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Von Martial S, Kok L, Gründel S, Augustin M, Blome C, Zeidler C, Steinbrink K, Ständer S, Tsianakas A. Introduction of a Specific Dermatological Rehabilitation Programme for Patients with Chronic Pruritus: A Pilot Study. Acta Derm Venereol 2022; 102:adv00831. [PMID: 36317589 PMCID: PMC10508275 DOI: 10.2340/actadv.v102.2930] [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] [Accepted: 11/01/2022] [Indexed: 11/07/2022] Open
Abstract
Chronic pruritus is a common symptom, associated with several severe medical conditions, great psychological burden, and reduced quality of life. It also poses socio-economic challenges concerning patients' work loss and healthcare costs. In Germany, medical rehabilitation programmes represent an integral part of the medical care of patients with chronic inflammatory skin diseases. However, such programmes play only a rudimentary role in the treatment of other dermatological diseases, such as dermatological oncology, genetic skin diseases, and chronic pruritus. Therefore, a specific antipruritic dermatological rehabilitation programme was developed in cooperation between the Department of Dermatology of the Medical Rehabilitation Center Bad Bentheim and the Center for Chronic Pruritus of the University Hospital of Muenster, Germany. This prospective study compared short-term patient-reported outcomes (n = 121) at the beginning and end of the rehabilitation programme. The majority of subjects had chronic pruritus on primary diseased, inflamed skin. Significant improvements in pruritus intensity (p ≤ 0.001), quality of life (p ≤ 0.001), anxiety symptoms (p ≤ 0.001) and depression (p ≤ 0.001), as well as an overall patient-relevant benefit (Patient Benefit Index 2.6 ± 1.06) and treatment-related patients' satisfaction, were shown. This suggests that implementation of this standardized rehabilitation programme for treatment of patients with chronic pruritus was successful.
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Affiliation(s)
- Sophia Von Martial
- Fachklinik Bad Bentheim, Department of Dermatology and Allergology, Am Bade 1, DE-48455 Bad Bentheim, Germany
| | - Lisa Kok
- Fachklinik Bad Bentheim, Department of Dermatology and Allergology, Am Bade 1, DE-48455 Bad Bentheim, Germany
| | - Sonja Gründel
- Fachklinik Bad Bentheim, Department of Dermatology and Allergology, Am Bade 1, DE-48455 Bad Bentheim, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christine Blome
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Claudia Zeidler
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Kerstin Steinbrink
- 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
| | - Athanasios Tsianakas
- Fachklinik Bad Bentheim, Department of Dermatology and Allergology, Am Bade 1, DE-48455 Bad Bentheim, Germany.
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Nast A, Werner RN, Dressler C, Zidane M, Heratizadeh A, Gaskins M. [Current dermatology guidelines in Germany and Europe : A selection of clinically relevant recommendations]. DER HAUTARZT 2021; 72:600-606. [PMID: 33666670 PMCID: PMC8238738 DOI: 10.1007/s00105-021-04775-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 12/18/2022]
Abstract
Clinical practice guidelines are systematically developed decision aids for specific medical conditions. In Germany, national dermatology guidelines are developed chiefly under the aegis of the German Dermatological Society in collaboration with the Professional Association of German Dermatologists. European and international dermatological guidelines also exist and are developed by a range of organisations, such as the European Centre for Guidelines Development, which was founded by the European Dermatology Forum in 2018. In the years 2019 and 2020, new or updated German national guidelines were published on topics such as pathological scars (hypertrophic scars and keloids), cutaneous lupus erythematosus, pyoderma grangrenosum, anal pruritus, anal eczema, anal canal and anal rim carcinomas, as well as the prevention of HPV-associated neoplasms through vaccination, syphilis and the systemic treatment of neurodermitis. A new European guideline on lichen planus closes a gap in the spectrum of guidelines available in Germany. Key recommendations and relevant changes in the guidelines are presented in this article.
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Affiliation(s)
- A Nast
- Division of Evidence-Based Medicine (dEBM), Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - R N Werner
- Division of Evidence-Based Medicine (dEBM), Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - C Dressler
- Division of Evidence-Based Medicine (dEBM), Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - M Zidane
- Division of Evidence-Based Medicine (dEBM), Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - A Heratizadeh
- Abteilung für Immundermatologie und experimentelle Allergologie, Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - M Gaskins
- Division of Evidence-Based Medicine (dEBM), Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
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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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Klinische Shortcuts in der Differenzialdiagnostik von Pruritus. Hautarzt 2020; 71:493-499. [DOI: 10.1007/s00105-020-04606-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Heckman CJ, Schut C, Riley M, Ehlers A, Valdes-Rodriguez R, Kupfer J, Gieler U, Stapleton JL. Development and psychometrics of the English version of the Itch Cognitions Questionnaire. PLoS One 2020; 15:e0230585. [PMID: 32191772 PMCID: PMC7081994 DOI: 10.1371/journal.pone.0230585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/03/2020] [Indexed: 01/25/2023] Open
Abstract
Background The aim of this study was to validate the English version of the Itch Cognition Questionnaire in a sample of patients with chronic itch due to psoriasis or atopic dermatitis. An English-language version of an instrument assessing itch-related cognitions is needed since cognitions can contribute to a worsening of itch, and chronic itch is prevalent in English-speaking counties and internationally. Methods The German Itch Cognitions Questionnaire was translated into English, and cognitive interviewing was conducted to finalize item wording. Internal and test-retest reliability, item discrimination, responsiveness to change, and construct, convergent, and discriminant validity were assessed in a national sample of 137 individuals with chronic itch due to atopic dermatitis or psoriasis recruited online. Results Internal reliability was high with Cronbach’s alphas of 0.93 for the Catastrophizing subscale and 0.88–0.90 for Coping. The Pearson’s correlation assessing 1-month test-retest reliability for the Catastrophizing subscale was r = 0.62 and for the Coping subscale was r = 0.61. The corrected item-total correlation revealed that items were relatively consistent with the scores for the subscales (with correlations ranging from 0.58 to 0.79), indicating very good item discrimination. Results of factor analysis, convergent and discriminant, and responsiveness to change analyses provided evidence for validity. Conclusions This study showed good psychometric characteristics of the English version of the Itch Cognitions Questionnaire. We suggest that future studies investigate the use of the measure in clinical practice to assist with treatment planning and outcome assessment related to itch as well as address study limitations such as sampling and replication.
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Affiliation(s)
- Carolyn J. Heckman
- Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States of America
- * E-mail:
| | - Christina Schut
- Institute of Medical Psychology, Justus-Liebig-University Gießen, Gießen, Germany
| | - Mary Riley
- Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States of America
| | - Anke Ehlers
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Rodrigo Valdes-Rodriguez
- Department of Dermatology, University of Virginia, Charlottesville, VA, United States of America
| | - Jörg Kupfer
- Institute of Medical Psychology, Justus-Liebig-University Gießen, Gießen, Germany
| | - Uwe Gieler
- Department of Dermatology, Justus-Liebig-University Gießen, Gießen, Germany
| | - Jerod L. Stapleton
- Department of Health Behavior, University of Kentucky, Lexington, KY, United States of America
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The Neuromodulatory Effect of Antipruritic Treatment of Chronic Prurigo. Dermatol Ther (Heidelb) 2019; 9:613-622. [PMID: 31512177 PMCID: PMC6828989 DOI: 10.1007/s13555-019-00321-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Indexed: 12/05/2022] Open
Abstract
Chronic prurigo is an extremely severe pruritic skin disease which presents with multiple, hyperkeratotic and erosive papules, nodules and/or plaques. Patients with this high-burden disease require effective therapies, but effective treatments with regulatory agency approval are currently lacking. Deeper understanding of the pathophysiology suggests that hypersensitive nerves play an important role in the development of chronic prurigo. Accordingly, a treatment with neuroactive substances which modulate hypersensitivity seems promising. Here, we review antipruritic therapies with a neuromodulative effect. Current treatment options, such as topical capsaicin or opioid-receptor modulators, and also novel and future treatment regimens, such as, for example, interleukin-31 antibodies and neurokinin-1 receptor antagonists, are discussed.
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Ständer S, Spellman MC, Kwon P, Yosipovitch G. The NK1 receptor antagonist serlopitant for treatment of chronic pruritus. Expert Opin Investig Drugs 2019; 28:659-666. [PMID: 31272246 DOI: 10.1080/13543784.2019.1638910] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Introduction: Pruritus is a common symptom associated with several potential underlying causes, including both dermatologic and systemic diseases; it can also occur without an identifiable cause. Current treatment options are limited and most patients experience impaired quality of life. Serlopitant is a neurokinin 1 (NK1) receptor antagonist under development for the treatment of pruritus associated with various dermatologic conditions and chronic pruritus of unknown origin. Areas covered: This review describes the epidemiology and unmet needs of patients with chronic pruritus, focusing specifically on patients with prurigo nodularis, psoriatic itch, and chronic pruritus of unknown origin; the rationale for targeting the NK1 receptor for treatment of chronic pruritus; and the clinical development of serlopitant, including efficacy and safety data from completed phase II studies. Expert opinion: There is an unmet need for novel, safe, and effective therapies to treat chronic pruritus. Serlopitant has shown promising efficacy, safety, and tolerability across different patient populations, including adolescents and elderly patients. In contrast to less convenient administration options, serlopitant is a once-daily oral tablet, which is expected to facilitate compliance.
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Affiliation(s)
- Sonja Ständer
- a Dermatology and Neurodermatology, Center for Chronic Pruritus, Department of Dermatology, University Hospital Münster , Münster , Germany
| | - Mary C Spellman
- b Department of Clinical Development, Menlo Therapeutics Inc , Redwood City , CA , USA
| | - Paul Kwon
- b Department of Clinical Development, Menlo Therapeutics Inc , Redwood City , CA , USA
| | - Gil Yosipovitch
- c Miami Itch Center, Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami , Miami , FL , USA
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Schneider G, Grebe A, Bruland P, Heuft G, Ständer S. Which patients with chronic pruritus are presented for psychological assessment by their dermatologists? Results from a consecutive sample. Br J Dermatol 2019; 181:1329-1330. [PMID: 31254402 PMCID: PMC6916583 DOI: 10.1111/bjd.18259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- G Schneider
- Department of Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany.,Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - A Grebe
- Department of Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany
| | - P Bruland
- Institute of Medical Informatics, University Hospital Münster, Münster, Germany
| | - G Heuft
- Department of Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany.,Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - S Ständer
- Center for Chronic Pruritus, University Hospital Münster, Münster, Germany.,Department of Dermatology, University Hospital Münster, Münster, Germany
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Kowalski EH, Kneiber D, Valdebran M, Patel U, Amber KT. Treatment-resistant prurigo nodularis: challenges and solutions. Clin Cosmet Investig Dermatol 2019; 12:163-172. [PMID: 30881076 PMCID: PMC6400231 DOI: 10.2147/ccid.s188070] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Prurigo nodualris (PN) is a chronic condition with highly pruritic, hyperkeratotic papules or nodules arising in the setting of chronic pruritus. While PN may serve as a phenotypic presentation of several underlying conditions such as atopic dermatitis, chronic kidney disease-related pruritus, and neurological diseases, it represents a distinct clinical entity that may persist despite the removal of the underlying cause, if one is identified. Neuronal proliferation, eosinophils, mast cells, and small-fiber neuropathy play a role in the production of pruritus in PN, although the exact mechanism has not yet been established. Identifying an underlying cause, if present, is essential to prevent recurrence of PN. Due to often present comorbidities, treatment is typically multimodal with utilization of topical and systemic therapies. We performed a PubMed/MEDLINE search for PN and present a review of recent developments in the treatment of PN. Treatment typically relies on the use of topical or intralesional steroids, though more severe or recalcitrant cases often necessitate the use of phototherapy or systemic immunosuppressives. Thalidomide and lenalidomide can both be used in severe cases; however, their toxicity profile makes them less favorable. Opioid receptor antagonists and neurokinin-1 receptor antagonists represent two novel families of therapeutic agents which may effectively treat PN with a lower toxicity profile than thalidomide or lenalidomide.
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Affiliation(s)
- Eric H Kowalski
- Department of Dermatology, University of Illinois at Chicago, Chicago, IL, USA,
| | - Diana Kneiber
- Department of Dermatology, University of Illinois at Chicago, Chicago, IL, USA,
| | - Manuel Valdebran
- Department of Dermatology, University of California, Irvine, Irvine, CA, USA
| | - Umangi Patel
- Department of Dermatology, University of Illinois at Chicago, Chicago, IL, USA,
| | - Kyle T Amber
- Department of Dermatology, University of Illinois at Chicago, Chicago, IL, USA,
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Zeidler C, Metz M, Steinke S, Ständer S. [Treatment of chronic pruritus-what is new?]. Hautarzt 2018; 69:641-646. [PMID: 29931387 DOI: 10.1007/s00105-018-4221-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chronic pruritus is one of the most common and stressful symptoms in medicine. Therapy remains a great challenge because of the lack of approved therapies. In the recent past a greater understanding of the pathogenesis has enabled the results to be translated into new forms of therapy. The various therapies target a wide range of points in the pruritic cascade-from blockade of intracellular and intercellular signaling pathways in the skin to the modulation of neurotransmission. This article provides a summary of current therapeutic options based on the current S2K guideline and gives an overview about recent developments in antipruritic treatments.
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Affiliation(s)
- C Zeidler
- Kompetenzzentrum Chronischer Pruritus (KCP) und Klinik für Hautkrankheiten, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland.
| | - M Metz
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - S Steinke
- Kompetenzzentrum Chronischer Pruritus (KCP) und Klinik für Hautkrankheiten, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland
| | - S Ständer
- Kompetenzzentrum Chronischer Pruritus (KCP) und Klinik für Hautkrankheiten, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland
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