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Borgonetti V, Morozzi M, Galeotti N. Neuroinflammation evoked mechanisms for neuropathic itch in the spared nerve injury mouse model of neuropathic pain. Neuropharmacology 2024; 259:110120. [PMID: 39159835 DOI: 10.1016/j.neuropharm.2024.110120] [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: 04/27/2024] [Revised: 08/11/2024] [Accepted: 08/16/2024] [Indexed: 08/21/2024]
Abstract
A large portion of neuropathic pain suffering patients may also concurrently experience neuropathic itch, with a negative impact on the quality of life. The limited understanding of neuropathic itch and the low efficacy of current anti-itch therapies dictate the urgent need of a better comprehension of molecular mechanisms involved and development of relevant animal models. This study was aimed to characterize the itching phenotype in a model of trauma-induced peripheral neuropathy, the spared nerve injury (SNI), and the molecular events underlying the overlap with the nociceptive behavior. SNI mice developed hyperknesis and spontaneous itch 7-14 days after surgery that was prevented by gabapentin treatment. Itch was associated with pain hypersensitivity, loss of intraepidermal nerve fiber (IENF) density and increased epidermal thickness. In coincidence with the peak of scratching behavior, SNI mice showed a spinal overexpression of IBA1 and GFAP, microglia and astrocyte markers respectively. An increase of the itch neuropeptide B-type natriuretic peptide (BNP) in NeuN+ cells, of its downstream effector interleukin 17 (IL17) along with increased pERK1/2 levels occurred in the spinal cord dorsal horn and DRG. A raise in BNP and IL17 was also detected at skin level. Stimulation of HaCat cells with conditioned medium from BV2-stimulated SH-SY5Y cells produced a dramatic reduction of HaCat cell viability. This study showed that SNI mice might represent a model for neuropathic itch and pain. Collectively, our finding suggest that neuropathic itch might initiate at spinal level, then affecting skin epidermis events, through a glia-mediated neuroinflammation-evoked BNP/IL17 mechanism.
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Affiliation(s)
- Vittoria Borgonetti
- Department of Neurosciences, Psychology, Drug Research and Child Health (Neurofarba), University of Florence, Viale G. Pieraccini 6, Florence, Italy
| | - Martina Morozzi
- Department of Neurosciences, Psychology, Drug Research and Child Health (Neurofarba), University of Florence, Viale G. Pieraccini 6, Florence, Italy
| | - Nicoletta Galeotti
- Department of Neurosciences, Psychology, Drug Research and Child Health (Neurofarba), University of Florence, Viale G. Pieraccini 6, Florence, Italy.
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2
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Baka P, Segelcke D, Birklein F, Pogatzki-Zahn EM, Bigalke S, Süer A, Dugas M, Steenken L, Sommer C, Papagianni A. Phenotyping peripheral neuropathies with and without pruritus: a cross-sectional multicenter study. Pain 2024:00006396-990000000-00638. [PMID: 38968397 DOI: 10.1097/j.pain.0000000000003300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/11/2024] [Indexed: 07/07/2024]
Abstract
ABSTRACT Pruritus often escapes physicians' attention in patients with peripheral neuropathy (PNP). Here we aimed to characterize neuropathic pruritus in a cohort of 191 patients with PNP (large, mixed, or small fiber) and 57 control subjects with deep phenotyping in a multicenter cross-sectional observational study at 3 German sites. All participants underwent thorough neurological examination, nerve conduction studies, quantitative sensory testing, and skin biopsies to assess intraepidermal nerve fiber density. Patients filled in a set of questionnaires assessing the characteristics of pruritus and pain, the presence of depression and anxiety, and quality of life. Based on the severity of pruritus and pain, patients were grouped into 4 groups: "pruritus," "pain," "pruritus and pain," and "no pruritus/no pain." Although 11% (21/191) of patients reported pruritus as their only symptom, further 34.6% (66/191) reported pruritus and pain. Patients with pain (with or without pruritus) were more affected by anxiety, depression, and reduced quality of life than control subjects. Patients with pruritus (with and without pain) had increases in cold detection threshold, showing Aδ-fiber dysfunction. The pruritus group had lower intraepidermal nerve fiber density at the thigh, concomitant with a more proximal distribution of symptoms compared with the other PNP groups. Stratification of patients with PNP by using cross-sectional datasets and multinominal logistic regression analysis revealed distinct patterns for the patient groups. Together, our study sheds light on the presence of neuropathic pruritus in patients with PNP and its relationship with neuropathic pain, outlines the sensory and structural abnormalities associated with neuropathic pruritus, and highlights its impact on anxiety levels.
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Affiliation(s)
- Panoraia Baka
- Department of Neurology, University Hospital Mainz, Mainz, Germany
| | - Daniel Segelcke
- Department of Anaesthesiology, Intensive Care, and Pain Medicine, University Hospital Münster, Germany
| | - Frank Birklein
- Department of Neurology, University Hospital Mainz, Mainz, Germany
| | - Esther M Pogatzki-Zahn
- Department of Anaesthesiology, Intensive Care, and Pain Medicine, University Hospital Münster, Germany
| | - Stephan Bigalke
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Ayşenur Süer
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Martin Dugas
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Livia Steenken
- Department of Neurology, University Hospital Mainz, Mainz, Germany
| | - Claudia Sommer
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
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Rasheed AAB, Birling MC, Lauria G, Gaveriaux-Ruff C, Herault Y. The COL6A5-p.Glu2272* mutation induces chronic itch in mice. Mamm Genome 2024; 35:122-134. [PMID: 38523187 DOI: 10.1007/s00335-024-10032-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/31/2024] [Indexed: 03/26/2024]
Abstract
Pruritus is a common irritating sensation that provokes the desire to scratch. Environmental and genetic factors contribute to the onset of pruritus. Moreover, itch can become a major burden when it becomes chronic. Interestingly, the rare Collagen VI alpha 5 (COL6A5) gene variant p.Glu2272* has been identified in two families and an independent patient with chronic neuropathic itch. These patients showed reduced COL6A5 expression in skin and normal skin morphology. However, little progress has been made until now toward understanding the relationships between this mutation and chronic itch. Therefore, we developed the first mouse model that recapitulates COL6A5-p.Glu2272* mutation using the CRISPR-Cas technology and characterized this new mouse model. The mutant mRNA, measured by RT-ddPCR, was expressed at normal levels in dorsal root ganglia and was decreased in skin. The functional exploration showed effects of the mutation with some sex dysmorphology. Mutant mice had increased skin permeability. Elevated spontaneous scratching and grooming was detected in male and female mutants, with increased anxiety-like behavior in female mutants. These results suggest that the COL6A5-p.Glu2272* mutation found in patients contributes to chronic itch and induces in mice additional behavioral changes. The COL6A5-p.Glu2272* mouse model could elucidate the pathophysiological mechanisms underlying COL6A5 role in itch and help identify potential new therapeutic targets.
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Affiliation(s)
- Ameer Abu Bakr Rasheed
- Université de Strasbourg, CNRS, INSERM Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), 1 rue Laurent Fries, 67400, Illkirch, France
| | - Marie-Christine Birling
- Université de Strasbourg, CNRS, INSERM Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), 1 rue Laurent Fries, 67400, Illkirch, France
- Université de Strasbourg, CNRS, INSERM, PHENOMIN-Institut Clinique de la Souris, (PHENOMIN-ICS), 1 rue Laurent Fries, 67400, Illkirch, France
| | - Giuseppe Lauria
- Neuroalgology Unit, IRCCS Foundation "Carlo Besta" Neurological Institute, 20133, Milan, Italy
| | - Claire Gaveriaux-Ruff
- Université de Strasbourg, CNRS, INSERM Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), 1 rue Laurent Fries, 67400, Illkirch, France
- Biotechnology and Cell Signaling, CNRS, University of Strasbourg, UMR7242, Illkirch-Graffenstaden, France
| | - Yann Herault
- Université de Strasbourg, CNRS, INSERM Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), 1 rue Laurent Fries, 67400, Illkirch, France.
- Université de Strasbourg, CNRS, INSERM, PHENOMIN-Institut Clinique de la Souris, (PHENOMIN-ICS), 1 rue Laurent Fries, 67400, Illkirch, France.
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Yu H, Ou G. Genetic analyses unravel the causal association of cytokine levels on lichen simplex chronicus risk: insights from a mendelian randomization study. Arch Dermatol Res 2024; 316:241. [PMID: 38795165 DOI: 10.1007/s00403-024-02964-8] [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: 03/03/2024] [Revised: 04/23/2024] [Accepted: 04/26/2024] [Indexed: 05/27/2024]
Abstract
Lichen simplex chronicus (LSC) presents a challenge in dermatology due to its elusive pathogenic mechanisms. While associations between circulating inflammatory cytokines and LSC were observed, the definitive causal dynamics remain to be elucidated. Our study used a two-sample Mendelian randomization (MR) approach to investigate causal relationships. We applied a suite of MR methodologies, including IVW, Weighted Median, MR-Egger, Weighted Mode, Simple Mode, MR-PRESSO, and the Steiger test, to ensure robust causal inference. Our analysis confirmed the causal impact of genetically determined cytokine levels on LSC risk, particularly MMP-10 (OR = 0.493, P = 0.004) and DNER (OR = 0.651, P = 0.043) in risk attenuation. We also found a positive causal correlation between GDNF levels (OR = 1.871, P = 0.007) and LSC prevalence. Notably, bidirectional causality was observed between DNER and LSC. Consistency across various MR analyses and sensitivity analyses confirmed the absence of horizontal pleiotropy, validating the causal estimates. This pioneering MR investigation unveils a novel genetically anchored causal relationship between the circulating levels of MMP-10, DNER, and GDNF and LSC risk. Although further validation is requisite, our findings augment the understanding of cytokine mediation in LSC and underscore prospective avenues for research.
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Affiliation(s)
- Haoyang Yu
- Department of Dermatology, Taizhou First People's Hospital, Taizhou, Zhejiang, 318020, P. R. China.
| | - Guanyong Ou
- School of Medicine, Southern University of Science and Technology, Shenzhen, Guangdong, 518055, P. R. China
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5
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Orliaguet M, Brenaut E, Ficheux A, Boisramé S, Misery L. Psychogenic and neurogenic components in patients with psychogenic or neuropathic pruritus: PRURINEURO: A non-interventional single-centre prospective assay. SKIN HEALTH AND DISEASE 2023; 3:e267. [PMID: 38047259 PMCID: PMC10690707 DOI: 10.1002/ski2.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/30/2023] [Accepted: 06/21/2023] [Indexed: 12/05/2023]
Abstract
Background The causes of pruritus are multiple and commonly classified into six different categories: dermatological, systemic, neuropathic, psychogenic, mixed and idiopathic. In clinical practice, psychogenic and neurogenic mechanisms tend to be separated in the etiological diagnosis of neuropathic or psychogenic disorders; nevertheless, studies investigating the respective psychogenic and neurogenic components are lacking. Objective The main objective of this work was to highlight the differences and potential common characteristics between psychogenic pruritus and neuropathic pruritus. Methods This study was a noninterventional single-centre prospective assay. Patients with neuropathic (NP) or psychogenic (PP) pruritus were proposed to participate. The psychogenic and neurogenic components of pruritus in these patients were evaluated using six validated questionnaires or criteria, namely, the diagnosis criteria of psychogenic pruritus, the NP5 questionnaire, the Brest Pruritus Qualitative Assessment Questionnaire, Hospital Anxiety and Depression Scale, Toronto Alexithymia Scale, and DN4i. Results Twenty-five patients with NP and 15 with PP were included. A difference between the two groups was observed for NP5, with mean scores of 2.8 ± 0.9 and 1.4 ± 1 for the NP and PP groups, respectively (p < 0.0001). For depression, the average score was 3.5 ± 3.9 for the NP group and 7.5 ± 5.1 for the PP group (p < 0.02). Conclusion While neuropathic and psychogenic disorders are different diagnoses, neuropathic and psychogenic components may exist simultaneously in patients with NP or PP.
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Affiliation(s)
- Marie Orliaguet
- LIENUniversity BrestBrestFrance
- Departments of Oral SurgeryBrest University HospitalBrestFrance
| | - Emilie Brenaut
- LIENUniversity BrestBrestFrance
- Departments of DermatologyBrest University HospitalBrestFrance
| | - Anne‐Sophie Ficheux
- LIENUniversity BrestBrestFrance
- Departments of DermatologyBrest University HospitalBrestFrance
| | - Sylvie Boisramé
- Departments of Oral SurgeryBrest University HospitalBrestFrance
| | - Laurent Misery
- LIENUniversity BrestBrestFrance
- Departments of DermatologyBrest University HospitalBrestFrance
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6
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Raolji S, Kumar P, Galor A. Ocular surface itch and pain: key differences and similarities between the two sensations. Curr Opin Allergy Clin Immunol 2023; 23:415-422. [PMID: 37490616 PMCID: PMC10529639 DOI: 10.1097/aci.0000000000000934] [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] [Indexed: 07/27/2023]
Abstract
PURPOSE OF REVIEW To review the pathophysiology and treatment of ocular itch and pain, encompassing nociceptive and neuropathic categories. RECENT FINDINGS Ocular itch and pain are sensations that arise from activation of ocular surface polymodal nerves. Nociceptive itch, commonly comorbid with ocular pain complaints, is mainly driven by a histamine-mediated type 1 hypersensitivity reaction. Beyond topical therapy, novel drug delivery systems are being explored to improve ocular residence time of nonsteroidal anti-inflammatory drugs (NSAIDs) and antihistamines. Nociceptive ocular pain can be driven by a variety of factors. Treatment focuses on addressing the causative sources of pain. Neuropathic ocular itch and pain are driven by nerve damage and dysfunction and as such, topical and oral neuromodulation have been explored as treatments. Oral neuromodulators include alpha 2 delta ligands, tricyclic antidepressants (TCAs), and low dose naltrexone. Novel therapies are being evaluated for both modalities such as difelikefalin (κ-opioid receptor agonist) for neuropathic itch and libvatrep (transient receptor potential vanilloid 1 antagonist) for neuropathic pain. SUMMARY Both ocular itch and pain can be driven by nociceptive and/or neuropathic mechanisms. Identifying contributors to abnormal ocular sensations is vital for precise medical care. Novel therapeutics for these conditions aim to improve patient outcomes and quality of life.
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Affiliation(s)
- Shyamal Raolji
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Preet Kumar
- Florida Atlantic University Schmidt College of Medicine, Boca Raton, FL
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
- Miami Veterans Administration Medical Center, 1201 NW 16th St, Miami, FL 33125
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7
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Cronin SJF, Tejada MA, Song R, Laval K, Cikes D, Ji M, Brai A, Stadlmann J, Novatchikova M, Perlot T, Ali OH, Botta L, Decker T, Lazovic J, Hagelkruys A, Enquist L, Rao S, Koyuncu OO, Penninger JM. Pseudorabies virus hijacks DDX3X, initiating an addictive "mad itch" and immune suppression, to facilitate viral spread. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.05.09.539956. [PMID: 37214906 PMCID: PMC10197578 DOI: 10.1101/2023.05.09.539956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Infections with defined Herpesviruses, such as Pseudorabies virus (PRV) and Varicella zoster virus (VZV) can cause neuropathic itch, referred to as "mad itch" in multiple species. The underlying mechanisms involved in neuropathic "mad itch" are poorly understood. Here, we show that PRV infections hijack the RNA helicase DDX3X in sensory neurons to facilitate anterograde transport of the virus along axons. PRV induces re-localization of DDX3X from the cell body to the axons which ultimately leads to death of the infected sensory neurons. Inducible genetic ablation of Ddx3x in sensory neurons results in neuronal death and "mad itch" in mice. This neuropathic "mad itch" is propagated through activation of the opioid system making the animals "addicted to itch". Moreover, we show that PRV co-opts and diverts T cell development in the thymus via a sensory neuron-IL-6-hypothalamus-corticosterone stress pathway. Our data reveal how PRV, through regulation of DDX3X in sensory neurons, travels along axons and triggers neuropathic itch and immune deviations to initiate pathophysiological programs which facilitate its spread to enhance infectivity.
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Affiliation(s)
- Shane J F Cronin
- Institute of Molecular Biotechnology Austria (IMBA), Dr. Bohrgasse 3, A-1030 Vienna, Austria
| | - Miguel A Tejada
- Institute of Molecular Biotechnology Austria (IMBA), Dr. Bohrgasse 3, A-1030 Vienna, Austria
| | - Ren Song
- Department of Molecular Biology, Princeton University, Princeton, New Jersey, USA
| | - Kathlyn Laval
- Department of Molecular Biology, Princeton University, Princeton, New Jersey, USA
- Department of Translational Physiology, Infectiology and Public Health, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Domagoj Cikes
- Institute of Molecular Biotechnology Austria (IMBA), Dr. Bohrgasse 3, A-1030 Vienna, Austria
| | - Ming Ji
- Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Annalaura Brai
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, I-53100 Siena, Italy
| | - Johannes Stadlmann
- Institute of Molecular Biotechnology Austria (IMBA), Dr. Bohrgasse 3, A-1030 Vienna, Austria
| | - Maria Novatchikova
- Institute of Molecular Biotechnology Austria (IMBA), Dr. Bohrgasse 3, A-1030 Vienna, Austria
| | - Thomas Perlot
- Institute of Molecular Biotechnology Austria (IMBA), Dr. Bohrgasse 3, A-1030 Vienna, Austria
| | - Omar Hasan Ali
- Department of Medical Genetics, Life Sciences Institute, University of British Columbia, Vancouver, Canada
- Institute of Immunobiology, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007 St. Gallen, Switzerland
- Department of Dermatology, University of Zurich, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Lorenzo Botta
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, I-53100 Siena, Italy
| | - Thomas Decker
- Max F. Perutz Laboratories, Department of Microbiology, Immunobiology and Genetics, University of Vienna, Vienna Biocenter, Vienna, Austria
| | - Jelena Lazovic
- Institute of Molecular Biotechnology Austria (IMBA), Dr. Bohrgasse 3, A-1030 Vienna, Austria
| | - Astrid Hagelkruys
- Institute of Molecular Biotechnology Austria (IMBA), Dr. Bohrgasse 3, A-1030 Vienna, Austria
| | - Lynn Enquist
- Department of Molecular Biology, Princeton University, Princeton, New Jersey, USA
| | - Shuan Rao
- Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Orkide O Koyuncu
- Department of Molecular Biology, Princeton University, Princeton, New Jersey, USA
- Department of Microbiology and Molecular Genetics, School of Medicine, University of California, Irvine, Irvine, CA 92697-4025, USA
| | - Josef M Penninger
- Institute of Molecular Biotechnology Austria (IMBA), Dr. Bohrgasse 3, A-1030 Vienna, Austria
- Department of Medical Genetics, Life Sciences Institute, University of British Columbia, Vancouver, Canada
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Hage A, Knoeri J, Leveziel L, Majoulet A, Buffault J, Labbé A, Baudouin C. [From ocular itching to eye rubbing: a review of the literature]. J Fr Ophtalmol 2023; 46:173-184. [PMID: 36635208 DOI: 10.1016/j.jfo.2022.09.009] [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: 05/02/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 01/11/2023]
Abstract
Ocular itching and eye rubbing are frequent complaints in an ophthalmology practice. Numerous studies address the consequences of eye rubbing, such as keratoconus. However, there are few studies concerning the pathophysiology of itching, its transmission pathways, or its interactions with eye rubbing. Through this literature review, we will address the various clinical, physiological and therapeutic aspects of this pair of symptoms with a variety of ocular consequences. We will then describe the state of the art in itching and scratching in dermatology, in order to draw a parallel between these two vicious cycles. A better understanding of the pathophysiology of ocular itching and eye rubbing, as well as new studies based on dermatological data, might allow more appropriate clinical management of our patients and their symptoms.
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Affiliation(s)
- A Hage
- Department of Ophthalmology III, National Hospital Centre for Ophthalmology Quinze-Vingts, IHU FOReSIGHT, Service 3-Pr Christophe Baudouin, 28, rue de Charenton, 75012, Paris, France.
| | - J Knoeri
- Department of Ophthalmology V, NATIONAL Hospital Centre for Ophthalmology Quinze-Vingts, IHU FOReSIGHT, 28, rue de Charenton, 75012, Paris, France
| | - L Leveziel
- Department of Ophthalmology V, NATIONAL Hospital Centre for Ophthalmology Quinze-Vingts, IHU FOReSIGHT, 28, rue de Charenton, 75012, Paris, France
| | - A Majoulet
- Department of Ophthalmology III, National Hospital Centre for Ophthalmology Quinze-Vingts, IHU FOReSIGHT, Service 3-Pr Christophe Baudouin, 28, rue de Charenton, 75012, Paris, France
| | - J Buffault
- Department of Ophthalmology III, National Hospital Centre for Ophthalmology Quinze-Vingts, IHU FOReSIGHT, Service 3-Pr Christophe Baudouin, 28, rue de Charenton, 75012, Paris, France
| | - A Labbé
- Department of Ophthalmology III, National Hospital Centre for Ophthalmology Quinze-Vingts, IHU FOReSIGHT, Service 3-Pr Christophe Baudouin, 28, rue de Charenton, 75012, Paris, France; Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, Université de Versailles Saint-Quentin en Yvellines, 9, avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France; Sorbonne Université, inserm, CNRS, Institut de la Vision, 17, rue Moreau, 75012, Paris, France
| | - C Baudouin
- Department of Ophthalmology III, National Hospital Centre for Ophthalmology Quinze-Vingts, IHU FOReSIGHT, Service 3-Pr Christophe Baudouin, 28, rue de Charenton, 75012, Paris, France; Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, Université de Versailles Saint-Quentin en Yvellines, 9, avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France; Sorbonne Université, inserm, CNRS, Institut de la Vision, 17, rue Moreau, 75012, Paris, France
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9
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Peristomal Skin Itch: An Integrative Review. J Wound Ostomy Continence Nurs 2022; 49:540-543. [PMID: 36099544 DOI: 10.1097/won.0000000000000903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Survey data from the United Stated, the United Kingdom, and the Netherlands indicate peristomal itch is prevalant among ostomy patients. Pruritus has a significant negative impact on health-related quality of life, resulting in discomfort and interrupted sleep. In ostomy patients, peristomal skin scratching also may interfere with adherence of the ostomy pouching system. This article reviews the classification and pathophysiology of itch in the peristomal skin, along with options for its management.
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10
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Van Loey NEE, de Jong AEE, Hofland HWC, van Laarhoven AIM. Role of burn severity and posttraumatic stress symptoms in the co-occurrence of itch and neuropathic pain after burns: A longitudinal study. Front Med (Lausanne) 2022; 9:997183. [PMID: 36314001 PMCID: PMC9596796 DOI: 10.3389/fmed.2022.997183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022] Open
Abstract
Itch and pain are common after burns. Neuropathic mechanisms may underlie both modalities but remain not well-understood. This study aims to prospectively document neuropathic pain symptoms and to identify potential itch symptom profiles that differ regarding duration and co-occurrence with neuropathic pain which may inform underlying pathophysiological mechanisms and respond to different treatments. Adult burn survivors (n = 192) self-reported itch and neuropathic pain at 2 weeks post-discharge, 3, 6, 12, and 18 months post-burn. Based on the presence of itch and pain symptoms over time, participants were allocated to one itch profile: transient itch/pain, chronic itch, or chronic itch & pain. Profiles were compared on itch intensity over time using General Linear Modeling. Age, gender, burn severity, posttraumatic stress (PTS) symptoms and baseline itch intensity were examined as potential predictors of the profiles in a Multi-nominal regression analysis. Neuropathic pain occurred in 54% after discharge which decreased to 24% 18 months later. Itch intensity was highest in the chronic itch & pain profile. Compared to the transient itch profile, the chronic itch & pain profile was associated with higher burn severity and more PTS symptoms. Compared to the chronic itch profile, the chronic itch & pain profile was associated with more PTS symptoms. Findings suggest that biological and psycho-dermatological processes underlie both chronic neuropathic pain and itch processes in burn scars. Further research should elucidate the mechanisms underlying the different itch profiles, with specific focus on skin innervation and psychological factors.
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Affiliation(s)
- N. E. E. Van Loey
- Association of Dutch Burn Centres, Maasstad Hospital, Department of Burn Center, Rotterdam, Netherlands,Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands,*Correspondence: N. E. E. Van Loey
| | | | - H. W. C. Hofland
- Association of Dutch Burn Centres, Maasstad Hospital, Department of Burn Center, Rotterdam, Netherlands
| | - A. I. M. van Laarhoven
- Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, Netherlands,Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, Netherlands
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11
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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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12
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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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Abd-Elsayed A, Pope J, Mundey DA, Slavin KV, Falowski S, Chitneni A, Popielarski SR, John J, Grodofsky S, Vanetesse T, Fishman MA, Kim P. Diagnosis, Treatment, and Management of Painful Scar: A Narrative Review. J Pain Res 2022; 15:925-937. [PMID: 35411187 PMCID: PMC8994628 DOI: 10.2147/jpr.s355096] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/29/2022] [Indexed: 12/26/2022] Open
Abstract
Painful scars can develop after surgery or trauma, with symptoms ranging from a minor itch to intractable allodynia. The problem of the painful scar may involve both intraneural and extraneural structures, requiring a systematic approach to diagnosis and treatment of this neuropathic pain condition that can impact quality of life and function profoundly. In this review, we outline the algorithm for the diagnosis, management, medical and surgical treatment of painful scars.
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Affiliation(s)
- Alaa Abd-Elsayed
- Department of Anesthesia, Division of Pain Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Correspondence: Alaa Abd-Elsayed, FASA Department of Anesthesia, Division of Pain Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI, 53792-3272, USA, Tel +1 608-263-8100, Fax +1 608-263-0575, Email
| | - Jason Pope
- Evolve Restorative Center, Santa Rosa, CA, USA
| | | | - Konstantin V Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
- Neurology Service, Jesse Brown Veterans Administration Medical Center, Chicago, IL, USA
| | | | - Ahish Chitneni
- Department of Rehabilitation and Regenerative Medicine, New York-Presbyterian Hospital - Columbia and Cornell, New York, NY, USA
| | | | - Jarod John
- Argires Marotti Neurosurgical Associates, Lancaster, PA, USA
| | | | - Tony Vanetesse
- Center for Interventional Pain Spine, LLC., Wilmington, DE, USA
| | | | - Philip Kim
- Center for Interventional Pain Spine, LLC., Wilmington, DE, USA
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14
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Yoon SH, Cho W, Mun J, Jeong W, Kim YD, Choi SS. Atypical presentation of complex regional pain syndrome: neuropathic itching - A case report. Anesth Pain Med (Seoul) 2022; 16:377-381. [PMID: 35139619 PMCID: PMC8828621 DOI: 10.17085/apm.21009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 07/26/2021] [Indexed: 11/18/2022] Open
Abstract
Background In some patients with neuropathic pain (NP), such as complex regional pain syndrome (CRPS), itching rather than pain is the main symptom making diagnosis and treatment difficult. Case We report a case of a 23-year-old male with a history of hypoxic brain damage who presented with pruritus of the left foot and ankle. His left foot was fractured, and he underwent surgery 6 months previously. After the operation and cast application, he developed uncontrolled pruritus, swelling, sweating, and flushing of the left foot skin with limping. On examination, he showed well-known features of CRPS without pain. He was diagnosed with an atypical CRPS with neuropathic itching (NI). With treatment modalities used for NP and CRPS, his pruritus subsided gradually, and the his ankle mobility improved. Conclusions Unexplained itching can be the main symptom in some CRPS patients. Treatment according to NP can improve symptoms of NI in CRPS patients.
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Affiliation(s)
- Syn-Hae Yoon
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Korea
| | - Woojong Cho
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Juhan Mun
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wonyeong Jeong
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Do Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong-Soo Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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15
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Roh YS, Choi J, Sutaria N, Kwatra SG. Itch: Epidemiology, clinical presentation, and diagnostic workup. J Am Acad Dermatol 2022; 86:1-14. [PMID: 34428534 PMCID: PMC8678917 DOI: 10.1016/j.jaad.2021.07.076] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/24/2021] [Accepted: 07/28/2021] [Indexed: 01/03/2023]
Abstract
Itch, or pruritus, is the uncomfortable sensation underlying the desire to scratch. Itch is a very common complaint in the general population that can result from dermatologic, systemic (eg, renal, hepatobiliary, endocrine), paraneoplastic, neuropathic, and psychogenic etiologies. Chronic itch is associated with significant sleep disturbances and profoundly reduces overall quality of life. Certain populations, including elderly and African Americans, are at increased risk of experiencing heightened burden of itch. Because of the variable clinical presentation and wide-ranging etiologies, itch presents a challenge for clinicians. The initial evaluation should include a complete blood count, with differential, hepatic, renal, and thyroid function testing along with diabetes screening. Further testing should be guided by history and physical examination findings. There should be a heightened concern for underlying malignancy in individuals older than 60 years of age who have a history of liver disease and diffuse itch less than 12 months of duration. For individuals with chronic pruritus of unknown origin, increased blood eosinophils may serve as a biomarker of T helper cell type 2 polarization and response to immunomodulator therapies. In this first part of a 2-part continuing medical education series, we describe the broader epidemiology and specific conditions associated with itch and the clinical presentation and diagnostic workup for patients with itch.
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Affiliation(s)
- Youkyung S. Roh
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Justin Choi
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nishadh Sutaria
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shawn G. Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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16
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Botulinum toxin type A therapy for bilateral focal neuropathic pruritus in multiple sclerosis: a case report. Int J Rehabil Res 2021; 44:382-383. [PMID: 34483290 DOI: 10.1097/mrr.0000000000000495] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Neuropathic pruritus is a form of chronic itch that occurs in the presence of direct damage to the nervous system. It tends to be severe, disabling, and difficult to treat. Usual antipruritic medications are largely ineffective and there is no consensus regarding the treatment approach. The authors report a case of a 58-year-old man with primary progressive multiple sclerosis and a history of unsatisfactory management of severe bilateral focal pruritus. Significant symptom relief was attained after local intradermal injections of botulinum toxin type A.
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17
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Okuno S, Hashimoto T, Satoh T. Case of neuropathic itch-associated prurigo nodules on the bilateral upper arms after unilateral herpes zoster in a patient with cervical herniated discs: Successful treatment with mirogabalin. J Dermatol 2021; 48:e585-e586. [PMID: 34486158 DOI: 10.1111/1346-8138.16147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/06/2021] [Accepted: 08/23/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Satoshi Okuno
- Department of Dermatology, National Defense Medical College, Tokorozawa, Japan
| | - Takashi Hashimoto
- Department of Dermatology, National Defense Medical College, Tokorozawa, Japan
| | - Takahiro Satoh
- Department of Dermatology, National Defense Medical College, Tokorozawa, Japan
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18
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Ingrasci G, Arbrouk M, Haitz K, Kirsner R, Yosipovitch G. A protracted, postherpetic neuralgic ulcer treated with risperidone and intranasal butorphanol. JAAD Case Rep 2021; 15:7-10. [PMID: 34381859 PMCID: PMC8340051 DOI: 10.1016/j.jdcr.2021.06.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Giuseppe Ingrasci
- Correspondence to: Giuseppe Ingrasci, BS, Department of Dermatology and Cutaneous Surgery, University of Miami, 1600 NW 10th Ave RMSB Building 2067B, Miami, FL 33131.
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19
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Abstract
Chronic pruritus (itch lasting ≥6 weeks) is a bothersome chief complaint that may present in a broad variety of diseases. Most itch-causing diagnoses fit into 1 of 5 categories (inflammatory, secondary to systemic disease, neuropathic, chronic pruritus of undetermined origin, and psychogenic itch) and this broad differential can be narrowed using key findings in the history and physical. In this article, we discuss which key findings are most pertinent for narrowing this differential and guiding further workup and treatment, as well as how to treat many itchy conditions.
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Affiliation(s)
- Zoe M Lipman
- Dr Phillip Frost Department of Dermatology and Miami Itch Center, University of Miami, University of Miami Hospital, 1600 Northwest 10th Avenue RMSB Building, 10th Street, 2067B Miami, FL, USA
| | - Giuseppe Ingrasci
- Dr Phillip Frost Department of Dermatology and Miami Itch Center, University of Miami, University of Miami Hospital, 1600 Northwest 10th Avenue RMSB Building, 10th Street, 2067B Miami, FL, USA
| | - Gil Yosipovitch
- Dr Phillip Frost Department of Dermatology and Miami Itch Center, University of Miami, University of Miami Hospital, 1600 Northwest 10th Avenue RMSB Building, 10th Street, 2067B Miami, FL, USA.
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20
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Cognitive Impairment in Inpatients with Prurigo Nodularis and Psychiatric Comorbidities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021. [PMID: 34207921 DOI: 10.3390/ijerph18126265.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Prurigo nodularis (PN) is a chronic refractory itchy dermatosis. Although psychiatric comorbidity is known, research in cognitive impairment is lacking. We evaluated the occurrence and types of cognitive impairment in a series of inpatients with PN. METHODS This was a retrospective chart review of all the patients with PN admitted to a referral neurological institute from September 2018 to March 2021. Any neurological and psychiatric disorder, along with neuroactive drugs taken, were concomitantly assessed. RESULTS A total of 16 patients with PN (median age: 70 years, two males) were selected from a total of 1806 hospital admissions. Most of them had a neurodegenerative cognitive disorder, from mild cognitive impairment (8) to Alzheimer's disease (1), followed by mixed disorder (degenerative and vascular) in six and vascular dementia in one. Comorbid psychiatric diseases (anxiety and depression) were more common than either individual condition, followed by bipolar disorder, whereas two patients did not show psychiatric manifestations. Most patients were on combined treatment with benzodiazepines and antidepressants. CONCLUSION Cognitive impairment can be observed in PN. In addition to screening for psychiatric comorbidity and initiating appropriate treatment or referral, clinicians may also consider the presence of cognitive impairment in PN of both degenerative and vascular origin.
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21
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Lanza G, Cosentino FII, Ferri R, Lanuzza B, Siragusa M, Tripodi M, Schepis C. Cognitive Impairment in Inpatients with Prurigo Nodularis and Psychiatric Comorbidities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126265. [PMID: 34207921 PMCID: PMC8296039 DOI: 10.3390/ijerph18126265] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/07/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Prurigo nodularis (PN) is a chronic refractory itchy dermatosis. Although psychiatric comorbidity is known, research in cognitive impairment is lacking. We evaluated the occurrence and types of cognitive impairment in a series of inpatients with PN. METHODS This was a retrospective chart review of all the patients with PN admitted to a referral neurological institute from September 2018 to March 2021. Any neurological and psychiatric disorder, along with neuroactive drugs taken, were concomitantly assessed. RESULTS A total of 16 patients with PN (median age: 70 years, two males) were selected from a total of 1806 hospital admissions. Most of them had a neurodegenerative cognitive disorder, from mild cognitive impairment (8) to Alzheimer's disease (1), followed by mixed disorder (degenerative and vascular) in six and vascular dementia in one. Comorbid psychiatric diseases (anxiety and depression) were more common than either individual condition, followed by bipolar disorder, whereas two patients did not show psychiatric manifestations. Most patients were on combined treatment with benzodiazepines and antidepressants. CONCLUSION Cognitive impairment can be observed in PN. In addition to screening for psychiatric comorbidity and initiating appropriate treatment or referral, clinicians may also consider the presence of cognitive impairment in PN of both degenerative and vascular origin.
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Affiliation(s)
- Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy
- Oasi Research Institute-IRCCS, Via Conte Ruggero 73, 94018 Troina, Italy; (F.I.I.C.); (R.F.); (B.L.); (M.S.); (M.T.); (C.S.)
- Correspondence: ; Tel.: +39-095-3782448
| | - Filomena Irene Ilaria Cosentino
- Oasi Research Institute-IRCCS, Via Conte Ruggero 73, 94018 Troina, Italy; (F.I.I.C.); (R.F.); (B.L.); (M.S.); (M.T.); (C.S.)
| | - Raffaele Ferri
- Oasi Research Institute-IRCCS, Via Conte Ruggero 73, 94018 Troina, Italy; (F.I.I.C.); (R.F.); (B.L.); (M.S.); (M.T.); (C.S.)
| | - Bartolo Lanuzza
- Oasi Research Institute-IRCCS, Via Conte Ruggero 73, 94018 Troina, Italy; (F.I.I.C.); (R.F.); (B.L.); (M.S.); (M.T.); (C.S.)
| | - Maddalena Siragusa
- Oasi Research Institute-IRCCS, Via Conte Ruggero 73, 94018 Troina, Italy; (F.I.I.C.); (R.F.); (B.L.); (M.S.); (M.T.); (C.S.)
| | - Mariangela Tripodi
- Oasi Research Institute-IRCCS, Via Conte Ruggero 73, 94018 Troina, Italy; (F.I.I.C.); (R.F.); (B.L.); (M.S.); (M.T.); (C.S.)
| | - Carmelo Schepis
- Oasi Research Institute-IRCCS, Via Conte Ruggero 73, 94018 Troina, Italy; (F.I.I.C.); (R.F.); (B.L.); (M.S.); (M.T.); (C.S.)
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22
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Raef HS, Elmariah SB. Vulvar Pruritus: A Review of Clinical Associations, Pathophysiology and Therapeutic Management. Front Med (Lausanne) 2021; 8:649402. [PMID: 33898486 PMCID: PMC8058221 DOI: 10.3389/fmed.2021.649402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/12/2021] [Indexed: 01/08/2023] Open
Abstract
Vulvar pruritus is an unpleasant sensation and frequent symptom associated with many dermatologic conditions, including infectious, inflammatory and neoplastic dermatoses affecting the female genitalia. It can lead to serious impairment of quality of life, impacting sexual function, relationships, sleep and self-esteem. In this review, common conditions associated with vulvar itch are discussed including atopic and contact dermatitis, lichen sclerosus, psoriasis and infectious vulvovaginitis. We review the potential physiologic, environmental and infectious factors that contribute to the development of vulvar itch and emphasize the importance of addressing their complex interplay when managing this disruptive and challenging symptom.
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Affiliation(s)
- Haya S Raef
- Tufts University School of Medicine, Boston, MA, United States.,Massachusetts General Hospital, Boston, MA, United States
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23
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Sreekantaswamy SA, Mollanazar N, Butler DC. Gabapentinoids for Pruritus in Older Adults: A Narrative Review. Dermatol Ther (Heidelb) 2021; 11:669-679. [PMID: 33721214 PMCID: PMC8163906 DOI: 10.1007/s13555-021-00513-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Indexed: 12/31/2022] Open
Abstract
There is currently no standardized algorithm for the treatment of chronic pruritus (CP), or itch lasting more than 6 weeks, in adults aged ≥ 65 years. The antiepileptic agents gabapentin and pregabalin, however, are gaining popularity in the dermatologic community for their efficacy in treating CP of neuropathic origin. Yet the lack of literature specifically looking at the safety and efficacy of these medications in older adults results in limited guidance for providers in the safe use of gabapentinoids. In this paper we discuss special considerations and recommendations for treating older adults with gabapentin and pregabalin and explore the possibility for these drugs to ameliorate CP of multiple etiologies.
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Affiliation(s)
- Shreya A Sreekantaswamy
- San Francisco Department of Dermatology, University of California, San Francisco, CA, USA
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Nicholas Mollanazar
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel C Butler
- San Francisco Department of Dermatology, University of California, San Francisco, CA, USA.
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24
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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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25
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Kahremany S, Hofmann L, Harari M, Gruzman A, Cohen G. Pruritus in psoriasis and atopic dermatitis: current treatments and new perspectives. Pharmacol Rep 2021; 73:443-453. [PMID: 33460006 DOI: 10.1007/s43440-020-00206-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/11/2020] [Accepted: 11/29/2020] [Indexed: 02/06/2023]
Abstract
Psoriasis and atopic dermatitis (AD) are two common chronic inflammatory skin diseases. Although showing different etiology and clinical manifestations, patients with either disease suffer from low health-related quality of life due to pruritus (dermal itch). Recent studies have revealed that more than 85% of psoriasis patients suffer from pruritus, and it is also the dominating symptom of AD. However, as this is a non-life treating symptom, it was partly neglected for years. In this review, we focus on current findings as well as the impact and potential treatments of pruritus in these two skin diseases. We first distinguish the type of itch based on involved mediators and modulators. This clear delineation between the types of pruritus based on involved receptors and pathways allows for precise treatment. In addition, insights into recent clinical trials aimed to alleviate pruritus by targeting these receptors are presented. We also report about novel advances in combinatorial treatments, dedicated to the type of pruritus linked to a causal disease. Altogether, we suggest that only a focused treatment tailored to the primary disease and the underlying molecular signals will provide fast and sustained relief of pruritus associated with psoriasis or AD.
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Affiliation(s)
- Shirin Kahremany
- Department of Chemistry, Faculty of Exact Sciences, Bar-Ilan University, 5290002, Ramat Gan, Israel. .,The Skin Research Institute, The Dead Sea and Arava Science Center, 86910, Masada, Israel.
| | - Lukas Hofmann
- Department of Chemistry, Faculty of Exact Sciences, Bar-Ilan University, 5290002, Ramat Gan, Israel
| | - Marco Harari
- Medical Climatotherapy Unit, The Dead Sea and Arava Science Center, 86910, Masada, Israel
| | - Arie Gruzman
- Department of Chemistry, Faculty of Exact Sciences, Bar-Ilan University, 5290002, Ramat Gan, Israel
| | - Guy Cohen
- The Skin Research Institute, The Dead Sea and Arava Science Center, 86910, Masada, Israel.,Ben Gurion University of the Negev, Eilat Campus, 8855630, Eilat, Israel
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26
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Lipman ZM, Magnolo N, Golpanian RS, Storck M, Yosipovich G, Zeidler C. Comparison of itch characteristics and sleep in patients with brachioradial pruritus and notalgia paresthetica: A retrospective analysis from 2 itch centers. JAAD Int 2020; 2:96-97. [PMID: 34409357 PMCID: PMC8362268 DOI: 10.1016/j.jdin.2020.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Zoe M Lipman
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami, Florida
| | - Nina Magnolo
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Germany
| | - Rachel S Golpanian
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami, Florida
| | - Michael Storck
- Institute for Medical Informatics and Center for Chronic Pruritus, University Hospital Münster, Germany
| | - Gil Yosipovich
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami, Florida
| | - Claudia Zeidler
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Germany
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27
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Pruritus in neuromyelitis optica spectrum disorders and multiple sclerosis. J Clin Neurosci 2020; 79:108-112. [DOI: 10.1016/j.jocn.2020.07.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 06/22/2020] [Accepted: 07/08/2020] [Indexed: 11/21/2022]
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28
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Kushnir V, Dmytrenko S, Katilov O, Kushnir N. Itching as the onset of pain (part 2). PAIN MEDICINE 2020. [DOI: 10.31636/pmjua.v5i1.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Itching of the skin is a particularly unpleasant subjective sensation that causes the need to scratch. Physiological itching occurs in response to environmental irritants (friction, insect crawling, temperature changes, etc.) and disappears after elimination of the cause. Pathological itching is caused by changes in the skin or throughout the body and causes a strong need to get rid of itching by combing or any other method. Itching is a common symptom of local (dermatological) or general (systemic) disease. It can be limited (localized) or diffuse (generalized).One of the causes of itching is often noted endocrine diseases and metabolic disorders: hyper- and hypofunction of the thyroid gland, diabetes mellitus and hyperparathyroidism. In thyroid hyperfunction, generalized (inconstant and little-pronounced) itching of the skin is observed in the clinical picture only in 10 % of patients. It is accepted that itching of the skin in thyrotoxicosis syndrome is due to increased activity of kinin in combination with an increase in major metabolism and an increase in body and skin temperature (123).Itching caused by impaired bile secretion is characteristic of many diseases of the liver: primary biliary cirrhosis, sclerosing cholangitis, viral hepatitis caused by cholestasis medications and other causes of obstructive jaundice. It is in these cases that prurigo is usually generalized, but in some typical cases it is more pronounced on the feet and palms. With this pathology, itching is caused by obstruction of the biliary tract, however, and to this day, no close correlation has been found between serum bilirubin and the severity of itching.If it was previously thought that itching in pathology of the peripheral or central nervous system, such as multiple sclerosis, neuropathy, compression or irritation of nerves (e.g., paraesthetic dorsalgia, brachioradial itching) is also a significant symptom, then modern studies prove that in more cases, itching is not characteristic of most pathologies of the nervous system, so after a detailed anamnesis, examination and initial research, the patient should be referred to a related specialist, except in cases of about obvious postherpetic neuropathy, painless paresthesia, or brachioradial itching, which can often be guided in the provision of primary care.Instead, there are some psychological conditions and a number of psychiatric illnesses (obsessive-compulsive disorders, depression, and parasite illusions) that are most commonly diagnosed with the exclusion method. Neurotic squabbles are scattered on the body of the excorii, covered with scales that may occur in any area of the body that the patient may reach, but are often limited by limbs.
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Ständer HF, Elmariah S, Zeidler C, Spellman M, Ständer S. Diagnostic and treatment algorithm for chronic nodular prurigo. J Am Acad Dermatol 2020; 82:460-468. [DOI: 10.1016/j.jaad.2019.07.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 07/03/2019] [Accepted: 07/09/2019] [Indexed: 12/31/2022]
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Physical Medicine and Rehabilitation Role on Notalgia Paresthetica: Case Report and Treatment Review. Am J Phys Med Rehabil 2019; 97:929-932. [PMID: 30439740 DOI: 10.1097/phm.0000000000000946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Notalgia paresthetica is a rarely reported T2-T6 sensory neuropathy whose etiology and treatment are not fully established. Although it is believed to be common in dermatological practice, it remains underrecognized, underdiagnosed, and therefore underreported. This case-report provides a physical medicine and rehabilitation perspective on notalgia paresthetica diagnosis and treatment. This article presents a case report of a 39-yr-old woman with pain, pruritus, and a hyperpigmented area in the right dorsal infra scapular region. The diagnosis of notalgia paresthetica was established. She was successfully treated with topical anesthetics, postural corrective exercises, scapular muscle strengthening, and pectoral muscle stretching. In this context, different treatment options were reviewed. A small set of pharmacological and nonpharmacological techniques were identified. Several of these modalities belong to the physical medicine and rehabilitation field of action.
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Huguen J, Brenaut E, Clerc CJ, Poizeau F, Marcorelles P, Quereux G, Dupuy A, Misery L. Comparison of Characteristics of Neuropathic and Non-neuropathic Pruritus to Develop a Tool for the Diagnosis of Neuropathic Pruritus: The NP5. Front Med (Lausanne) 2019; 6:79. [PMID: 31111028 PMCID: PMC6499201 DOI: 10.3389/fmed.2019.00079] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 04/01/2019] [Indexed: 12/26/2022] Open
Abstract
The diagnosis of neuropathic pruritus (NP) may be difficult. The aim of this study was to compare the characteristics of both neuropathic pruritus and non-neuropathic pruritus (NNP) in order to elaborate a tool to help the diagnosis of NP without clinical examination. One hundred and seven patients were included: Fifty three in the NP group and Fifty four in the NNP group. In multiple regression, presence of twinges, absence of burning, worsening with activity, no worsening with stress, and relief with cold ambient temperature were independent factors that were associated with NP. A score of two criteria out of five was optimal to discriminate NP from NNP with a sensitivity of 76% and a specificity of 77%. Alloknesis, hyperknesis, or the ice cube test were not included because their evaluation is based on clinical examination. Future high-powered studies are needed to confirm the results of the present study.
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Affiliation(s)
- Johanna Huguen
- Department of Dermatology, University Hospital, Brest, France.,Department of Dermatology, Quimper Hospital, Quimper, France
| | - Emilie Brenaut
- Department of Dermatology, University Hospital, Brest, France.,Laboratoire Interactions Epitheliums Neurones, Université de Bretagne Occidentale, Brest, France
| | | | - Florence Poizeau
- Department of Dermatology, University Hospital, Rennes, France.,UPRES EA 7449 REPERES Pharmacoepidemiology and Health Services Research, Rennes University, Rennes, France
| | - Pascale Marcorelles
- Laboratoire Interactions Epitheliums Neurones, Université de Bretagne Occidentale, Brest, France.,Department of Pathology, University Hospital, Brest, France
| | - Gaëlle Quereux
- Department of Dermatology, University Hospital, Nantes, France
| | - Alain Dupuy
- Department of Dermatology, University Hospital, Rennes, France.,UPRES EA 7449 REPERES Pharmacoepidemiology and Health Services Research, Rennes University, Rennes, France
| | - Laurent Misery
- Laboratoire Interactions Epitheliums Neurones, Université de Bretagne Occidentale, Brest, France.,Department of Pathology, University Hospital, Brest, France
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Rinaldi G. The Itch-Scratch Cycle: A Review of the Mechanisms. Dermatol Pract Concept 2019; 9:90-97. [PMID: 31106010 PMCID: PMC6502296 DOI: 10.5826/dpc.0902a03] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Despite being one of the most common presenting dermatological symptoms, itching continues to perplex health care professionals because it is notoriously difficult to control. OBJECTIVE This review gathers evidence to answer the 2-part question, "Why do we itch and scratch?" by exploring the history of itchy disease, the neurobiology of itch, and the 4 different clinical origins of itch: pruritogenic, neurological, neuropathic, and psychological. RESULTS The automated scratching reflex and its biological and psychological reasons for existence are complicated and poorly understood. Currently, there are a myriad of treatments available for individuals suffering from this condition; however, many remain symptomatic. CONCLUSIONS The itch-scratch cycle is a complex pain-like sensation with a reflex-like response. In the future, continued exploration into the mechanisms behind itch and scratch may open the doors for new therapeutic interventions.
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Abstract
Neuropathic itch is a pathological condition that is due to damage within the nervous system. This type of itch can be severe and unrelenting, which has a very negative impact on quality of life. Neuropathic itch is more common than generally appreciated because most types of neuropathic pain have a neuropathic itch counterpart. Unfortunately, much like neuropathic pain, there is a lack of effective treatments for neuropathic itch. Here, we consider the neural basis of itch and then describe how injuries within these neural circuits can lead to neuropathic itch in both animal models and human disease states.
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34
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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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Dermatology today and tomorrow: from symptom control to targeted therapy. J Eur Acad Dermatol Venereol 2018; 33 Suppl 1:3-36. [DOI: 10.1111/jdv.15335] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 11/05/2018] [Indexed: 02/07/2023]
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36
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Mack MR, Kim BS. The Itch–Scratch Cycle: A Neuroimmune Perspective. Trends Immunol 2018; 39:980-991. [DOI: 10.1016/j.it.2018.10.001] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 09/20/2018] [Accepted: 10/01/2018] [Indexed: 12/18/2022]
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37
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Rosen JD, Fostini AC, Yosipovitch G. Diagnosis and Management of Neuropathic Itch. Dermatol Clin 2018; 36:213-224. [DOI: 10.1016/j.det.2018.02.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Rosen JD, Fostini AC, Chan YH, Nattkemper LA, Yosipovitch G. Cross-sectional study of clinical distinctions between neuropathic and inflammatory pruritus. J Am Acad Dermatol 2018; 79:1143-1144. [PMID: 29864468 DOI: 10.1016/j.jaad.2018.05.1236] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 05/04/2018] [Accepted: 05/28/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Jordan Daniel Rosen
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida; Miami Itch Center, University of Miami Miller School of Medicine, Miami, Florida
| | - Anna Chiara Fostini
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida; Miami Itch Center, University of Miami Miller School of Medicine, Miami, Florida; Section of Dermatology, Department of Medicine, University of Verona, Verona, Italy
| | - Yoing Huak Chan
- Biostatistic Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Leigh Ann Nattkemper
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida; Miami Itch Center, University of Miami Miller School of Medicine, Miami, Florida
| | - Gil Yosipovitch
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida; Miami Itch Center, University of Miami Miller School of Medicine, Miami, Florida.
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Millington G, Collins A, Lovell C, Leslie T, Yong A, Morgan J, Ajithkumar T, Andrews M, Rushbook S, Coelho R, Catten S, Lee K, Skellett A, Affleck A, Exton L, Mohd Mustapa M, Levell N, McHenry P, Gibbon K, Buckley D, Leslie T, Mallon E, Wakelin S, Ungureanu S, Hunasehally R, Cork M, Johnston G, Chiang N, Natkunarajah J, Worsnop F, Duarte Williamson C, Donnelly J, Towers K, Saunders C, Adbi Salad A, Brain A. British Association of Dermatologists’ guidelines for the investigation and management of generalized pruritus in adults without an underlying dermatosis, 2018. Br J Dermatol 2018; 178:34-60. [DOI: 10.1111/bjd.16117] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2017] [Indexed: 12/20/2022]
Affiliation(s)
- G.W.M. Millington
- Dermatology Department Norfolk and Norwich University Hospital Colney Lane Norwich NR4 7UY U.K
| | - A. Collins
- Haematology Department Norfolk and Norwich University Hospital Colney Lane Norwich NR4 7UY U.K
| | - C.R. Lovell
- Dermatology Department Royal United Hospital Combe Park Bath BA1 3NG U.K
| | - T.A. Leslie
- Dermatology Department Royal Free Hospital Pond Street London NW3 2QGU.K
| | - A.S.W. Yong
- Dermatology Department Norfolk and Norwich University Hospital Colney Lane Norwich NR4 7UY U.K
| | - J.D. Morgan
- General Practitioner Chet Valley Medical Practice 40–48 George Lane London NR14 6QH U.K
| | - T. Ajithkumar
- Oncology Department Addenbrooke's Hospital Hills Road Cambridge CB2 2QQ U.K
| | - M.J. Andrews
- Nephrology Department Norfolk and Norwich University Hospital Colney Lane Norwich NR4 7UY U.K
| | - S.M. Rushbook
- Hepatology Unit Norfolk and Norwich University Hospital Colney Lane Norwich NR4 7UY U.K
| | - R.R. Coelho
- Dermatology Department St George's Hospital Blackshaw Road London SW17 0QT U.K
| | - S.J. Catten
- Dermatology Department Norfolk and Norwich University Hospital Colney Lane Norwich NR4 7UY U.K
| | - K.Y.C. Lee
- Dermatology Department Norfolk and Norwich University Hospital Colney Lane Norwich NR4 7UY U.K
| | - A.M. Skellett
- Dermatology Department Norfolk and Norwich University Hospital Colney Lane Norwich NR4 7UY U.K
| | - A.G. Affleck
- Dermatology Department Ninewells Hospital Dundee DD1 9SY U.K
| | - L.S. Exton
- British Association of Dermatologists Willan House 4 Fitzroy Square London W1T 5HQ U.K
| | - M.F. Mohd Mustapa
- British Association of Dermatologists Willan House 4 Fitzroy Square London W1T 5HQ U.K
| | - N.J. Levell
- Dermatology Department Norfolk and Norwich University Hospital Colney Lane Norwich NR4 7UY U.K
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Wachholz PA, Masuda PY, Pinto ACVD, Martelli ACC. Impact of drug therapy on brachioradial pruritus. An Bras Dermatol 2017; 92:281-282. [PMID: 28538902 PMCID: PMC5429128 DOI: 10.1590/abd1806-4841.20175321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 03/01/2016] [Indexed: 12/03/2022] Open
Abstract
Few studies have described therapeutic options in brachioradial pruritus. We
describe a cross-sectional study of brachioradial pruritus patients treated in
an outpatient unit. We reviewed medical records and interviewed brachioradial
pruritus patients without indication for decompressive surgery, in order to
access the perceptions of intensity of pruritus prior to treatment and response
to therapy. We found that antidepressants and anticonvulsants were the most
frequently prescribed drugs. Best reductions in pruritus were associated with
its highest intensities prior to treatment, and with longer periods of
therapy.
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Affiliation(s)
- Patrick Alexander Wachholz
- Department of Public Health, Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP) - São Paulo (SP), Brazil
| | - Paula Yoshiko Masuda
- Department of Dermatology, Instituto Lauro de Souza Lima (ILSL) - Bauru (SP), Brazil
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He Z, Ren M, Wang X, Guo Q, Qi X. Pruritus may be a common symptom related to neuromyelitis optica spectrum disorders. Mult Scler Relat Disord 2017; 13:1-3. [DOI: 10.1016/j.msard.2017.01.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/15/2017] [Accepted: 01/25/2017] [Indexed: 11/25/2022]
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Atış G, Bilir Kaya B. Pregabalin treatment of three cases with brachioradial pruritus. Dermatol Ther 2017; 30. [DOI: 10.1111/dth.12459] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/26/2016] [Accepted: 11/29/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Güldehan Atış
- Department of Dermatology; Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| | - Başak Bilir Kaya
- Department of Physical Medicine and Rehabilitation; Dr. Siyami Ersek Thorax and Cardiaovascular Surgery Training and Research Hospital, İstanbul, Turkey
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45
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Shuhui G, Jiagang L, Siqing H, Haifeng C, Qingrong T, Bohao Z. Rare Cervical Intramedullary Cavernous Angioma with Trigeminal Neuralgia and Cervical Itch: Case Report and Review of the Literature. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e25151. [PMID: 28191336 PMCID: PMC5292155 DOI: 10.5812/ircmj.25151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 04/26/2015] [Accepted: 06/06/2015] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Intramedullary cavernous angioma (ICA) is a rare lesion of the spinal cord, representing only 3% - 5% of central nervous system lesions. The coexistence of trigeminal neuralgia and refractory itch is very rarely encountered in clinical practice. To our knowledge, a report of an ICA with trigeminal neuralgia and local neuropathic itch has never been published to date. Thus, we present a very interesting case of a C2 ICA. CASE PRESENTATION A 61-year-old female presented with right facial pain for three years, which was exacerbated by accompanying cervical pain and itch for one month. The patient's symptoms were relieved after surgery, and there was no recurrence of lesions one year later. CONCLUSIONS ICA with trigeminal neuralgia and local neuropathic itch is very rarely encountered in clinical practice. As it is not always diagnosed at first, some patients miss the best treatment period. Therefore, we call for emphasis to be placed on early diagnosis and timely surgical treatment.
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Affiliation(s)
- Gong Shuhui
- Department of Neurosurgery, Sichuan University, West China Hospital, P. R. China
| | - Liu Jiagang
- Department of Neurosurgery, Sichuan University, West China Hospital, P. R. China
| | - Huang Siqing
- Department of Neurosurgery, Sichuan University, West China Hospital, P. R. China
| | - Chen Haifeng
- Department of Neurosurgery, Sichuan University, West China Hospital, P. R. China
| | - Tang Qingrong
- The Third People’s Hospital of Shenzhen, Shenzhen, P. R. China
| | - Zhao Bohao
- Department of Neurosurgery, Sichuan University, West China Hospital, P. R. China
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González Sánchez M, Llorente Ayuso L, Ruiz Morales J, Martínez Salio A. Neuropathic pruritus as the p]resenting symptom of lupus transverse myelitis. J Neurol Sci 2016; 368:138-9. [DOI: 10.1016/j.jns.2016.06.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 06/18/2016] [Accepted: 06/30/2016] [Indexed: 11/24/2022]
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Pereira MP, Kremer AE, Mettang T, Ständer S. Chronic Pruritus in the Absence of Skin Disease: Pathophysiology, Diagnosis and Treatment. Am J Clin Dermatol 2016; 17:337-48. [PMID: 27216284 DOI: 10.1007/s40257-016-0198-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Chronic pruritus arises not only from dermatoses, but also, in up to half of cases, from extracutaneous origins. A multitude of systemic, neurological, psychiatric, and somatoform conditions are associated with pruritus in the absence of skin disease. Moreover, pruritus is a frequently observed side effect of many drugs. It is therefore difficult for physicians to make a correct diagnosis. Chronic pruritus patients frequently present to the dermatologist with skin lesions secondary to a long-lasting scratching behavior, such as lichenification and prurigo nodularis. A structured clinical history and physical examination are essential in order to evaluate the pruritus, along with systematic, medical history-adapted laboratory and radiological tests carried out according to the differential diagnosis. For therapeutic reasons, a symptomatic therapy should be promptly initiated parallel to the diagnostic procedures. Once the underlying factor(s) leading to the pruritus are identified, a targeted therapy should be implemented. Importantly, the treatment of accompanying disorders such as sleep disturbances or mental symptoms should be taken into consideration. Even after successful treatment of the underlying cause, pruritus may persist, likely due to chronicity processes including peripheral and central sensitization or impaired inhibition at spinal level. A vast arsenal of topical and systemic agents targeting these pathophysiological mechanisms has been used to deter further chronicity. The therapeutic options currently available are, however, still insufficient for many patients. Thus, future studies aiming to unveil the complex mechanisms underlying chronic pruritus and develop new therapeutic agents are urgently needed.
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Affiliation(s)
- Manuel P Pereira
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Von-Esmarch-Str. 58, 48149, Münster, Germany
| | - Andreas E Kremer
- Department of Medicine 1, Gastroenterology, Pneumology and Endocrinology, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
| | - Thomas Mettang
- Department of Nephrology, DKD, Helios Klinik, Wiesbaden, Germany
| | - Sonja Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Von-Esmarch-Str. 58, 48149, Münster, Germany.
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48
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49
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Hébant B, Miret N, Berthelot L, Jaafar M, Maltête D, Lefaucheur R. Generalized pruritus preceding paraneoplastic neuropathy. J Clin Neurosci 2016; 26:156-7. [DOI: 10.1016/j.jocn.2015.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 09/09/2015] [Accepted: 09/19/2015] [Indexed: 10/22/2022]
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Abstract
Chronic itch in the elderly is a common problem, with a significant impact on quality of life and sleep in elderly patients. Chronic itch may be attributable to several causes, including dry skin, immunosenescence and neural degeneration. Itch may also be caused by skin diseases, such as seborrhoeic dermatitis and stasis dermatitis; systemic conditions, such as end-stage renal disease and diabetes; and psychogenic conditions, such as depression and anxiety. The use of polypharmacy may also cause itch, with or without a rash. Specifically, thiazides and calcium channel blockers have been known to cause itch in elderly patients. Management should be tailored according to the underlying dermatological or systemic aetiology of itch. Topical treatment is the mainstay of therapy, providing special emphasis on skin hydration and barrier repair. In addition, topical and oral medications that target the nervous system and reduce neuronal hypersensitization, such as gabapentin and selective antidepressants, have a role in treating patients with severe chronic itch. Furthermore, management must account for changes in metabolism and pharmacokinetics of drugs in the aging population in order to prevent the occurrence of adverse effects.
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