669764 DOI: 10.1016/j.cell.2023.10.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 08/20/2023] [Accepted: 10/18/2023] [Indexed: 11/25/2023]
Abstract
Itch is an unpleasant sensation that evokes a desire to scratch. The skin barrier is constantly exposed to microbes and their products. However, the role of microbes in itch generation is unknown. Here, we show that Staphylococcus aureus, a bacterial pathogen associated with itchy skin diseases, directly activates pruriceptor sensory neurons to drive itch. Epicutaneous S. aureus exposure causes robust itch and scratch-induced damage. By testing multiple isogenic bacterial mutants for virulence factors, we identify the S. aureus serine protease V8 as a critical mediator in evoking spontaneous itch and alloknesis. V8 cleaves proteinase-activated receptor 1 (PAR1) on mouse and human sensory neurons. Targeting PAR1 through genetic deficiency, small interfering RNA (siRNA) knockdown, or pharmacological blockade decreases itch and skin damage caused by V8 and S. aureus exposure. Thus, we identify a mechanism of action for a pruritogenic bacterial factor and demonstrate the potential of inhibiting V8-PAR1 signaling to treat itch.
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Affiliation(s)
- Liwen Deng
- Department of Immunology, Harvard Medical School, Boston, MA 02215, USA
| | - Flavia Costa
- Department of Immunology and Microbiology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Kimbria J Blake
- Department of Immunology, Harvard Medical School, Boston, MA 02215, USA
| | - Samantha Choi
- Department of Immunology, Harvard Medical School, Boston, MA 02215, USA
| | - Arundhasa Chandrabalan
- Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario N6A 5C1, Canada
| | - Muhammad Saad Yousuf
- Department of Neuroscience and Center for Advanced Pain Studies, University of Texas at Dallas, Richardson, TX 75080, USA
| | - Stephanie Shiers
- Department of Neuroscience and Center for Advanced Pain Studies, University of Texas at Dallas, Richardson, TX 75080, USA
| | - Daniel Dubreuil
- Departments of Neurology and Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Daniela Vega-Mendoza
- Division of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Corinne Rolland
- IRSD, Université de Toulouse, INSERM, INRAe, ENVT, Université Toulouse III-Paul Sabatier (UPS), Toulouse, France
| | - Celine Deraison
- IRSD, Université de Toulouse, INSERM, INRAe, ENVT, Université Toulouse III-Paul Sabatier (UPS), Toulouse, France
| | - Tiphaine Voisin
- Department of Immunology, Harvard Medical School, Boston, MA 02215, USA
| | - Michelle D Bagood
- Department of Dermatology, University of California, San Diego, La Jolla, CA 92093, USA
| | - Lucia Wesemann
- Department of Immunology, Harvard Medical School, Boston, MA 02215, USA
| | - Abigail M Frey
- Department of Immunology, Harvard Medical School, Boston, MA 02215, USA
| | - Joseph S Palumbo
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Brian J Wainger
- Departments of Neurology and Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Richard L Gallo
- Department of Dermatology, University of California, San Diego, La Jolla, CA 92093, USA
| | | | - Nathalie Vergnolle
- IRSD, Université de Toulouse, INSERM, INRAe, ENVT, Université Toulouse III-Paul Sabatier (UPS), Toulouse, France
| | - Theodore J Price
- Department of Neuroscience and Center for Advanced Pain Studies, University of Texas at Dallas, Richardson, TX 75080, USA
| | - Rithwik Ramachandran
- Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario N6A 5C1, Canada
| | - Alexander R Horswill
- Department of Immunology and Microbiology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Isaac M Chiu
- Department of Immunology, Harvard Medical School, Boston, MA 02215, USA.
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12
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Renkhold L, Wiegmann H, Pfleiderer B, Süer A, Zeidler C, Pereira MP, Schmelz M, Ständer S, Agelopoulos K. Scratching increases epidermal neuronal branching and alters psychophysical testing responses in atopic dermatitis and brachioradial pruritus. Front Mol Neurosci 2023; 16:1260345. [PMID: 37795274 PMCID: PMC10546039 DOI: 10.3389/fnmol.2023.1260345] [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: 07/17/2023] [Accepted: 08/25/2023] [Indexed: 10/06/2023] Open
Abstract
Background Chronic scratching imposes a major stress on the skin and can lead to itch intensity worsening, and consequently, patients may enter an itch-scratch cycle. This repetitive mechanical stress can result in lichenification, worsening of epidermal barrier function, and enhanced cutaneous inflammation. Furthermore, a reduction of intraepidermal nerve fibers was previously described in lichenification. Aim The aim of this study was to investigate the influence of chronic scratching on the epidermal neuroanatomy and on sensory changes, in particular the prevalence of hyperknesis and alloknesis in patients after mechanical, chemical, and electrical stimuli. Methods Analyses were performed on pruritic lichenified (chronically scratched), pruritic non-lichenified (not chronically scratched), and non-pruritic non-lesional (unaffected) skin areas of patients with inflammatory pruritus, i.e., atopic dermatitis (n = 35), and neuropathic pruritus, i.e., brachioradial pruritus (n = 34) vs. healthy matched controls (n = 64). Our fine-grained spatial skin characterization enabled specifically studying the differential effects of chronic scratching in inflammatory and neuropathic itch. Results Analysis of intraepidermal nerve fiber density showed rarefaction of fibers in all three skin areas of patients compared with healthy controls in both diagnoses. Even more, the two pruritic areas had significantly less nerve fibers than the unaffected skin, whereas electrically induced itch was massively increased. Epidermal branching of the remaining nerve fibers in lichenified/chronically scratched skin was increased, particularly in patients with brachioradial pruritus, which may contribute to the pronounced local neuronal sensitivity. Hyperknesis and alloknesis were found to increase independently of lichenification. Conclusion Our results indicate that chronic scratching may not affect intraepidermal nerve fiber density but leads to a stronger branching pattern of intraepidermal nerve fibers, which may contribute to local hypersensitivity. The increased sensitivity in the pruritic areas suggests mechanisms of peripheral sensitization, whereas the increased sensation of electrically and chemically induced itch in unaffected skin indicates central sensitization for itch.
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Affiliation(s)
- Lina Renkhold
- Department of Dermatology and Centre for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Henning Wiegmann
- Department of Dermatology and Centre for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Bettina Pfleiderer
- Clinic of Radiology, Medical Faculty, University Hospital Münster, University of Münster, Münster, Germany
| | - Aysenur Süer
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Claudia Zeidler
- Department of Dermatology and Centre for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Manuel P. Pereira
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Martin Schmelz
- Department of Experimental Pain Research, MCTN, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Sonja Ständer
- Department of Dermatology and Centre for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Konstantin Agelopoulos
- Department of Dermatology and Centre for Chronic Pruritus, University Hospital Münster, Münster, Germany
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13
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Follansbee T, Dong X. A tactile twist: decoding the phenomena of mechanical itch and alloknesis. Front Mol Neurosci 2023; 16:1278151. [PMID: 37771556 PMCID: PMC10523328 DOI: 10.3389/fnmol.2023.1278151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/30/2023] [Indexed: 09/30/2023] Open
Abstract
Itch is a sensation in the skin which provokes the desire to scratch. In the past few decades there has been a significant elucidation of the immune and neural pathways which underly the sensation of itch. An interesting divergence in the itch pathway relates to the type of stimulation used to evoke an itchy sensation. Commonly, chemical mediators of itch such as histamine are injected into the skin where they activate their cognate receptors on sensory neurons. Another way to evoke itch, particularly in patients with chronic itch, is to use light mechanical stimulation. Investigation into these pathways utilizing the mouse model have shown that the neuronal pathways which underly chemical itch are distinct from those which mediate itch in response to mechanical stimulation. Specific populations of primary sensory neurons, spinal interneurons and transmission neurons have been identified which suggests a labeled line for itch transmission. Additionally, Piezo channels, which underly mechanosensation, were discovered to play an important role in the mechanical itch pathway. Given these novel findings relating to the mechanical itch pathway, the purpose of this review is to summarize the reports from human subjects and animal studies to highlight the advances in our understanding of mechanical itch and alloknesis.
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Affiliation(s)
- Taylor Follansbee
- Department of Neuroscience, Howard Huges Medical Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Xinzhong Dong
- Department of Neuroscience, Howard Huges Medical Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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14
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Bordoni B, Escher AR, Girgenti GT, Tobbi F, Bonanzinga R. Osteopathic Approach for Keloids and Hypertrophic Scars. Cureus 2023; 15:e44815. [PMID: 37692181 PMCID: PMC10483258 DOI: 10.7759/cureus.44815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 09/12/2023] Open
Abstract
The skin is a complex organ, a system that influences and is influenced by the body system, with different skin layers always mechano-biologically active. In the presence of a lesion that damages the dermis, the skin undergoes sensory, morphological, and functional alterations. The subsequent adaptation is the formation of scar tissue, following distinct and overlapping biological phases. For reasons not yet fully elucidated, some healing processes lead to pathological scars, from which symptoms such as pain, itching, and functional limitations are derived. Currently, there is no gold standard treatment that fully meets the needs of different scars and can eliminate any symptoms that the patient suffers. One such treatment is manual medicine, which involves direct manual approaches to the site of injury. Reviewing the phases that allow the skin to be remodeled following an injury, this article reflects on the usefulness of resorting to these procedures, highlighting erroneous concepts on which the manual approach is based, compared to what the current literature highlights the cicatricial processes. Considering pathological scar adaptations, it would be better to follow a gentle manual approach.
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Affiliation(s)
- Bruno Bordoni
- Physical Medicine and Rehabilitation, Foundation Don Carlo Gnocchi, Milan, ITA
| | - Allan R Escher
- Anesthesiology/Pain Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
| | - Gregory T Girgenti
- Anesthesiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
| | - Filippo Tobbi
- Osteopathy, PGO (Post Graduate Osteopathic) Institute, Lesignano De' bagni, ITA
| | - Roberto Bonanzinga
- Osteopathy, PGO (Post Graduate Osteopathic) Institute, Lesignano De' bagni, ITA
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15
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Vander Does A, Ju T, Mohsin N, Chopra D, Yosipovitch G. How to get rid of itching. Pharmacol Ther 2023; 243:108355. [PMID: 36739914 DOI: 10.1016/j.pharmthera.2023.108355] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/01/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
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.
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Affiliation(s)
- Ashley Vander Does
- Dr Phillip Frost Department of Dermatology and Miami Itch Center, University of Miami, Miami, FL, USA
| | - Teresa Ju
- Dr Phillip Frost Department of Dermatology and Miami Itch Center, University of Miami, Miami, FL, USA
| | - Noreen Mohsin
- Dr Phillip Frost Department of Dermatology and Miami Itch Center, University of Miami, Miami, FL, USA
| | - Divya Chopra
- Dr Phillip Frost Department of Dermatology and Miami Itch Center, University of Miami, Miami, FL, USA
| | - Gil Yosipovitch
- Dr Phillip Frost Department of Dermatology and Miami Itch Center, University of Miami, Miami, FL, USA.
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16
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Hashimoto T, Okuzawa M, Yamamoto M, Okuno S, Satoh T. Increased touch-evoked itch (punctate hyperknesis) in postherpetic itch: Implications of reduced intraepidermal nerve fibers representing small fiber neuropathy. J Dermatol 2023; 50:393-396. [PMID: 36353761 DOI: 10.1111/1346-8138.16627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/11/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022]
Abstract
Chronic itch conditions are often accompanied by neural itch sensitization, known as hyperknesis (excessive itch induced by stimuli that would normally induce only mild itching or pain) and alloknesis (considerable itch evoked by light tactile stimuli). Herpes zoster (shingles) can cause neuropathic itch (postherpetic itch), although it is unknown whether hyperknesis accompanies postherpetic itch. The authors report five patients with postherpetic itch who showed increased touch-evoked itch (punctate hyperknesis) in the affected skin areas compared with the contralateral site. Collected skin biopsy specimens from two patients showed histopathologically detected reduced intraepidermal nerve fibers in the affected skin areas, reflective of small C/Aδ fiber neuropathy. In one case, improvement in itching and comparable levels of touch-evoked itch on the affected and contralateral sites were noted after 6 months without any medication, accompanied by restored intraepidermal nerve fibers proven through rebiopsy of the affected site. Reduced intraepidermal nerve fibers could be one of the precipitating factors for postherpetic itch and its associated punctate hyperknesis.
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Affiliation(s)
- Takashi Hashimoto
- Department of Dermatology, National Defense Medical College, Tokorozawa, Japan
| | - Manami Okuzawa
- Department of Dermatology, National Defense Medical College, Tokorozawa, Japan
| | - Mihiro Yamamoto
- Department of Dermatology, National Defense Medical College, Tokorozawa, Japan
| | - Satoshi Okuno
- Department of Dermatology, National Defense Medical College, Tokorozawa, Japan
| | - Takahiro Satoh
- Department of Dermatology, National Defense Medical College, Tokorozawa, Japan
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17
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Correa-Illanes G. Successful treatment of notalgia paresthetica with lidocaine 5% medicated plaster: a case report. Pain Manag 2022; 12:887-894. [PMID: 36189717 DOI: 10.2217/pmt-2022-0003] [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: 11/21/2022] Open
Abstract
Notalgia paresthetica (NP) is a sensory neuropathy characterized by chronic, localized pruritus in a circumscribed area on the upper back. Pruritus, frequently resistant to treatment, may be accompanied by pain, paresthesia, allodynia and alloknesis. There is a paucity of data in the NP literature about the use of lidocaine 5% medicated plaster. This case involves a 75-year-old woman with NP and a history of many unsuccessful local or systemic treatments. The patient was treated with lidocaine 5% medicated plaster, while other therapies were progressively retired. After 11 weeks of therapy, a significant reduction in the intensity of itching was achieved and the itching area was reduced. The patient also reported an associated improvement in her quality of life throughout therapy. In conclusion, lidocaine 5% medicated plaster was successful in relieving itching and other symptoms in this case of NP.
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18
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Agelopoulos K, Wiegmann H, Schmelz M, Ständer S. [Neurobiology of pruritus: new concepts]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2022; 73:593-599. [PMID: 35925233 DOI: 10.1007/s00105-022-05017-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The underlying mechanisms of pruritus and chronic pruritus (CP) in particular, remain poorly understood; however, current research has revealed promising new concepts in which the importance of the interaction of neuronal cells of different classes, immune cells and keratinocytes is becoming increasingly clearer. RESEARCH QUESTION In this review article the current concepts in pruritus research are presented and summarized. MATERIAL AND METHOD This is a review article based on the current literature. RESULTS Different classes of sensory afferents, such as mechano-insensitive C‑fibers (histaminergic pruritus) and non-histaminergic pruriceptive C‑fibers and Aδ-fibers are involved in CP. The central sensitization in CP manifests as hyperknesis and alloknesis, the latter triggered by Aβ-fibers and Merkel cells. In recent years, the importance of inflammatory cells, such as Th1 and Th2 cells but also basophilic, eosinophilic granulocytes and mast cells has become clear. In CP there appears to be close communication between neuronal cells, immune cells and keratinocytes. Recent studies have focused on proinflammatory interleukins, such as IL-31, IL‑4 and IL-13 and their receptors. The Janus kinase/signal transducers and activators of transcription (JAK/STAT) signaling pathway also plays an important role in the triggered signaling cascades that ultimately lead to pruritus perception. Therefore, in current treatment studies not only the interleukins and their receptors but also the JAK/STAT signaling pathway are directly targeted. CONCLUSION The discovery of new mechanisms and interactions in CP highlights the complexity of this disease. Even if this and the treatment options derived from this are already very promising, a much better understanding of the mechanisms of CP is urgently needed in order to enable further options for an optimized treatment.
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Affiliation(s)
- Konstantin Agelopoulos
- Kompetenzzentrum chronischer Pruritus, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
| | - Henning Wiegmann
- Kompetenzzentrum chronischer Pruritus, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
| | - Martin Schmelz
- Abteilung Experimentelle Schmerzforschung, CBTM, Med. Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Sonja Ständer
- Kompetenzzentrum chronischer Pruritus, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland.
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19
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Schneider G, Ständer S, Kahnert S, Pereira MP, Mess C, Huck V, Agelopoulos K, Frank G, Schneider SW. Biological and psychosocial factors associated with the persistence of pruritus symptoms: protocol for a prospective, exploratory observational study in Germany (individual project of the Interdisciplinary SOMACROSS Research Unit [RU 5211]). BMJ Open 2022; 12:e060811. [PMID: 35798519 PMCID: PMC9263938 DOI: 10.1136/bmjopen-2022-060811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Chronic pruritus (CP) is a symptom of dermatologic, neurologic, systemic and psychosomatic diseases. CP has a prevalence of ~20% in the general population and is therefore a significant burden on society, but the transition from acute pruritus to CP is not well understood. It probably involves interactions between biological and psychosocial factors and pruritus-specific risk factors as well as mechanisms shared with other persistent somatic symptoms addressed in other projects of the SOMACROSS Research Unit (RU). Here we aim to identify psychosocial and biological factors and their interactions which might be associated with the persistence of CP with and without immunologic/inflammatory origin, that is, atopic dermatitis and pruritus on non-inflamed skin. We expect that psychosocial factors relevant to the persistence of symptoms such as fatigue and pain may also show associations to CP. METHODS AND ANALYSIS In this prospective, exploratory observational study situated in Germany, three cohorts of 40 patients each with acute exacerbation of atopic dermatitis and chronic atopic dermatitis and 40 CP patients with unaffected skin will be recruited for a comprehensive translational investigation including pruritus-specific and the shared psychosocial assessments of the RU SOMACROSS. Pruritus-specific measures will include questionnaires, quantitative sensory testing, cutaneous nerve fibre morphology, skin barrier morphology, epidermal metabolism and pruritogen blood levels. Within 1 year, patients and 80 age-matched and sex-matched healthy controls will be examined at three time points, allowing cross-sectional comparison and a longitudinal investigation of predictive outcome factors in patients under treatment according to existing guidelines. ETHICS AND DISSEMINATION The study has been approved by the ethics committees of Hamburg (2020-10200-BO-ff) and Münster (2020-676 f-S), Germany. All participants are required to provide written informed consent. Findings will be disseminated through peer-reviewed publications, scientific conferences and involvement of relevant stakeholders, patients and the lay public. TRIAL REGISTRATION NUMBER DRKS00026646.
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Affiliation(s)
- Gudrun Schneider
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Munster, Munster, Nordrhein-Westfalen, Germany
| | - Sonja Ständer
- Competence Center Chronic Pruritus, Department of Dermatology, University Hospital Munster, Munster, Nordrhein-Westfalen, Germany
| | - Stefan Kahnert
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Munster, Munster, Nordrhein-Westfalen, Germany
| | - Manuel Pedro Pereira
- Competence Center Chronic Pruritus, Department of Dermatology, University Hospital Munster, Munster, Nordrhein-Westfalen, Germany
| | - Christian Mess
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Volker Huck
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Konstantin Agelopoulos
- Competence Center Chronic Pruritus, Department of Dermatology, University Hospital Munster, Munster, Nordrhein-Westfalen, Germany
| | - Gina Frank
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Munster, Munster, Nordrhein-Westfalen, Germany
| | - Stefan W Schneider
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
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20
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McAuliffe LR, Koch CS, Serpell J, Campbell KL. Associations Between Atopic Dermatitis and Anxiety, Aggression, and Fear-Based Behaviors in Dogs. J Am Anim Hosp Assoc 2022; 58:161-167. [PMID: 35793484 DOI: 10.5326/jaaha-ms-7210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2021] [Indexed: 11/11/2022]
Abstract
The goal of this study was to determine if anxiety, aggression, and fear-related behaviors are more common in pruritic dogs with atopic dermatitis than nonpruritic, healthy dogs. One hundred forty-one pruritic dogs >1 yr of age with a clinical diagnosis of atopic dermatitis and a >3 mo history of pruritus were recruited. Dog owners completed a behavioral survey (canine behavioral assessment and research questionnaire) and a pruritus scale (pruritus visual analog scale). Pruritic, atopic dogs showed significant increases in fear- and anxiety-related behaviors as well as aggression compared with a large control group of healthy dogs. Stranger-directed aggression, owner-directed aggression, familiar-dog aggression, dog-directed fear, nonsocial fear, touch sensitivity, excitability, and attention-seeking behaviors were all increased in the study group. Trainability was decreased in the study group. Chronically pruritic dogs experience fear and anxiety and are more likely to display aggression. This is an important welfare issue for these animals. Early recognition of the behavioral derangements that can be associated with chronic pruritic skin disease could allow early intervention with a multidisciplinary approach for these patients, thus improving patient and owner quality of life and long-term treatment outcomes.
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Affiliation(s)
- Lindsay R McAuliffe
- From the University of Missouri Veterinary Health Center, Wentzville, Missouri (L.R.M., K.L.C.)
| | - Colleen S Koch
- From the Lincoln Land Animal Clinic Ltd., Jacksonville, Illinois (C.S.K.)
| | - James Serpell
- From the University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania (J.S.)
| | - Karen L Campbell
- From the University of Missouri Veterinary Health Center, Wentzville, Missouri (L.R.M., K.L.C.)
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21
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Røikjer J, Croosu SS, Hansen TM, Frøkjær JB, Andersen HH, Arendt-Nielsen L, Mørch CD, Ejskjaer N. The Histamine-Induced Axon-Reflex Response in People With Type 1 Diabetes With and Without Peripheral Neuropathy and Pain: A Clinical, Observational Study. THE JOURNAL OF PAIN 2022; 23:1167-1176. [PMID: 35121142 DOI: 10.1016/j.jpain.2022.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/04/2022] [Accepted: 01/09/2022] [Indexed: 11/29/2022]
Abstract
Small nerve fibres are important when studying diabetic peripheral neuropathy (DPN) as they could be first affected. However, assessing their integrity and function adequately remains a major challenge. The aim of this study was to investigate the association between different degrees of DPN, the presence of neuropathic pain, and the intensity of the axon-reflex flare response provoked by epidermal histamine. Eighty adults were included and divided into 4 groups of 20 with type 1 diabetes and: painful DPN (T1DM+PDPN), non-painful DPN (T1DM+DPN), no DPN and no pain (T1DM-DPN), and 20 persons without diabetes or pain (HC). The vasomotor responses were captured by a Full-field Laser Speckle Perfusion Imager. The response was lowest in T1DM+DPN, followed by T1DM+PDPN, T1DM-DPN and HC. The response was significantly reduced in DPN (T1DM+DPN, T1DM+PDPN) compared with people without (T1DM-DPN, HC) (P < .001). The response was also attenuated in diabetes irrespective of the degree of DPN (T1DM+PDPN, T1DM+DPN, T1DM-DPN) (P < .001). There were no differences in the response between painful neuropathy (T1DM+PDPN) and painless DPN (T1DM+DPN) (P = .189). The method can distinguish between groups with and without diabetes and with and without DPN but cannot distinguish between groups with and without painful DPN. PERSPECTIVE: This study describes how diabetes attenuates the axon-reflex response, and how it is affected by neuropathy and pain clarifying previous findings. Furthermore, the study is the first to utilize histamine when evoking the response, thus providing a new and fast alternative for future studies into the pathophysiology of neuropathic pain.
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Affiliation(s)
- Johan Røikjer
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark; Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
| | | | - Tine Maria Hansen
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jens Brøndum Frøkjær
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Denmark
| | - Hjalte Holm Andersen
- SMI, Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark and Department of Medical Gastroenterology, Mech-Sense, Aalborg University Hospital, Aalborg, Denmark
| | - Carsten Dahl Mørch
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
| | - Niels Ejskjaer
- Steno Diabetes Center North Denmark, Aalborg University Hospital; Clinical Medicine and Endocrinology, Aalborg University Hospital, Aalborg, Denmark
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22
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Hashimoto T, Okuno S, Okuzawa M, Satoh T. Dupilumab improves both histaminergic and touch-evoked itch sensitization (hyperknesis) in atopic dermatitis: a pilot study. J Eur Acad Dermatol Venereol 2022; 36:e911-e912. [PMID: 35735991 DOI: 10.1111/jdv.18356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- T Hashimoto
- Department of Dermatology, National Defense Medical College, Tokorozawa, Japan
| | - S Okuno
- Department of Dermatology, National Defense Medical College, Tokorozawa, Japan
| | - M Okuzawa
- Department of Dermatology, National Defense Medical College, Tokorozawa, Japan
| | - T Satoh
- Department of Dermatology, National Defense Medical College, Tokorozawa, Japan
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23
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Mechanisms and therapeutic targets for neuropathic itch. Curr Opin Neurobiol 2022; 75:102573. [PMID: 35689909 DOI: 10.1016/j.conb.2022.102573] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 04/05/2022] [Accepted: 05/06/2022] [Indexed: 01/04/2023]
Abstract
Neuropathic pruritus conditions arise from structural and/or functional damage of the peripheral or central nervous system. Novel findings of pruritus specific mediators and pathways strengthen the specificity theory of pruritus transmission, however electrophysiological studies suggest that focal activation of nociceptors and distinct discharge patterns of primary afferents also contribute to the development of the sensation of pruritus. A complex interplay between excitatory and inhibitory interneurons at spinal level, non-neuronal cells and descending modulation from upper centers contributes to neuronal sensitization and clinically to the chronicity of pruritus, as well as accompanying phenomena such as alloknesis and hyperknesis. Several topical, systemic and non-pharmacological therapeutic approaches directed at distinct targets are currently available.
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24
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Misery L. Chronic prurigo. Br J Dermatol 2022; 187:464-471. [DOI: 10.1111/bjd.21698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/25/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Laurent Misery
- Univ Brest, LIEN Brest France
- University Hospital of Brest Department of Dermatology, Venerology and Allergology and French Expert Centre on Pruritus Brest France
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25
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Aliotta GE, Lo Vecchio S, Elberling J, Arendt-Nielsen L. Evaluation of itch and pain induced by bovine adrenal medulla (BAM)8-22, a new human model of non-histaminergic itch. Exp Dermatol 2022; 31:1402-1410. [PMID: 35587729 DOI: 10.1111/exd.14611] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/03/2022] [Accepted: 05/16/2022] [Indexed: 11/27/2022]
Abstract
Chronic itch is a socioeconomic burden with limited management options. Non-histaminergic itch, involved in problematic pathological itch conditions, is transmitted by a subgroup of polymodal C-fibers. Cowhage is traditionally used for studying experimentally induced non-histaminergic itch in humans, but encounter some limitations. The present study therefore aims to design a new human, experimental model of non-histaminergic itch based on the application of bovine adrenal medulla (BAM)8-22, an endogenous peptide that activates MrgprX1 receptor. 22 healthy subjects were recruited. Different concentrations (0.5, 1, and 2 mg/ml) of BAM8-22 solution and vehicle, applied by a single skin prick test (SPT), were tested in the first session. In the second session, the BAM8-22 solution (1 mg/ml) was applied by different number of SPTs (1, 5, and 25) and by heat-inactivated cowhage spicules coated with BAM8-22. Provoked itch and pain intensities were monitored for 9 minutes followed by the measurement of superficial blood perfusion (SBP), mechanical and thermal sensitivity. BAM8-22 induced itch at the concentration of 1 mg/ml, 2 mg/ml (p<0.05), and with the significantly highest intensity when applied through BAM8-22 spicules (p<0.001). No concomitant pain sensation nor increased SBP were observed. SBP increased only in the 25 SPTs area probably due to micro-trauma from the multiple skin penetrations. Mechanical and thermal sensitivities were not affected by any of the applications. BAM8-22 applied through heat-inactivated spicules was the most efficient method to induce itch (without pain nor changes in SBP, mechanical and thermal sensitivity) suggesting BAM8-22 as a novel non-histaminergic, human, experimental itch model.
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Affiliation(s)
- Giulia Erica Aliotta
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark
| | - Silvia Lo Vecchio
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark
| | - Jesper Elberling
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark.,Department of Medical Gastroenterology, Mech-Sense, Aalborg University Hospital, Aalborg, Denmark
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26
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Kwatra SG, Misery L, Clibborn C, Steinhoff M. Molecular and cellular mechanisms of itch and pain in atopic dermatitis and implications for novel therapeutics. Clin Transl Immunology 2022; 11:e1390. [PMID: 35582626 PMCID: PMC9082890 DOI: 10.1002/cti2.1390] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 12/03/2022] Open
Abstract
Atopic dermatitis is a chronic inflammatory skin disease. Patients with atopic dermatitis experience inflammatory lesions associated with intense itch and pain, which lead to sleep disturbance and poor mental health and quality of life. We review the molecular mechanisms underlying itch and pain symptoms in atopic dermatitis and discuss the current clinical development of treatments for moderate‐to‐severe atopic dermatitis. The molecular pathology of atopic dermatitis includes aberrant immune activation involving significant cross‐talk among the skin and immune and neuronal cells. Exogenous and endogenous triggers modulate stimulation of mediators including cytokine/chemokine expression/release by the skin and immune cells, which causes inflammation, skin barrier disruption, activation and growth of sensory neurons, itch and pain. These complex interactions among cell types are mediated primarily by cytokines, but also involve chemokines, neurotransmitters, lipids, proteases, antimicrobial peptides, agonists of ion channels or various G protein–coupled receptors. Patients with atopic dermatitis have a cytokine profile characterised by abnormal levels of interleukins 4, 12, 13, 18, 22, 31 and 33; thymic stromal lymphopoietin; and interferon gamma. Cytokine receptors mainly signal through the Janus kinase/signal transducer and activator of transcription pathway. Among emerging novel therapeutics, several Janus kinase inhibitors are being developed for topical or systemic treatment of moderate‐to‐severe atopic dermatitis because of their potential to modulate cytokine expression and release. Janus kinase inhibitors lead to changes in gene expression that have favourable effects on local and systemic cytokine release, and probably other mediators, thus successfully modulating molecular mechanisms responsible for itch and pain in atopic dermatitis.
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Affiliation(s)
- Shawn G Kwatra
- Department of Dermatology Johns Hopkins University School of Medicine Baltimore MD USA
| | - Laurent Misery
- Department of Dermatology University Hospital of Brest Brest France
| | | | - Martin Steinhoff
- Department of Dermatology and Venereology Hamad Medical Corporation Doha Qatar.,Translational Research Institute Academic Health System Hamad Medical Corporation Doha Qatar.,Dermatology Institute Academic Health System Hamad Medical Corporation Doha Qatar.,Department of Dermatology Weill Cornell Medicine-Qatar Doha Qatar.,Qatar University, College of Medicine Doha Qatar.,Department of Dermatology Weill Cornell Medicine New York NY USA
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27
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Agelopoulos K, Pereira MP, Wiegmann H, Ständer S. Cutaneous neuroimmune crosstalk in pruritus. Trends Mol Med 2022; 28:452-462. [DOI: 10.1016/j.molmed.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/03/2022] [Accepted: 03/16/2022] [Indexed: 10/18/2022]
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28
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Millard SK, Bokelmann K, Schalbroeck R, van der Wee NJA, van Loey NEE, van Laarhoven AIM. No indications for altered EEG oscillatory activity in patients with chronic post-burn itch compared to healthy controls. Sci Rep 2022; 12:5184. [PMID: 35338171 PMCID: PMC8956573 DOI: 10.1038/s41598-022-08742-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 02/14/2022] [Indexed: 11/23/2022] Open
Abstract
A large proportion of patients with burn injuries develop chronic itch, which impacts quality of life. The underlying pathophysiological mechanisms are poorly understood. This cross-sectional pilot study investigates whether altered cortical oscillatory processes are involved in chronic post-burn itch. Continuous electroencephalography (EEG) data were recorded during rest and stimulation of non-injured skin, inducing itch (histamine and electrical) and cold-pressor task pain for 15 adults with chronic post-burn itch and 15 matched healthy controls. Quantitative metrics comprised oscillatory power and peak frequencies in theta, alpha, and beta bands. No statistical differences between patients and healthy controls were found in oscillatory activity during rest or stimulation, with Bayesian analysis suggesting equivocal evidence. However, post-traumatic stress symptoms and duration of chronic itch may be associated with changes in oscillatory activity. A lack of differences in cortical oscillatory processing and itch levels at non-injured sites, suggests that itch symptoms have a localised character in this sample of patients with post-burn itch. For future studies, a biopsychological approach with integration of peripheral and central nervous system techniques, linear and non-linear EEG analysis, injured and non-injured stimulation sites, and incorporation of individual characteristics is recommended. Insight into pathophysiological mechanisms underlying chronic post-burn itch could improve diagnostics and treatments.
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Affiliation(s)
- Samantha K Millard
- Health, Medical, and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands.,Centre for Pain IMPACT, Neuroscience Research Australia, 139 Barker Street, Randwick, Sydney, NSW, 2031, Australia.,School of Medical Science, Faculty of Medicine, University of New South Wales, 18 High St, Kensington, Sydney, NSW, 2052, Australia
| | - Klara Bokelmann
- Health, Medical, and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands
| | - Rik Schalbroeck
- Health, Medical, and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands
| | - Nic J A van der Wee
- Department of Psychiatry, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Nancy E E van Loey
- Association of Dutch Burn Centers, Maasstad Hospital, Burn Center, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands.,Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, The Netherlands
| | - Antoinette I M van Laarhoven
- Health, Medical, and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands. .,Department of Psychiatry, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands. .,Leiden Institute for Brain and Cognition (LIBC), Leiden University, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
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29
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Kiyohara T, Fukudome T, Kamio Y, Koike Y, Murota H. Clinical Course of Atopic Dermatitis in an Adult with Amyotrophic Lateral Sclerosis: Aetiological Implications of Voluntary Movements and Dermatitis Severity. Acta Derm Venereol 2022; 102:adv00644. [PMID: 35088872 PMCID: PMC9558317 DOI: 10.2340/actadv.v102.1121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract is missing (Short communication)
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Affiliation(s)
| | | | | | | | - Hiroyuki Murota
- Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki city, 852-8501 Nagasaki, Japan.
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30
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Giordano R, Aliotta GE, Johannesen AS, Voetmann-Jensen D, Laustsen FH, Andersen LA, Rezai A, Fredsgaard M, Vecchio SL, Arendt-Nielsen L, Thomsen MH, Stensballe A. Effects of Salicornia-Based Skin Cream Application on Healthy Humans’ Experimental Model of Pain and Itching. Pharmaceuticals (Basel) 2022; 15:ph15020150. [PMID: 35215262 PMCID: PMC8876271 DOI: 10.3390/ph15020150] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 12/11/2022] Open
Abstract
Halophyte plants are salt-tolerant and are acclimated for growth in saline soils such as along coastal areas. Among the halophytes, the Salicornia species have been used as both folk medicine and functional food for many years due to their high levels of bioactive compounds with supposed anti-inflammatory and antioxidative effects. However, the properties of Salicornia bioactive extracts on pain and itching still remain unclear. In this study, 30 healthy volunteers were randomized to treatments with 10% Salicornia-based cream or placebo cream for 24 or 48 h. On day 0, and 24 or 48 h post cream application, cold/heat detection and pain thresholds, mechanical pain thresholds and sensitivity, trans-epidermal water loss, histamine- and cowhage-evoked itch, and micro-vascular reactivity (neurogenic inflammation) were assessed to evaluate the analgesic, anti-pruritogenic and vasomotor effects. Skin permeability was reduced in the Salicornia-treated area for 48 h compared with 24 h application (p-value < 0.05). After 48 h of application, a decrease in mechanical-evoked itching (hyperkinesis) compared with 24 h treatment (p-value < 0.05) and increased warm detection and heat pain thresholds (p-value < 0.05) was found. Histamine-induced neurogenic inflammation showed a significant reduction in the cream-treated areas after 48 h compared with 24 h (p-value < 0.05). The results of this study indicate the overall inhibitory effect of Salicornia on hyperkinesis (mechanically evoked itch), the analgesic effect on thermal sensation, and modulation of the skin barrier architecture. Further studies are needed for the assessment of the long-term effects.
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Affiliation(s)
- Rocco Giordano
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark; (R.G.); (G.E.A.); (S.L.V.); (L.A.-N.)
- Translational Biomarkers in Pain and Precision Medicine, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark; (A.S.J.); (D.V.-J.); (F.H.L.); (L.A.A.); (A.R.)
| | - Giulia Erica Aliotta
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark; (R.G.); (G.E.A.); (S.L.V.); (L.A.-N.)
- Translational Biomarkers in Pain and Precision Medicine, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark; (A.S.J.); (D.V.-J.); (F.H.L.); (L.A.A.); (A.R.)
| | - Anja Stokholm Johannesen
- Translational Biomarkers in Pain and Precision Medicine, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark; (A.S.J.); (D.V.-J.); (F.H.L.); (L.A.A.); (A.R.)
| | - Dina Voetmann-Jensen
- Translational Biomarkers in Pain and Precision Medicine, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark; (A.S.J.); (D.V.-J.); (F.H.L.); (L.A.A.); (A.R.)
| | - Frederikke Hillebrand Laustsen
- Translational Biomarkers in Pain and Precision Medicine, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark; (A.S.J.); (D.V.-J.); (F.H.L.); (L.A.A.); (A.R.)
| | - Lasse Allermann Andersen
- Translational Biomarkers in Pain and Precision Medicine, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark; (A.S.J.); (D.V.-J.); (F.H.L.); (L.A.A.); (A.R.)
| | - Aman Rezai
- Translational Biomarkers in Pain and Precision Medicine, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark; (A.S.J.); (D.V.-J.); (F.H.L.); (L.A.A.); (A.R.)
| | - Malthe Fredsgaard
- Department of Energy Technology, Aalborg University, 6700 Esbjerg, Denmark; (M.F.); (M.H.T.)
| | - Silvia Lo Vecchio
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark; (R.G.); (G.E.A.); (S.L.V.); (L.A.-N.)
- Translational Biomarkers in Pain and Precision Medicine, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark; (A.S.J.); (D.V.-J.); (F.H.L.); (L.A.A.); (A.R.)
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark; (R.G.); (G.E.A.); (S.L.V.); (L.A.-N.)
- Translational Biomarkers in Pain and Precision Medicine, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark; (A.S.J.); (D.V.-J.); (F.H.L.); (L.A.A.); (A.R.)
- Department of Medical Gastroenterology, Mech-Sense, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Mette Hedegaard Thomsen
- Department of Energy Technology, Aalborg University, 6700 Esbjerg, Denmark; (M.F.); (M.H.T.)
| | - Allan Stensballe
- Translational Biomarkers in Pain and Precision Medicine, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg, Denmark; (A.S.J.); (D.V.-J.); (F.H.L.); (L.A.A.); (A.R.)
- Correspondence: ; Tel.: +45-61-608-786
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31
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Weng L, van Laarhoven AIM, Peerdeman KJ, Evers AWM. Induction and generalization of nocebo effects on itch. Exp Dermatol 2022; 31:878-889. [PMID: 35000228 PMCID: PMC9304305 DOI: 10.1111/exd.14522] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 12/20/2021] [Indexed: 11/29/2022]
Abstract
Nocebo effects, that is, negative treatment outcomes due to negative expectancies, can increase itch. Moreover, indirect evidence has shown that nocebo hyperknesis can generalize to another itch modality. Knowledge on response generalization can help to prevent and decrease negative effects. The aims of this study were to investigate (1) the efficacy of inducing nocebo effects on cowhage‐evoked itch via verbal suggestions and (2) whether these effects can generalize to (2a) mechanically evoked touch and (2b) mechanically evoked itch. Forty‐four healthy participants watched a video suggesting that a nocebo solution increases cowhage‐evoked itch and that a control solution does not affect itch. Subsequently, cowhage, mechanical itch, and mechanical touch stimuli were applied. Nocebo effects were measured as the difference in both mean and peak of the outcomes itch and urge to scratch between nocebo and control trials. Main analyses revealed significant nocebo effects on mean and peak itch for all stimuli. For urge to scratch, a significant nocebo effect was only observed for mechanical touch (peak). As mechanical stimuli did not induce pure sensations as planned, posthoc sensitivity analyses were run for mechanical stimuli that individually induced either touch or itch at baseline. These analyses showed similar results for generalization to mechanical itch, but generalization to mechanical touch was non‐significant. This study showed that merely verbal suggestion can induce nocebo effects on cowhage‐evoked itch and that these effects can generalize to another itch modality. Future studies may examine how to prevent negative experiences from generalizing to subsequent encounters.
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Affiliation(s)
- Lingling Weng
- Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioral Sciences, Leiden University, Leiden, the Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, the Netherlands
| | - Antoinette I M van Laarhoven
- Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioral Sciences, Leiden University, Leiden, the Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, the Netherlands
| | - Kaya J Peerdeman
- Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioral Sciences, Leiden University, Leiden, the Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, the Netherlands
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioral Sciences, Leiden University, Leiden, the Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, the Netherlands.,Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands.,Medical Delta, Leiden University, Technical University Delft, Rotterdam University, the Netherlands
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32
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Misery L, Shourick J, Reychler G, Taieb C. Association between chronic idiopathic cough and sensitive skin syndromes is a new argument in favor of common neuropathic pathways: results from a survey on 4050 subjects. Sci Rep 2021; 11:16976. [PMID: 34417530 PMCID: PMC8379212 DOI: 10.1038/s41598-021-96608-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 08/06/2021] [Indexed: 02/07/2023] Open
Abstract
Sensitive skin syndrome has a neuropathic origin, which is why it is frequently associated with irritable bowel syndrome. We have looked for a possible association with chronic cough, which is commonly maintained by neurogenic mechanisms, whatever the initial cause(s). A survey was carried out on a representative sample of the population over 15 years of age using the quota method. The questionnaire included sociodemographic data and questions about sensitive skin, the presence of chronic cough, smoking and possible causes of chronic cough. Chronic cough was assessed by the Leicester Cough Questionnaire, and 4050 subjects responded (mean age: 45 years). Overall, 12.2% of subjects with a chronic cough were compared to the 87.8% without any cough. Among them, 72.5% had sensitive skin (vs. 47.8%, p < 0.001); additionally, 17.4% of the subjects with sensitive skin had a chronic cough (vs. 6.9% if no sensitive skin). These proportions were higher if very sensitive skin was reported. The risk of having chronic cough was twice as high if sensitive skin was reported [OR = 1.9 (1.5-2.4), p < 0.001]. The risk of having sensitive skin was also twice as high for chronic cough. Thus, chronic cough and sensitive skin are frequently associated. This association represents a new argument in favor of a neuropathic nature of sensitive skin. Sensitive skin and chronic cough are both modes of overreaction to environmental factors, which tend to be autonomized by neurogenic mechanisms. Dermatologists should ask their patients if they have a chronic cough, and pneumologists should ask about the presence of sensitive skin.
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Affiliation(s)
- Laurent Misery
- Laboratory of Neurosciences, University of Western Brittany, Brest, France.
- Department of Dermatology, University Hospital of Brest, Brest, France.
| | | | - Grégory Reychler
- Department of Pneumology, University Clinics Saint-Luc, Brussels, Belgium
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33
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Komiya E, Tominaga M, Hatano R, Kamikubo Y, Toyama S, Sakairi H, Honda K, Itoh T, Kamata Y, Tsurumachi M, Kishi R, Ohnuma K, Sakurai T, Morimoto C, Takamori K. Peripheral endomorphins drive mechanical alloknesis under the enzymatic control of CD26/DPPIV. J Allergy Clin Immunol 2021; 149:1085-1096. [PMID: 34411589 DOI: 10.1016/j.jaci.2021.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 06/29/2021] [Accepted: 08/02/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Mechanical alloknesis (or innocuous mechanical stimuli-evoked itch) often occurs in dry skin-based disorders such as atopic dermatitis and psoriasis. However, the molecular and cellular mechanisms underlying mechanical alloknesis remain unclear. We recently reported the involvement of CD26 in the regulation of psoriatic itch. This molecule exhibits dipeptidyl peptidase IV (DPPIV) enzyme activity and exerts its biologic effects by processing various substances, including neuropeptides. OBJECTIVE The aim of the present study was to investigate the peripheral mechanisms of mechanical alloknesis by using CD26/DPPIV knockout (CD26KO) mice. METHODS We applied innocuous mechanical stimuli to CD26KO or wild-type mice. The total number of scratching responses was counted as the alloknesis score. Immunohistochemical and behavioral pharmacologic analyses were then performed to examine the physiologic activities of CD26/DPPIV or endomorphins (EMs), endogenous agonists of μ-opioid receptors. RESULTS Mechanical alloknesis was more frequent in CD26KO mice than in wild-type mice. The alloknesis score in CD26KO mice was significantly reduced by the intradermal administration of recombinant DPPIV or naloxone methiodide, a peripheral μ-opioid receptor antagonist, but not by that of mutant DPPIV without enzyme activity. EMs (EM-1 and EM-2), selective ligands for μ-opioid receptors, are substrates for DPPIV. Immunohistochemically, EMs were located in keratinocytes, fibroblasts, and peripheral sensory nerves. Behavioral analyses revealed that EMs preferentially provoked mechanical alloknesis over chemical itch. DPPIV-digested forms of EMs did not induce mechanical alloknesis. CONCLUSION The present results suggest that EMs induce mechanical alloknesis at the periphery under the enzymatic control of CD26/DPPIV.
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Affiliation(s)
- Eriko Komiya
- Juntendo Itch Research Center, Institute for Environmental and Gender-Specific Medicine, Graduate School of Medicine, Juntendo University, Chiba, Japan
| | - Mitsutoshi Tominaga
- Juntendo Itch Research Center, Institute for Environmental and Gender-Specific Medicine, Graduate School of Medicine, Juntendo University, Chiba, Japan; Anti-Aging Skin Research Laboratory, Graduate School of Medicine, Juntendo University, Chiba, Japan
| | - Ryo Hatano
- Department of Therapy Development and Innovation for Immune Disorders and Cancers, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Yuji Kamikubo
- Department of Pharmacology, Juntendo University School of Medicine, Tokyo, Japan
| | - Sumika Toyama
- Juntendo Itch Research Center, Institute for Environmental and Gender-Specific Medicine, Graduate School of Medicine, Juntendo University, Chiba, Japan
| | - Hakushun Sakairi
- Department of Pharmacology, Juntendo University School of Medicine, Tokyo, Japan
| | - Kotaro Honda
- Juntendo Itch Research Center, Institute for Environmental and Gender-Specific Medicine, Graduate School of Medicine, Juntendo University, Chiba, Japan
| | - Takumi Itoh
- Department of Therapy Development and Innovation for Immune Disorders and Cancers, Graduate School of Medicine, Juntendo University, Tokyo, Japan; Atopy (Allergy) Research Center, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Yayoi Kamata
- Juntendo Itch Research Center, Institute for Environmental and Gender-Specific Medicine, Graduate School of Medicine, Juntendo University, Chiba, Japan; Anti-Aging Skin Research Laboratory, Graduate School of Medicine, Juntendo University, Chiba, Japan
| | - Munehiro Tsurumachi
- Juntendo Itch Research Center, Institute for Environmental and Gender-Specific Medicine, Graduate School of Medicine, Juntendo University, Chiba, Japan; Department of Dermatology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Ryoma Kishi
- Juntendo Itch Research Center, Institute for Environmental and Gender-Specific Medicine, Graduate School of Medicine, Juntendo University, Chiba, Japan; Department of Dermatology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kei Ohnuma
- Department of Therapy Development and Innovation for Immune Disorders and Cancers, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Takashi Sakurai
- Department of Pharmacology, Juntendo University School of Medicine, Tokyo, Japan
| | - Chikao Morimoto
- Department of Therapy Development and Innovation for Immune Disorders and Cancers, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Kenji Takamori
- Juntendo Itch Research Center, Institute for Environmental and Gender-Specific Medicine, Graduate School of Medicine, Juntendo University, Chiba, Japan; Anti-Aging Skin Research Laboratory, Graduate School of Medicine, Juntendo University, Chiba, Japan; Department of Dermatology, Juntendo University Urayasu Hospital, Chiba, Japan.
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34
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Garcovich S, Maurelli M, Gisondi P, Peris K, Yosipovitch G, Girolomoni G. Pruritus as a Distinctive Feature of Type 2 Inflammation. Vaccines (Basel) 2021; 9:vaccines9030303. [PMID: 33807098 PMCID: PMC8005108 DOI: 10.3390/vaccines9030303] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 12/13/2022] Open
Abstract
Pruritus is a common symptom of several skin diseases, both inflammatory and neoplastic. Pruritus might have a tremendous impact on patients’ quality of life and strongly interfere with sleep, social, and work activities. We review the role of type-2 inflammation and immunity in the pathogenesis of chronic pruritic conditions of the skin. Type 2 cytokines, including IL-4, IL-13, thymic stromal lymphopoietin, periostin, IL-31, IL-25, and IL-33 are released by mast cells, innate lymphoid cells 2, keratinocytes, and type 2 T lymphocytes, and are master regulators of chronic itch. These cytokines might act as direct pruritogen on primary sensory neurons (pruriceptors) or alter the sensitivity to other itch mediators Type 2 inflammation- and immunity-dominated skin diseases, including atopic dermatitis, prurigo nodularis, bullous pemphigoid, scabies, parasitic diseases, urticaria, and Sézary syndrome are indeed conditions associated with most severe pruritus. In contrast, in other skin diseases, such as scleroderma, lupus erythematosus, hidradenitis suppurativa, and acne, type 2 inflammation is less represented, and pruritus is milder or variable. Th2 inflammation and immunity evolved to protect against parasites, and thus, the scratching response evoked by pruritus might have developed to alert about the presence and to remove parasites from the skin surface.
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Affiliation(s)
- Simone Garcovich
- Dermatology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
- Dermatology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Correspondence:
| | - Martina Maurelli
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, 37126 Verona, Italy; (M.M.); (P.G.); (G.G.)
| | - Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, 37126 Verona, Italy; (M.M.); (P.G.); (G.G.)
| | - Ketty Peris
- Dermatology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
- Dermatology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Gil Yosipovitch
- Miami Itch Center, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL 33136, USA;
| | - Giampiero Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, 37126 Verona, Italy; (M.M.); (P.G.); (G.G.)
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Takeuchi S, Inoue K, Kuretake K, Kiyomatsu-Oda M, Furue M. Dupilumab shows slow, steady effectiveness for intractable prurigo in patients with atopic dermatitis. J Dermatol 2021; 48:638-644. [PMID: 33742710 DOI: 10.1111/1346-8138.15843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/17/2021] [Accepted: 02/21/2021] [Indexed: 11/27/2022]
Abstract
Prurigo lesions in atopic dermatitis are intractable. This single-center, retrospective study examined dupilumab's clinical effects on intractable prurigo. Twenty adult atopic dermatitis patients (12 with prurigo, eight without) were administrated dupilumab. Its effects on itching and disease severity were examined with Numerical Rating Scale-Itch (NRS-I), Eczema Area and Severity Index (EASI), and Investigator Global Assessment (IGA) scores; body surface areas (BSA); and thymus- and activation-regulated chemokine (TARC), total immunoglobulin (Ig)E, and eosinophil levels. NRS-I scores, EASI scores, TARC levels, and total IgE levels before dupilumab treatment were not statistically different between the prurigo and non-prurigo groups. With dupilumab treatment, NRS-I scores, EASI scores, IGA scores, BSA, TARC levels, and total IgE levels were significantly reduced from baseline in both groups at 1-2 months and onward, but skin symptom improvement in the prurigo group was slower than in the non-prurigo group, as evidenced by significantly higher EASI scores, BSA, and TARC levels at several time points during the 12 months of dupilumab treatment. Prurigo patients were slower in EASI-50 achievement and significantly lower in EASI-90 achievement at 12 months than non-prurigo patients. Adherence to dupilumab was not different, but total equivalent amounts of concomitant therapeutic agents (corticosteroids and tacrolimus) used during dupilumab treatment were significantly higher in the prurigo group (median, 56.2 g/week) than in the non-prurigo group (median, 33.7 g/week). There were 2.2 adverse events per patient on average; ocular complaints were most frequent. Dupilumab was effective in treating intractable prurigo, but despite significantly greater concomitant therapeutic agent use, skin symptom improvement was slower in prurigo patients than in non-prurigo patients.
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Affiliation(s)
- Satoshi Takeuchi
- Department of Dermatology, Federation of National Public Service Personnel Mutual Aid Associations, Hamanomachi Hospital, Fukuoka, Japan.,Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keiichi Inoue
- Department of Dermatology, Federation of National Public Service Personnel Mutual Aid Associations, Hamanomachi Hospital, Fukuoka, Japan
| | - Keisuke Kuretake
- Department of Dermatology, Federation of National Public Service Personnel Mutual Aid Associations, Hamanomachi Hospital, Fukuoka, Japan
| | - Mari Kiyomatsu-Oda
- Department of Dermatology, Federation of National Public Service Personnel Mutual Aid Associations, Hamanomachi Hospital, Fukuoka, Japan
| | - Masutaka Furue
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Pereira MP, Wiegmann H, Agelopoulos K, Ständer S. Neuropathic Itch: Routes to Clinical Diagnosis. Front Med (Lausanne) 2021; 8:641746. [PMID: 33732722 PMCID: PMC7959783 DOI: 10.3389/fmed.2021.641746] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/03/2021] [Indexed: 01/08/2023] Open
Abstract
Neuropathic itch occurs due to damage of neurons of the peripheral or central nervous system. Several entities, including metabolic, neurodegenerative, orthopedic, infectious, autoimmune, malignant, and iatrogenic conditions, may affect the somatosensory system and induce neuropathic itch. Due to the complex nature of neuropathic itch, particularly concerning its clinical presentation and possible etiological factors, diagnostic work-up of this condition is challenging. A detailed medical history, especially in regard to the itch, and a comprehensive physical examination are relevant to detect characteristic signs and symptoms of neuropathic itch and to rule out other possible causes for chronic itch. Complementary diagnostic exams, especially laboratory tests, determination of the intraepidermal nerve fiber density via a skin biopsy and radiological examinations may be indicated to confirm the diagnosis of neuropathic itch and to identify underlying etiological factors. Functional assessments such as quantitative sensory testing, nerve conduction studies, evoked potentials, or microneurography may be considered in particular cases. This review article provides a comprehensive overview of the diagnostic work-up recommended for patients with neuropathic itch.
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Affiliation(s)
- Manuel Pedro Pereira
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Henning Wiegmann
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Konstantin Agelopoulos
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Sonja Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
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Nguyen E, Lim G, Ding H, Hachisuka J, Ko MC, Ross SE. Morphine acts on spinal dynorphin neurons to cause itch through disinhibition. Sci Transl Med 2021; 13:13/579/eabc3774. [DOI: 10.1126/scitranslmed.abc3774] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/13/2020] [Indexed: 12/18/2022]
Abstract
Morphine-induced itch is a very common and debilitating side effect that occurs in laboring women who receive epidural analgesia and in patients who receive spinal morphine for relief of perioperative pain. Although antihistamines are still widely prescribed for the treatment of morphine-induced itch, their use is controversial because the cellular basis for morphine-induced itch remains unclear. Here, we used animal models and show that neuraxial morphine causes itch through neurons and not mast cells. In particular, we found that spinal dynorphin (Pdyn) neurons are both necessary and sufficient for morphine-induced itch in mice. Agonism of the kappa-opioid receptor alleviated morphine-induced itch in mice and nonhuman primates. Thus, our findings not only reveal that morphine causes itch through a mechanism of disinhibition but also challenge the long-standing use of antihistamines, thereby informing the treatment of millions worldwide.
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Affiliation(s)
- Eileen Nguyen
- Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
- Medical Scientist Training Program, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Grace Lim
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Huiping Ding
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Junichi Hachisuka
- Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
| | - Mei-Chuan Ko
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Sarah E. Ross
- Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
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Misery L. Pruriplastic Itch-A Novel Pathogenic Concept in Chronic Pruritus. Front Med (Lausanne) 2021; 7:615118. [PMID: 33553207 PMCID: PMC7854543 DOI: 10.3389/fmed.2020.615118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/22/2020] [Indexed: 11/24/2022] Open
Abstract
The International Association for the Study of Pain (IASP) defined three descriptors for pain: nociceptive pain is “pain that arises from actual or threatened damage to non neural tissue and is due to the activation of nociceptors”; neuropathic pain is “pain caused by a lesion or disease of the somatosensory nervous system”; and nociplastic pain is “pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain.” Based on clinical and pathophysiological arguments, a similar definition of “pruriplastic pruritus” should be made. Pruriplastic pruritus would include psychogenic pruritus, as well as some cases of pruritus ani, vulvar pruritus, sensitive skin or other poorly understood cases of pruritus. This new descriptor of itch could serve as systematic screening for altered pruriceptive function in patients who suffer from chronic itch and it may also help in defining better tailored treatment by identifying patients who are likely to respond better to centrally rather than to peripherally targeted therapies.
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Itch: A Paradigm of Neuroimmune Crosstalk. Immunity 2020; 52:753-766. [PMID: 32433948 DOI: 10.1016/j.immuni.2020.04.008] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/07/2020] [Accepted: 04/17/2020] [Indexed: 02/07/2023]
Abstract
Although the medical definition of itch has been in existence for 360 years, only in the last 20 years have we begun to understand the basic mechanisms that underlie this unique sensation. Therapeutics that specifically target chronic itch as a pathologic entity are currently still not available. Recent seminal advances in itch circuitry within the nervous system have intersected with discoveries in immunology in unexpected ways to rapidly inform emerging treatment strategies. The current review aims to introduce these basic concepts in itch biology and highlight how distinct immunologic pathways integrate with recently identified itch-sensory circuits in the nervous system to inform a major new paradigm of neuroimmunology and therapeutic development for chronic itch.
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40
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Misery L. Fardeau de la dermatite atopique chez l’enfant et l’adolescent. Ann Dermatol Venereol 2020; 147:11S31-11S36. [DOI: 10.1016/s0151-9638(20)31086-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Granot M, Yakov S, Ramon M. Enhanced Itch Intensity Is Associated with Less Efficient Descending Inhibition Processing for Itch But Not Pain Attenuation in Chronic Dermatology Patients. PAIN MEDICINE 2020; 21:2538-2545. [DOI: 10.1093/pm/pnz263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
The study aims were 1) to investigate the direction of mutual inhibitory pathways on itch intensity by utilizing conditioned pain modulation paradigms for pain and itch attenuation and 2) to explore whether itch severity is affected by the individual pain sensitivity profile, as well as pain scores reported during the tests and the past week.
Design
Cross-sectional.
Setting
Testing was conducted at the Department of Dermatology, Rambam Health Care Campus.
Subjects
Forty patients suffering from chronic skin disorders associated with itch and treated in the Dermatology Clinic at Rambam Health Care Campus participated in the study.
Methods
Efficacy of descending inhibition was evaluated by two conditioned pain modulation (CPM) paradigms: by pruriception (CPMItch) induced by cold and heat as counterstimuli to inhibit itch intensity and by nociception (CPMPain). Severity and interference of clinical pain were assessed using the Brief Pain Inventory (BPI).
Results
Robust CPMItch responses were obtained following the various noxious stimulations. No associations were observed between CPMPain and CPMItch, itch severity, skin disease severity, and clinical pain symptoms. According to the linear regression model, itch severity was independently associated with less efficient CPMItch (B = –0.750, P < 0.001) and more efficient CPMPain (B = 0.031, P = 0.016), which affects itch in opposing manners.
Conclusions
Findings indicate that the intrinsic capacity to inhibit pain and itch by exposure to exogenous noxious stimuli autonomously affects itch intensity in an opposing manner. These findings may shed new light on the mutual mechanistic similarity and dissimilarity between pain and itch and their hierarchy.
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Affiliation(s)
- Michal Granot
- The Laboratory of Clinical Neurophysiology, the Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- The Faculty of Social Welfare and Health Studies, University of Haifa, Haifa, Israel
| | - Sarit Yakov
- Department of Dermatology, Rambam Health Care Campus, Haifa, Israel
| | - Michal Ramon
- Department of Dermatology, Rambam Health Care Campus, Haifa, Israel
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Ramon M, Yakov S, Kuperman P, Granot M. The role of itch and pain modulation in the prediction of phototherapy outcomes: a prospective cohort study. J DERMATOL TREAT 2020; 33:1037-1041. [PMID: 32700633 DOI: 10.1080/09546634.2020.1800572] [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: 10/23/2022]
Abstract
OBJECTIVES Ability to predict which chronic itch patients will benefit from particular treatments is a challenge. Common features in itch and pain in respect to sensory elicitation, and mechanisms of processing including sensitization and inhibition at the peripheral and central levels, may serve to understand variability in treatment outcomes. As such this study aimed to explore whether phototherapy outcomes can be predicted by psychophysical parameters of pain and itch modulatory processing. METHODS Prospective cohort study on chronic-itch patients (n = 44) assessed before 20 treatments of NB UVB. Level of itch and pain reduction following painful stimulation (reflecting the 'pain inhibits pain' phenomenon) used to assess the top-down modulation response efficacy. Magnitude of Conditioned Pain Modulation (CPM) for itch (CPM-itch) and for pain (CPM-pain) (reflecting inhibition) and magnitude of temporal summation (TS) of pain (reflecting ascending facilitation pathways) assessed to predict treatment effect. RESULTS Higher improvement of itch symptoms following phototherapy was correlated with more efficient CPM-itch (r = 0.62, p < .001), but not magnitude of CPM-pain or level of temporal summation. DISCUSSION Findings emphasize the role of descending inhibition pathways in determining phototherapy efficacy in chronic itch patients. Such an evaluation-based approach may contribute to better patient selection for phototherapy improving patients' disease outcomes.
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Affiliation(s)
- Michal Ramon
- Department of Dermatology, Rambam Health Care Campus, Haifa, Israel
| | - Sarit Yakov
- Department of Dermatology, Rambam Health Care Campus, Haifa, Israel
| | - Pora Kuperman
- The Faculty of Social Welfare and Health Studies, University of Haifa, Haifa, Israel
| | - Michal Granot
- The Faculty of Social Welfare and Health Studies, University of Haifa, Haifa, Israel.,The Laboratory of Clinical Neurophysiology, the Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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43
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Sakai K, Akiyama T. New insights into the mechanisms behind mechanical itch. Exp Dermatol 2020; 29:680-686. [PMID: 32621303 DOI: 10.1111/exd.14143] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/12/2020] [Accepted: 06/25/2020] [Indexed: 12/25/2022]
Abstract
Gentle tactile stimuli, such as insects crawling on the skin, can cause itching sensation called mechanical itch. Recent studies have begun to shed light on the neural mechanisms of mechanical itch. Interestingly, the neural pathway for mechanical itch is apparently different from that for chemical itch triggered by the activation of pruriceptors with various mediators. Mechanical itch dysesthesia is frequently seen in patients with chronic itch. Mechanisms of this dysesthesia are plausibly involved in central sensitization. In this review, we summarize the current knowledge of mechanical itch under normal and pathological conditions.
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Affiliation(s)
- Kent Sakai
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery and Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tasuku Akiyama
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery and Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
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44
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Vincenzi B, Trower M, Duggal A, Guglielmini P, Harris P, Jackson D, Lacouture ME, Ratti E, Tonini G, Wood A, Ständer S. Neurokinin-1 antagonist orvepitant for EGFRI-induced pruritus in patients with cancer: a randomised, placebo-controlled phase II trial. BMJ Open 2020; 10:e030114. [PMID: 32034016 PMCID: PMC7045265 DOI: 10.1136/bmjopen-2019-030114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of orvepitant (10 or 30 mg given once daily, orally for 4 weeks), a neurokinin-1 receptor antagonist, compared with placebo in reducing the intensity of epidermal growth factor receptor inhibitor (EGFRI)-induced intense pruritus. DESIGN Randomised, double-blind, placebo-controlled clinical trial. SETTING 15 hospitals in Italy and five hospitals in the UK. PARTICIPANTS 44 patients aged ≥18 years receiving an EGFRI for a histologically confirmed malignant solid tumour and experiencing moderate or intense pruritus after EGFRI treatment. INTERVENTION 30 or 10 mg orvepitant or placebo tablets once daily for 4 weeks (randomised 1:1:1). PRIMARY AND SECONDARY OUTCOME MEASURES The primary endpoint was change from baseline in mean patient-recorded numerical rating scale (NRS) score (over the last three recordings) at week 4. Secondary outcome measures were NRS score, verbal rating scale score, Skindex-16 and Leeds Sleep Evaluation Questionnaire at each study visit (baseline, weeks 1, 4, 8); rescue medication use; EGFRI dose reduction; and study withdrawal because of intense uncontrolled pruritus. RESULTS The trial was terminated early because of recruitment challenges; only 44 of the planned 90 patients were randomised. All patients were analysed for efficacy and safety. Mean NRS score change from baseline to week 4 was -2.78 (SD: 2.64) points in the 30 mg group, -3.04 (SD: 3.06) points in the 10 mg group and -3.21 (SD: 1.77) points in the placebo group; the difference between orvepitant and placebo was not statistically significant. No safety signal was detected. Adverse events related to orvepitant (asthenia, dizziness, dry mouth, hyperhidrosis) were all of mild or moderate severity. CONCLUSIONS Orvepitant was safe and well tolerated. No difference in NRS score between the orvepitant and placebo groups was observed at the week 4 primary endpoint. A number of explanations for this outcome are possible. TRIAL REGISTRATION NUMBER EudraCT2013-002763-25.
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Affiliation(s)
- Bruno Vincenzi
- Medical Oncology, Universita Campus Bio-Medico di Roma Facolta di Medicina e Chirurgia, Roma, Italy
| | | | - Ajay Duggal
- Adnovate Clinical Development Strategies, East Sussex, UK
| | | | | | | | - Mario E Lacouture
- Department of Dermatology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Giuseppe Tonini
- Medical Oncology, Universita Campus Bio-Medico di Roma Facolta di Medicina e Chirurgia, Roma, Italy
| | | | - Sonja Ständer
- Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
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45
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Pereira MP, Derichs L, Meyer Zu Hörste G, Agelopoulos K, Ständer S. Generalized chronic itch induced by small-fibre neuropathy: clinical profile and proposed diagnostic criteria. J Eur Acad Dermatol Venereol 2020; 34:1795-1802. [PMID: 31838774 DOI: 10.1111/jdv.16151] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 11/26/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Small-fibre neuropathy (SFN) is a known cause for pain, however, it may be also associated with chronic itch. The clinical profile of chronic itch due to SFN is poorly defined and accordingly under-diagnosed in clinical care. OBJECTIVES To establish the clinical profile of patients with SFN and to propose diagnostic criteria for this patient population. METHODS Clinical data from patients diagnosed with SFN [chronic generalized itch and reduced intraepidermal nerve fibre density (IENFD)] were analysed retrospectively. RESULTS A total of 142 patients (60 females, median age: 62.5 years) were included. Patients reported daily, moderate to severe itch intensity scores occurring mostly in attacks (62.5%). Only 11 patients experienced exclusively itch, while the remaining patients (92%) reported pruralgia (itch along with painful sensations). Burning (50%), a sensation like needle pricks (46%) and tingling (45%) were the sensory symptoms reported by most patients. Cold or ice application led to an alleviation of the symptoms. The IENFD did not correlate with itch intensity; however, patients with a severely reduced IENFD (<30% of the normative cut-off value) reported more frequently sharp, spiky and drilling sensations compared to the remaining patients. The quality of life was moderately impaired and correlated with itch intensity, whereas anxiety and depression scores were low. CONCLUSIONS Onset of pruralgia on normal appearing skin, occurrence in attacks and symptomatic alleviation with cold/ice application should alert physicians for a possible neuropathic SFN-related origin of itch. A reduced IENFD can confirm the diagnosis of SFN.
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Affiliation(s)
- M P Pereira
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - L Derichs
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - G Meyer Zu Hörste
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - K Agelopoulos
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - S Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
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46
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Abstract
Itch is a topic to which everyone can relate. The physiological roles of itch are increasingly understood and appreciated. The pathophysiological consequences of itch impact quality of life as much as pain. These dynamics have led to increasingly deep dives into the mechanisms that underlie and contribute to the sensation of itch. When the prior review on the physiology of itching was published in this journal in 1941, itch was a black box of interest to a small number of neuroscientists and dermatologists. Itch is now appreciated as a complex and colorful Rubik's cube. Acute and chronic itch are being carefully scratched apart and reassembled by puzzle solvers across the biomedical spectrum. New mediators are being identified. Mechanisms blur boundaries of the circuitry that blend neuroscience and immunology. Measures involve psychophysics and behavioral psychology. The efforts associated with these approaches are positively impacting the care of itchy patients. There is now the potential to markedly alleviate chronic itch, a condition that does not end life, but often ruins it. We review the itch field and provide a current understanding of the pathophysiology of itch. Itch is a disease, not only a symptom of disease.
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Affiliation(s)
- Ferda Cevikbas
- Dermira, Inc., Menlo Park, California; and Harvard Medical School and the Cutaneous Biology Research Center at Massachusetts General Hospital, Charlestown, Massachusetts
| | - Ethan A Lerner
- Dermira, Inc., Menlo Park, California; and Harvard Medical School and the Cutaneous Biology Research Center at Massachusetts General Hospital, Charlestown, Massachusetts
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47
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Yosipovitch G, Berger T, Fassett MS. Neuroimmune interactions in chronic itch of atopic dermatitis. J Eur Acad Dermatol Venereol 2019; 34:239-250. [PMID: 31566796 PMCID: PMC7027518 DOI: 10.1111/jdv.15973] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 09/11/2019] [Indexed: 12/30/2022]
Abstract
Itch is a defining symptom of atopic dermatitis. Crosstalk between keratinocytes, the immune system and non‐histaminergic sensory nerves is responsible for the pathophysiology of chronic itch in atopic dermatitis. An expanding understanding of the contribution of the nervous system and its interaction with immune pathways in atopic itch are helping to identify new therapeutic strategies.
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Affiliation(s)
- G Yosipovitch
- Department of Dermatology and Cutaneous Surgery and Miami Itch Center, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - T Berger
- Department of Dermatology, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - M S Fassett
- Department of Dermatology, School of Medicine, University of California San Francisco, San Francisco, CA, USA
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48
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Yosipovitch G, Rosen JD, Hashimoto T. Itch: From mechanism to (novel) therapeutic approaches. J Allergy Clin Immunol 2019; 142:1375-1390. [PMID: 30409247 DOI: 10.1016/j.jaci.2018.09.005] [Citation(s) in RCA: 183] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/27/2018] [Accepted: 09/07/2018] [Indexed: 12/13/2022]
Abstract
Itch is a common sensory experience that is prevalent in patients with inflammatory skin diseases, as well as in those with systemic and neuropathic conditions. In patients with these conditions, itch is often severe and significantly affects quality of life. Itch is encoded by 2 major neuronal pathways: histaminergic (in acute itch) and nonhistaminergic (in chronic itch). In the majority of cases, crosstalk existing between keratinocytes, the immune system, and nonhistaminergic sensory nerves is responsible for the pathophysiology of chronic itch. This review provides an overview of the current understanding of the molecular, neural, and immune mechanisms of itch: beginning in the skin, proceeding to the spinal cord, and eventually ascending to the brain, where itch is processed. A growing understanding of the mechanisms of chronic itch is expanding, as is our pipeline of more targeted topical and systemic therapies. Our therapeutic armamentarium for treating chronic itch has expanded in the last 5 years, with developments of topical and systemic treatments targeting the neural and immune systems.
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Affiliation(s)
- Gil Yosipovitch
- Department of Dermatology and Cutaneous Surgery and Miami Itch Center Miller School of Medicine University of Miami, Miami, Fla.
| | - Jordan Daniel Rosen
- Department of Dermatology and Cutaneous Surgery and Miami Itch Center Miller School of Medicine University of Miami, Miami, Fla
| | - Takashi Hashimoto
- Department of Dermatology and Cutaneous Surgery and Miami Itch Center Miller School of Medicine University of Miami, Miami, Fla
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Itch sensitization? A systematic review of studies using quantitative sensory testing in patients with chronic itch. Pain 2019; 160:2661-2678. [DOI: 10.1097/j.pain.0000000000001678] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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50
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Identification of a Spinal Circuit for Mechanical and Persistent Spontaneous Itch. Neuron 2019; 103:1135-1149.e6. [PMID: 31324538 DOI: 10.1016/j.neuron.2019.06.016] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 04/17/2019] [Accepted: 06/20/2019] [Indexed: 12/12/2022]
Abstract
Lightly stroking the lips or gently poking some skin regions can evoke mechanical itch in healthy human subjects. Sensitization of mechanical itch and persistent spontaneous itch are intractable symptoms in chronic itch patients. However, the underlying neural circuits are not well defined. We identified a subpopulation of excitatory interneurons expressing Urocortin 3::Cre (Ucn3+) in the dorsal spinal cord as a central node in the pathway that transmits acute mechanical itch and mechanical itch sensitization as well as persistent spontaneous itch under chronic itch conditions. This population receives peripheral inputs from Toll-like receptor 5-positive (TLR5+) Aβ low-threshold mechanoreceptors and is directly innervated by inhibitory interneurons expressing neuropeptide Y::Cre (NPY+) in the dorsal spinal cord. Reduced synaptic inhibition and increased intrinsic excitability of Ucn3+ neurons lead to chronic itch sensitization. Our study sheds new light on the neural basis of chronic itch and unveils novel avenues for developing mechanism-specific therapeutic advancements.
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