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Yook HJ, Lee JH. Prurigo Nodularis: Pathogenesis and the Horizon of Potential Therapeutics. Int J Mol Sci 2024; 25:5164. [PMID: 38791201 PMCID: PMC11121340 DOI: 10.3390/ijms25105164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/18/2024] [Accepted: 04/18/2024] [Indexed: 05/26/2024] Open
Abstract
Chronic pruritus that lasts for over 6 weeks can present in various forms, like papules, nodules, and plaque types, with prurigo nodularis (PN) being the most prevalent. The pathogenesis of PN involves the dysregulation of immune cell-neural circuits and is associated with peripheral neuropathies, possibly due to chronic scratching. PN is a persistent and challenging condition, involving complex interactions among the skin, immune system, and nervous system. Lesional skin in PN exhibits the infiltration of diverse immune cells like T cells, eosinophils, macrophages, and mast cells, leading to the release of inflammatory cytokines and itch-inducing substances. Activated sensory nerve fibers aggravate pruritus by releasing neurotransmitters, perpetuating a vicious cycle of itching and scratching. Traditional treatments often fail, but recent advancements in understanding the inflammatory and itch transmission mechanisms of PN have paved the way for innovative therapeutic approaches, which are explored in this review.
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Affiliation(s)
| | - Ji Hyun Lee
- Department of Dermatology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, #222 Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
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Murota H, Arima K, Yoshida T, Fujita H. Disease burden and treatment satisfaction in patients with prurigo nodularis in Japan. J Dermatol 2024; 51:223-233. [PMID: 38066728 DOI: 10.1111/1346-8138.17045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/28/2023] [Accepted: 11/02/2023] [Indexed: 02/04/2024]
Abstract
Prurigo nodularis (PN) is a chronic inflammatory skin disorder with a high disease burden. In this cross-sectional, web-based survey, Global Questions (GQ), the Numerical Rating Scales (NRS) for pruritus, burning sensation and sleep disturbance, the Short-Form-8 (SF-8) Health Survey, Dermatology Life Quality Index (DLQI), Patient Health Questionnaire 9 (PHQ-9), Work Productivity and Activity Impairment (WPAI), and Treatment Satisfaction Questionnaire for Medication-9 (TSQM-9) scores were used to assess the current disease burden and treatment satisfaction among patients with PN in Japan. In total, 97 patients were included (55.7% male, median age 51 years, median duration of PN 36 months). Based on GQ scores, 35.1% of patients had mild disease, 50.5% moderate, and 14.4% severe disease. Disease burden increased as the severity of PN increased, as indicated by worsening of pruritus NRS scores and quality of life (DLQI, PHQ-9, WPAI presenteeism, work productivity loss, and activity impairment scores). Patients with comorbid atopic dermatitis (AD) also had more intense pruritus than those without AD. Mean ± standard deviation TSQM-9 scores for effectiveness, convenience, and global satisfaction were 54.7 ± 18.1%, 62.4 ± 15.2%, and 57.4 ± 15.9%, respectively. TSQM-9 scores were lowest in patients receiving the most intensive guideline-directed treatment (i.e., topical corticosteroids + systemic oral corticosteroids or cyclosporine), highlighting an unmet need for more effective treatment options for patients with PN. In summary, Japanese patients with PN reported increased disease burden and reduced treatment satisfaction with increased disease severity, despite the use of guideline-recommended therapies.
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Affiliation(s)
- Hiroyuki Murota
- Department of Dermatology, Nagasaki University School of Medical Sciences, Nagasaki, Japan
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Millington GWM, Shobajo MT, Wall J, Jafferany M. Somatization in dermatology. SKIN HEALTH AND DISEASE 2022; 2:e164. [PMID: 36479272 PMCID: PMC9720197 DOI: 10.1002/ski2.164] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/19/2022] [Accepted: 08/24/2022] [Indexed: 06/07/2023]
Abstract
Medically unexplained dermatologic symptoms, such as pruritus, numbness and burning are known as somatization. These cutaneous symptoms can be very difficult to treat because of an absence of an objective explanation and they may not fit neatly into any known dermatological or psychiatric condition. These disorders are more commonly encountered in primary care and in dermatology, rather than in psychiatry. Certain skin disorders, for example, pruritus, could be a manifestation of somatization and others may predispose to somatic symptoms, for example, atopic dermatitis and psoriasis. Although there has been increasing research in the interconnection between psychiatry and dermatology, psychodermatology is a relatively new crossover discipline in clinical practice and recognition of psychodermatological conditions, such as cutaneous somatic disorders, can be difficult. Somatization may occur with or without the existence of a dermatological disease. When a dermatological disorder is present, somatization should be considered when the patient is worrying too much about their skin, spending too much time and energy on it and especially if the patient also complains of many non-cutaneous symptoms. Purely cutaneous somatic conditions include for example, the genital pain syndromes or Gardner-Diamond syndrome, characterized by unexplained bruising, which usually affects women. Effective management tools may include mindfulness therapies, pharmacotherapy with selective serotonin reuptake inhibitors, tricyclic antidepressants and cognitive conduct therapy. Electroconvulsive therapy can also be considered in extremely rare cases for treatment of severe somatization on a background of mood disorders. This paper discusses somatization, its relationship to immunodermatoses and its relevance to clinical practice.
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Affiliation(s)
- George W. M. Millington
- Norwich Medical SchoolNorwichUK
- Dermatology DepartmentNorfolk and Norwich University HospitalNorwichUK
| | - Morinola T. Shobajo
- Department of DermatologyUniversity of Illinois at Chicago College of MedicineChicagoIllinoisUSA
| | | | - Mohammad Jafferany
- Department of PsychiatryCentral Michigan University/CMU Medical Education PartnersSaginawMichiganUSA
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Jalenques I, Bourlot F, Martinez E, Pereira B, D'Incan M, Lauron S, Rondepierre F. Prevalence and Odds of Anxiety Disorders and Anxiety Symptoms in Children and Adults with Psoriasis: Systematic Review and Meta-analysi. Acta Derm Venereol 2022; 102:adv00769. [DOI: 10.2340/actadv.v102.1386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The magnitude of the association between psoriasis and depression has been evaluated, but not that between psoriasis and anxiety. The aim of this systematic review and meta-analysis was to examine the prevalence and odds of anxiety disorders and symptoms in patients with psoriasis. Five medical databases (Cochrane Database, EMBASE, PubMed, PsychINFO, ScienceDirect) were searched for relevant literature. A total of 101 eligible articles were identified. Meta-analysis revealed different prevalence rates depending on the type of anxiety disorder: 15% [95% confidence interval [CI] 9–21] for social anxiety disorder, 11% [9–14] for generalized anxiety disorder, and 9% [95% CI 8–10] for unspecified anxiety disorder. There were insufficient studies assessing other anxiety disorders to be able to draw any conclusions on their true prevalence. Meta-analysis also showed a high prevalence of anxiety symptoms (34% [95% CI 32–37]). Case-control studies showed a positive association between psoriasis and unspecified anxiety disorder (odds ratio 1.48 [1.18; 1.85]) and between psoriasis and anxiety symptoms (odds ratio 2.51 [2.02; 3.12]). All meta-analyses revealed an important heterogeneity, which could be explained in each case by methodological factors. The results of this study raise the necessity of screening for the presence of anxiety disorders, as previously recommended for depressive disorders, in patients with psoriasis and, if necessary, to refer such patients for evaluation by a mental health professional and appropriate treatment.
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Chu L, Shu X, Wu Y, Yang H, Lu Q, Deng H. Abnormal Plasma Levels of Steroids and Their Ratios in Patients With Prurigo Nodularis: A Pilot Study. Front Physiol 2022; 13:835269. [PMID: 35837010 PMCID: PMC9273777 DOI: 10.3389/fphys.2022.835269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/06/2022] [Indexed: 12/12/2022] Open
Abstract
Background: It has been suggested that cortisol levels are abnormal in chronic urticaria and atopic dermatitis, but other steroids, such as dehydroepiandrosterone (DHEA) and testosterone, are still unknown, and whether these hormones affect the maintenance of skin homeostasis or the pathogenesis of skin diseases is not fully understood. Limited data are available on steroid levels in prurigo nodularis (PN)-related research, and no study has examined the association between pruritus severity and steroid levels in PN patients. Aims: This pilot study aimed to investigate the differences in the levels of five steroids combined with their ratios in plasma between PN patients and controls and to examine the associations between the biomarkers and pruritus severity. Methods: Plasma concentrations of five steroids, including cortisol, cortisone, testosterone, progesterone, and dehydroepiandrosterone (DHEA), in 36 patients with PN were compared with concentrations in thirty-six and matched healthy controls. The concentrations of steroids were quantitated using liquid chromatography-tandem mass spectrometry. The PN symptoms, including pruritus severity, pain, and life quality, were assessed with the use of the visual analog scale, prurigo score index, numerical rating scale, and verbal rating scale and dermatology life quality index scores. Results: In comparison with controls, PN patients had lower levels of plasma cortisol and cortisone, which negatively correlated with PN symptoms. PN patients had higher levels of cortisone and testosterone to cortisol, which positively correlated with pruritus severity. Additionally, there were no significant differences in plasma concentrations of DHEA and testosterone between the two groups. We found no correlation between plasma concentrations of DHEA and testosterone and pruritus severity. Conclusion: This pilot study suggests that there may be abnormalities in peripheral blood levels of cortisol, and cortisone and the ratios of cortisone and testosterone to cortisol in patients with PN, and they are related to pruritus severity. The plasma concentrations of testosterone and DHEA may be not abnormal in PN patients and may not be associated with pruritus severity.
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Affiliation(s)
- Liuxi Chu
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, China
- Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing, China
- Institute of Child Development and Education, Southeast University, Nanjing, China
| | - Xin Shu
- Department of Dermatology, The Third Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Yan Wu
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, China
- Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing, China
- Institute of Child Development and Education, Southeast University, Nanjing, China
| | - Haoran Yang
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, China
- Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing, China
- Institute of Child Development and Education, Southeast University, Nanjing, China
| | - Qin Lu
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, China
- Department of Prescription Science, School of Basic Medical Sciences, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Huihua Deng
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, China
- Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing, China
- Institute of Child Development and Education, Southeast University, Nanjing, China
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Misery L. Chronic prurigo. Br J Dermatol 2022; 187:464-471. [DOI: 10.1111/bjd.21698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/25/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Laurent Misery
- Univ Brest, LIEN Brest France
- University Hospital of Brest Department of Dermatology, Venerology and Allergology and French Expert Centre on Pruritus Brest France
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Chu L, Wang L, Wu Y, Yang H, Wang W, Lu Q, Deng H. REMOVED: Plasma Steroids and Endocannabinoids Used as Biomarkers to Assess the Pruritus Severity of Patients With Prurigo Nodularis. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:T244-T253. [PMID: 35331446 DOI: 10.1016/j.ad.2021.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 10/09/2021] [Accepted: 10/11/2021] [Indexed: 10/20/2022] Open
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This article has been retracted at the request of the first author and the approval of all of the co-authors. After publication, the author contacted the journal regarding errors affecting the statistical analysis: the incorrect identification of patients in the part of clinical information and biomarker's levels led to incorrect conclusions of the study. The data is lacking experimental verification due to data loss and errors. The editor in chief accepted the retraction. The authors offer their apologies.
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Affiliation(s)
- L Chu
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, China; Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing, China; Institute of Child Development and Education, Southeast University, Nanjing, China
| | - L Wang
- Department of Rehabilitation Medicine, the Third Medical Centre, Chinese PLA General Hospital, Pekín, China
| | - Y Wu
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, China; Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing, China; Institute of Child Development and Education, Southeast University, Nanjing, China
| | - H Yang
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, China; Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing, China; Institute of Child Development and Education, Southeast University, Nanjing, China
| | - W Wang
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, China; Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing, China; Institute of Child Development and Education, Southeast University, Nanjing, China
| | - Q Lu
- Department of Prescription Science, School of Basic Medical Sciences, Hebei University of Chinese Medicine, Shijiazhuang 050200, Hebei, China.
| | - H Deng
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, China; Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing, China; Institute of Child Development and Education, Southeast University, Nanjing, China.
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Chu L, Wang LK, Wu Y, Yang H, Wang W, Lu Q, Deng H. REMOVED: Plasma Steroids and Endocannabinoids Used as Biomarkers to Assess the Pruritus Severity of Patients With Prurigo Nodularis. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:244-253. [PMID: 35282859 DOI: 10.1016/j.ad.2022.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 10/11/2021] [Indexed: 12/16/2022] Open
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This article has been retracted at the request of the first author and the approval of all of the co-authors. After publication, the author contacted the journal regarding errors affecting the statistical analysis: the incorrect identification of patients in the part of clinical information and biomarker's levels led to incorrect conclusions of the study. The data is lacking experimental verification due to data loss and errors. The editor in chief accepted the retraction. The authors offer their apologies.
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Affiliation(s)
- L Chu
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, China; Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing, China; Institute of Child Development and Education, Southeast University, Nanjing, China
| | - L-K Wang
- Department of Rehabilitation Medicine, the Third Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Y Wu
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, China; Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing, China; Institute of Child Development and Education, Southeast University, Nanjing, China
| | - H Yang
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, China; Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing, China; Institute of Child Development and Education, Southeast University, Nanjing, China
| | - W Wang
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, China; Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing, China; Institute of Child Development and Education, Southeast University, Nanjing, China
| | - Q Lu
- Department of Prescription Science, School of Basic Medical Sciences, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, China.
| | - H Deng
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, China; Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing, China; Institute of Child Development and Education, Southeast University, Nanjing, China.
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Epidemiology, Comorbidities, and Prescription Patterns of Korean Prurigo Nodularis Patients: A Multi-Institution Study. J Clin Med 2021; 11:jcm11010095. [PMID: 35011837 PMCID: PMC8745727 DOI: 10.3390/jcm11010095] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/12/2021] [Accepted: 12/21/2021] [Indexed: 12/17/2022] Open
Abstract
Prurigo nodularis (PN) is a chronic dermatosis typified by extraordinarily itchy nodules. However, little is known of the nature and extent of PN in Asian people. This study aimed to describe the epidemiology, comorbidities, and prescription pattern of PN in Koreans based on a large dermatology outpatient cohort. Patients with PN were identified from the Catholic Medical Center (CMC) clinical data warehouse. Anonymized data on age, sex, diagnostic codes, prescriptions, visitation dates, and other relevant parameters were collected. Pearson correlation analysis was used to calculate the correlation between PN prevalence and patient age. Conditional logistic regression modeling was adopted to measure the comorbidity risk of PN. A total of 3591 patients with PN were identified at the Catholic Medical Center Health System dermatology outpatient clinic in the period 2007–2020. A comparison of the study patients with age- and sex-matched controls (dermatology outpatients without PN) indicated that PN was associated with various comorbidities including chronic kidney disease (adjusted odds ratio (aOR), 1.48; 95% confidence interval (CI), 1.29–1.70), dyslipidemia (aOR, 1.88; 95% CI, 1.56–2.27), type 2 diabetes mellitus (aOR, 1.37; 95% CI, 1.22–1.54), arterial hypertension (aOR, 1.50; 95% CI, 1.30–1.73), autoimmune thyroiditis (aOR, 2.43; 95% CI, 1.42–4.16), non-Hodgkin’s lymphoma (aOR, 1.95; 95% CI, 1.23–3.07), and atopic dermatitis (aOR, 2.16, 95% CI, 1.91–2.45). Regarding prescription patterns, topical steroids were most favored, followed by topical calcineurin inhibitors; oral antihistamines were the most preferred systemic agent for PN. PN is a relatively rare but significant disease among Korean dermatology outpatients with a high comorbidity burden compared to dermatology outpatients without PN. There is great need for breakthroughs in PN treatment.
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Chu L, Wu Y, Yang L, Yang H, Lu Q, Deng H. Abnormal Levels of Cortisol and Cortisone in Patients with Prurigo Nodularis. Indian J Dermatol 2021; 66:685-687. [PMID: 35283524 PMCID: PMC8906291 DOI: 10.4103/ijd.ijd_912_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Liuxi Chu
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, Jiangsu, China.,Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing, Jiangsu, China
| | - Yan Wu
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, Jiangsu, China.,Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing, Jiangsu, China
| | - Lili Yang
- Department of Dermatology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Haoran Yang
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, Jiangsu, China.,Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing, Jiangsu, China
| | - Qin Lu
- Department of Prescription Science, School of Basic Medical Sciences, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, China. E-mail:
| | - Huihua Deng
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, Jiangsu, China.,Key Laboratory of Child Development and Learning Science (Southeast University), Ministry of Education, Nanjing, Jiangsu, China
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11
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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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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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14
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Reverte M, Pereira MP, Ständer S, Misery L, Brenaut E. [Clinical characteristics of patients with prurigo nodularis: A descriptive study]. Ann Dermatol Venereol 2020; 147:564-568. [PMID: 32475624 DOI: 10.1016/j.annder.2020.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/12/2020] [Accepted: 04/16/2020] [Indexed: 10/24/2022]
Affiliation(s)
- M Reverte
- Service de dermatologie, CHU de Brest, 2, avenue Foch, 29609 Brest cedex, France
| | - M-P Pereira
- Service de dermatologie, centre de compétence du prurit chronique, hôpital universitaire de Münster, Münster, Allemagne
| | - S Ständer
- Service de dermatologie, centre de compétence du prurit chronique, hôpital universitaire de Münster, Münster, Allemagne
| | - L Misery
- Service de dermatologie, CHU de Brest, 2, avenue Foch, 29609 Brest cedex, France; Université de Brest, LIEN, 29200 Brest, France
| | - E Brenaut
- Service de dermatologie, CHU de Brest, 2, avenue Foch, 29609 Brest cedex, France; Université de Brest, LIEN, 29200 Brest, France.
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Huang AH, Williams KA, Kwatra SG. Prurigo nodularis: Epidemiology and clinical features. J Am Acad Dermatol 2020; 83:1559-1565. [PMID: 32454098 DOI: 10.1016/j.jaad.2020.04.183] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 12/14/2022]
Abstract
Prurigo nodularis (PN) is a chronic inflammatory skin disease characterized by intensely pruritic, hyperkeratotic nodules that favor the extensor surfaces of the extremities and the trunk. In addition to its significant impact on quality of life, many patients with PN are recalcitrant to therapy because there are currently no therapies approved by the US Food and Drug Administration. In the first article of this 2-part continuing medical education series, we describe the broader epidemiology, patient demographics, physical examination findings, and symptoms to aid in the timely recognition and diagnosis of PN. Furthermore, we quantify the burden of comorbidities in PN by discussing the broad spectrum of systemic diseases and mental health conditions that have been associated with this condition. The second article of this 2-part series focuses on the pathogenesis of PN and provides detailed algorithms for comprehensive work-up and management.
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Affiliation(s)
- Amy H Huang
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Kyle A Williams
- 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; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
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Pereira MP, Hoffmann V, Weisshaar E, Wallengren J, Halvorsen JA, Garcovich S, Misery L, Brenaut E, Savk E, Potekaev N, Lvov A, Bobko S, Szepietowski JC, Reich A, Bozek A, Legat FJ, Metz M, Streit M, Serra-Baldrich E, Gonçalo M, Storck M, Greiwe I, Nau T, Steinke S, Dugas M, Ständer S, Zeidler C. Chronic nodular prurigo: clinical profile and burden. A European cross-sectional study. J Eur Acad Dermatol Venereol 2020; 34:2373-2383. [PMID: 32078192 DOI: 10.1111/jdv.16309] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/27/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Chronic nodular prurigo (CNPG) is a condition characterized by chronic itch, a prolonged scratching behaviour and the presence of pruriginous nodules. A comprehensive understanding of this condition, especially regarding its clinical characteristics and impact on quality of life is still lacking. OBJECTIVES Aim of this pan-European multicentre cross-sectional study was to establish the clinical profile of CNPG, including its associated burden. METHODS Fifteen centres from 12 European countries recruited CNPG patients presenting at the centre or using the centres' own databases. Patients were asked to complete a questionnaire in paper or electronic format. Demography, current co-morbidities, underlying disease, itch intensity, additional sensory symptoms, quality of life, highest burden and emotional experience of itch were assessed. RESULTS A total of 509 patients (210 male, median age: 64 years [52; 72]) were enrolled. Of these, 406 reported itch and CNPG lesions in the previous 7 days and qualified to complete the whole questionnaire. We recorded moderate to severe worst itch intensity scores in the previous 24 h. Scores were higher in patients with lower educational levels and those coming from Eastern or Southern Europe. Most patients experience itch often or always (71%) and report that their everyday life is negatively affected (53%). Itch intensity was considered to be the most burdensome aspect of the disease by 49% of the patients, followed by the visibility of skin lesions (21%) and bleeding of lesions (21%). The majority of patients was unaware of an underlying condition contributing to CNPG (64%), while psychiatric diseases were the conditions most often mentioned in association with CNPG (19%). CONCLUSIONS This multicentre cross-sectional study shows that itch is the dominant symptom in CNPG and reveals that the profile of the disease is similar throughout Europe.
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Affiliation(s)
- M P Pereira
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - V Hoffmann
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - E Weisshaar
- Occupational Medicine, Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - J Wallengren
- Department of Clinical Sciences Lund, Dermatology and Venereology and Skane University Hospital, Lund, Sweden
| | - J A Halvorsen
- Department of Dermatology, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - S Garcovich
- Institute of Dermatology, F. Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - L Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - E Brenaut
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - E Savk
- Department of Dermatology, Aydin Adnan Menderes University, Aydın, Turkey
| | - N Potekaev
- Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology, Moscow, Russia
| | - A Lvov
- Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology, Moscow, Russia
| | - S Bobko
- Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology, Moscow, Russia
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - A Reich
- Department of Dermatology, University of Rzeszów, Rzeszów, Poland
| | - A Bozek
- Department of Dermatology, School of Medicine, University of Information Technology and Management, Rzeszow, Poland
| | - F J Legat
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - M Metz
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Streit
- Department of Dermatology, Kantonsspital Aarau, Aarau, Switzerland
| | | | - M Gonçalo
- Department of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - M Storck
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - I Greiwe
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - T Nau
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - S Steinke
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - M Dugas
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - S Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - C Zeidler
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
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Association between Prurigo Nodularis and Etiologies of Peripheral Neuropathy: Suggesting a Role for Neural Dysregulation in Pathogenesis. MEDICINES 2020; 7:medicines7010004. [PMID: 31936197 PMCID: PMC7167799 DOI: 10.3390/medicines7010004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/26/2019] [Accepted: 12/26/2019] [Indexed: 12/16/2022]
Abstract
Background: Prurigo nodularis (PN) is an intensely pruritic skin condition of considerable morbidity. However, the pathogenesis of PN and its association with underlying neuropathy is unclear. Objective: We sought to investigate the association between PN and etiologies of peripheral neuropathy. Methods: A cross-sectional analysis of adult patients (≥18-year-old) with PN, AD, and Psoriasis at the Johns Hopkins Health System over a six-year period (January 2013–January 2019) was performed. The strength of association with etiologies of peripheral neuropathy were compared to a control cohort of individuals without PN, as well as those with AD or psoriasis. Results: A total of 1122 patients with PN were compared to 10,390 AD patients, 15,056 patients with psoriasis, and a control cohort of 4,949,017 individuals without PN, with respect to 25 comorbidities associated with peripheral neuropathies. Limitations: Comparisons between peripheral neuropathies and PN represent associations but are not causal relationships. Conclusion: Prurigo nodularis is strongly associated with peripheral neuropathies, suggesting a role for neural dysregulation in pathogenesis.
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Akarsu S, Ozbagcivan O, Ilknur T, Semiz F, Inci BB, Fetil E. Xerosis cutis and associated co-factors in women with prurigo nodularis. An Bras Dermatol 2018; 93:671-679. [PMID: 30156616 PMCID: PMC6106662 DOI: 10.1590/abd1806-4841.20187127] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 08/20/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Current data regarding the associated factors of prurigo nodularis are still uncertain, except for atopic predisposition. OBJECTIVES The purposes of this study were to (1) determine the frequencies of xerosis and other accompanying diseases of female patients with prurigo nodularis; (2) compare the demographic, clinical and accompanying disease characteristics by grouping these patients according to whether they have associated xerosis (who were subsequently subgrouped as atopic or non-atopic) or not. METHODS In this retrospective descriptive study, 80 females with PN were categorized according to the accompanying diseases (dermatological, systemic, neurological, psychogenic, mixed, or undetermined origin). RESULTS A total of 45 associated co-factors including dermatological in 63 (78.8%), systemic in 57 (71.3%), psychological in 33 (41.3%) and neurological co-factors in 14 (17.5%) of all patients with prurigo nodularis were detected. Xerosis was observed in 48 (60%) patients (non-atopic co-factors in 66.7% of them). The ratio of patients with mixed co-factors, dermatological+systemic co-factors and dermatological+systemic+psychological co-factors were found to be significantly higher in patients with xerosis compared to those without xerosis. STUDY LIMITATIONS Our study has certain limitations such as the absence of an age-matched control group, absence of follow-up data and the fact that the diagnosis of xerosis has not been based on objective methods. CONCLUSIONS Xerosis has been identified in more than half of the patients with PN and it has been determined that in most patients xerosis is associated especially with diabetes mellitus and other conditions related to prurigo nodularis.
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Affiliation(s)
- Sevgi Akarsu
- Department of Dermatology, Faculty of Medicine, Dokuz Eylul
University, Izmir, Turkey
| | - Ozlem Ozbagcivan
- Department of Dermatology, Faculty of Medicine, Dokuz Eylul
University, Izmir, Turkey
| | - Turna Ilknur
- Department of Dermatology, Faculty of Medicine, Dokuz Eylul
University, Izmir, Turkey
| | - Fatma Semiz
- Department of Dermatology, Faculty of Medicine, Dokuz Eylul
University, Izmir, Turkey
| | - Burcu Bahar Inci
- Department of Dermatology, Faculty of Medicine, Dokuz Eylul
University, Izmir, Turkey
| | - Emel Fetil
- Department of Dermatology, Faculty of Medicine, Dokuz Eylul
University, Izmir, Turkey
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Brenaut E, Halvorsen JA, Dalgard FJ, Lien L, Balieva F, Sampogna F, Linder D, Evers AWM, Jemec GBE, Gieler U, Szepietowski J, Poot F, Altunay IK, Finlay AY, Salek SS, Szabo C, Lvov A, Marron SE, Tomas-Aragones L, Kupfer J, Misery L. The self-assessed psychological comorbidities of prurigo in European patients: a multicentre study in 13 countries. J Eur Acad Dermatol Venereol 2018; 33:157-162. [PMID: 29923228 DOI: 10.1111/jdv.15145] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/08/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Prurigo is defined by the presence of chronic pruritus and multiple localized or generalized pruriginous lesions. OBJECTIVE The aim of this study was to assess the psychological burden of prurigo in patients of European countries. METHODS In this multicentre European study, 3635 general dermatology outpatients and 1359 controls were included. Socio-demographic data and answers to questionnaires (regarding quality of life, general health, anxiety and depression and suicidal ideation) were collected. RESULTS There were 27 patients with prurigo; of these, 63% were men, and the mean age was 58.6 years. Among patients with prurigo, 10 of 27 (37%) suffered from anxiety and 8 of 27 (29%) from depression. Suicidal ideation was reported in 5 of 27 (19%) patients, and for four of these five patients, suicidal ideation was related to their skin disease. These frequencies were higher in the 10 commonest dermatological diseases (including psoriasis, atopic dermatitis and leg ulcers). The impact on quality of life was severe, with a mean Dermatologic Life Quality Index (DLQI) of 12.4, with an extreme impact on quality of life for 23% of patients and a very large impact for 27% of patients. CONCLUSION The psychological comorbidities of prurigo are common, greater than those of other skin diseases, and their impact on quality of life is significant. Thus, it is important to study this condition and to find new treatments.
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Affiliation(s)
- E Brenaut
- Department of Dermatology, University Hospital, Brest, France
| | - J A Halvorsen
- Department of Dermatology, Oslo University Hospital, Oslo University, Oslo, Norway
| | - F J Dalgard
- Department of Dermatology and Venereology, Skåne University Hospital, Lund University, Malmö, Sweden.,National Centre for Dual Diagnosis, Innlandet Hospital Trust, Brumunddal, Norway
| | - L Lien
- National Centre for Dual Diagnosis, Innlandet Hospital Trust, Brumunddal, Norway
| | - F Balieva
- Department of Dermatology, Stavanger University Hospital, Stavanger, Norway
| | - F Sampogna
- Clinical Epidemiology Unit, Istituto Dermopatico dell'Immacolata (IDI)- IRCCS FLMM, Rome, Italy
| | - D Linder
- Section of Biostatistics, University of Oslo, Oslo, Norway
| | - A W M Evers
- Department of Health, Medicine and Neuropsychology, Leiden University, Leiden, The Netherlands
| | - G B E Jemec
- Department of Dermatology, Zealand University Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - U Gieler
- Department of Dermatology, Justus Liebig University, Giessen, Germany
| | - J Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - F Poot
- Department of Dermatology, Universite Libre de Bruxelles, Brussels, Belgium
| | - I K Altunay
- Dermatology and Veneteology Clinic, Şişli Hamidiye Etfal Training and Research Center, University of Health Science, Istanbul, Turkey
| | - A Y Finlay
- Department of Dermatology, Cardiff University School of Medicine, Cardiff, UK
| | - S S Salek
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - C Szabo
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - A Lvov
- Moscow Scientific and Practical Centre of Dermatovenereology and Cosmetology, Moscow, Russia
| | - S E Marron
- Department of Dermatology, Royo Villanova Hospital, Zaragoza, Spain
| | - L Tomas-Aragones
- Department of Psychology, University of Zaragoza, Zaragoza, Spain
| | - J Kupfer
- Institute of Medical Psychology, Justus Liebig University, Giessen, Germany
| | - L Misery
- Department of Dermatology, University Hospital, Brest, France
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20
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Jafferany M, Davari ME. Itch and psyche: psychiatric aspects of pruritus. Int J Dermatol 2018; 58:3-23. [PMID: 29917231 DOI: 10.1111/ijd.14081] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 04/07/2018] [Accepted: 05/16/2018] [Indexed: 01/02/2023]
Abstract
Itch, also referred to as pruritus, is an unpleasant cutaneous sensation provoking the desire to scratch. It is often an uncomfortable, subjective sensation responsible for decreased quality of life in a variety of psychodermatological conditions. Comorbid psychiatric conditions, including depression and anxiety, are frequently associated with itch and scratch cycle. The reciprocal and intricate relationship between the psyche and itch has been widely studied. The neurobiology of itch involves the complexity of specific mediators, itch-related neuronal pathways, and central processing of itch. The connection between itch and the psyche can be grouped under three headings: pruritic diseases with psychosocial sequelae, pruritic diseases aggravated by psychosocial factors, and psychiatric disorders causing pruritus. Itch and pain modulation go together in most circumstances and involve various substances including histamine, interleukins, protease-activated receptors, transient receptor potential receptors, opioids, and cannabinoids. The close interaction between keratinocytes and nerve endings modulating pain and itch also play a major role. Management of itch associated with its psychosomatic components is directed at an underlying cause and adopting a holistic approach to address not only dermatologic and somatosensory aspects, but also the cognitive, emotional, and psychosocial components. An integrated multidisciplinary team consisting of a dermatologist, psychiatrist, psychologist, and social worker is vital in addressing the multifaceted aspects of pruritus.
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22
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Fleming P, Bai J, Pratt M, Sibbald C, Lynde C, Gulliver W. The prevalence of anxiety in patients with psoriasis: a systematic review of observational studies and clinical trials. J Eur Acad Dermatol Venereol 2016; 31:798-807. [DOI: 10.1111/jdv.13891] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 07/18/2016] [Indexed: 12/29/2022]
Affiliation(s)
- P. Fleming
- Division of Dermatology; University of Toronto; Toronto ON Canada
| | - J.W. Bai
- MD Program; Faculty of Medicine; University of Toronto; Toronto ON Canada
| | - M. Pratt
- Faculty of Medicine; Memorial University of Newfoundland; St. John's NF Canada
| | - C. Sibbald
- Division of Dermatology; University of Toronto; Toronto ON Canada
| | - C. Lynde
- Division of Dermatology; University of Toronto; Toronto ON Canada
- Lynde Dermatology (Private Practice); Markham ON Canada
| | - W.P. Gulliver
- Department of Medicine; Faculty of Medicine; Memorial University of Newfoundland; St. John's NF Canada
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Jørgensen KM, Egeberg A, Gislason GH, Skov L, Thyssen JP. Anxiety, depression and suicide in patients with prurigo nodularis. J Eur Acad Dermatol Venereol 2016; 31:e106-e107. [PMID: 27505149 DOI: 10.1111/jdv.13827] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- K M Jørgensen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - A Egeberg
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - G H Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.,The Danish Heart Foundation, Copenhagen, Denmark.,The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - L Skov
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - J P Thyssen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
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Roubille C, Richer V, Starnino T, McCourt C, McFARLANE A, Fleming P, Siu S, Kraft J, Lynde C, Pope JE, Gulliver W, Keeling S, Dutz J, Bessette L, Bissonnette R, Haraoui B. Dr. Roubille, et al reply. J Rheumatol 2016; 43:993-4. [PMID: 27134278 DOI: 10.3899/jrheum.151347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Camille Roubille
- Rheumatology Research Fellow, University of Montreal Hospital Research Center (Centre de Recherche du CHUM), Notre-Dame Hospital, Quebec City, Quebec;
| | - Vincent Richer
- Dermatology Resident, Department of Medicine, Dermatology Service, St-Luc Hospital, Quebec City, Quebec
| | - Tara Starnino
- Rheumatology Resident, Sacré-Coeur Hospital of Montreal, University of Montreal, Quebec City, Quebec
| | - Collette McCourt
- Clinical Fellow in Immunodermatology, Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia
| | - Alexandra McFARLANE
- Internal Medicine Resident, Division of Rheumatology, University of Alberta, Edmonton, Alberta
| | - Patrick Fleming
- Dermatology Resident, Division of Dermatology, University of Toronto, Toronto, Ontario
| | - Stephanie Siu
- Internal Medicine Resident, Division of Rheumatology, Western University of Canada, London, Ontario
| | - John Kraft
- Dermatologist, Lynde Dermatology, Markham, Ontario
| | | | - Janet E Pope
- Professor of Rheumatology, Division of Rheumatology, Western University of Canada, London, Ontario
| | - Wayne Gulliver
- Professor of Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland
| | - Stephanie Keeling
- Associate Professor of Rheumatology, Division of Rheumatology, University of Alberta, Edmonton, Alberta
| | - Jan Dutz
- Professor of Dermatology, Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia
| | - Louis Bessette
- Associate Professor of Medicine, Centre de Recherche du CHU de Québec, Department of Medicine, Laval University, Quebec City, Quebec
| | | | - Boulos Haraoui
- Head of Clinical Research Unit, Institut de Rhumatologie de Montréal, Quebec City, Quebec, Canada
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Oh CC, Li H, Lee W, Tey HL. Biopsychosocial Factors Associated with Prurigo Nodularis in Endogenous Eczema. Indian J Dermatol 2015; 60:525. [PMID: 26538749 PMCID: PMC4601470 DOI: 10.4103/0019-5154.164451] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Prurigo nodularis is a dermatological manifestation secondary to chronic scratching or picking on focal areas of the skin. Its pathogenesis remains poorly understood, and limited data has indicated its association with psychological factors. Aim: To determine the biological, psychological and social factors associated with the occurrence of prurigo nodularis in patients with underlying endogenous eczema. Methods: A prospective case-control questionnaire –based study on patients with endogenous eczema, with and without prurigo nodules, was performed. The Impact of Skin Disease on Daily Life questionnaire was used to assess dimensions of physical functioning, including extent and severity of skin disease, itch, pain, fatigue and scratching, as well as dimensions of psychological and social functioning, including mood, illness cognition, disease-related impact, stigmatization and social support. Results: Thirty-six cases and 47 controls were recruited. Patients with endogenous eczema and prurigo nodules indicated a higher itch score on the visual analog scale over the previous 4 weeks compared to those without prurigo nodules (p=0.0292). There were no significant differences between the 2 groups in the scores reflecting the other parameters of physical, psychological and social functioning. Conclusion: In patients with endogenous eczema, those with prurigo nodules experience a greater itch intensity compared to those without prurigo nodules. There were no other physical, psychological and social factors that were found to be associated with the occurrence of prurigo nodules in endogenous eczema.
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Affiliation(s)
- Choon Chiat Oh
- Department of Dermatology, National Skin Centre, Singapore General Hospital, Singapore
| | - Huihua Li
- Department Health Service Research, Singapore General Hospital, Singapore
| | - Wellington Lee
- Department of Dermatology, National Skin Centre, Singapore General Hospital, Singapore
| | - Hong Liang Tey
- Department of Dermatology, National Skin Centre, Singapore General Hospital, Singapore
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Craig-Müller SA, Reichenberg JS. The Other Itch That Rashes: a Clinical and Therapeutic Approach to Pruritus and Skin Picking Disorders. Curr Allergy Asthma Rep 2015; 15:31. [PMID: 26141577 DOI: 10.1007/s11882-015-0532-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Patients with skin picking disorders (SPDs) have historically been an under recognized and under treated group. Originally classified an impulse control disorder, skin picking disorder is now considered under the obsessive-compulsive disorder (OCD) and obsessive-compulsive-related disorder (OCRD) spectrum. Workup of SPD concentrates on differentiating this condition from primary skin disorders, systemic conditions associated with pruritus, and psychocutaneous syndromes. It is important to first address any underlying pruritic disorders (if present) that may be a trigger to pick the skin. First-line treatment for SPD is cognitive behavioral therapy. When necessary, pharmacologic therapy can be helpful as well.
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Konda D, Chandrashekar L, Rajappa M, Kattimani S, Thappa DM, Ananthanarayanan PH. Serotonin and interleukin-6: Association with pruritus severity, sleep quality and depression severity in Prurigo Nodularis. Asian J Psychiatr 2015; 17:24-8. [PMID: 26277226 DOI: 10.1016/j.ajp.2015.07.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 06/23/2015] [Accepted: 07/20/2015] [Indexed: 10/23/2022]
Abstract
Prurigo Nodularis (PN) is a chronic skin condition of unknown etiology. It is said to be associated with psychological factors. However, studies to identify the same are few. Hence, we undertook to assess the association between quality of sleep, depression, pruritus severity in cases of PN and to assess association of serum serotonin, interleukin (IL)-6 with sleep, depression and pruritus severity. This cross-sectional study involves 39 patients with PN and 39 age and gender matched healthy controls. Subjective quality of sleep, depressive symptom severity and pruritus severity were collected through clinician based interview. Serum serotonin and serum IL-6 were estimated by ELISA. Spearman correlation was used to assess the strength of association between biochemical parameters and clinical parameters. Cases had significantly higher percentage of depression, a higher score of depression severity, higher serum IL-6 level and lower serum serotonin levels. Serum serotonin and serum IL-6 showed significant correlation with the severity of pruritus (r=-0.66, p<0.01 and r=0.60, p<0.01). However, both these parameters showed a significantly negative correlation between them (r=-0.92, p<0.01). Though cause and effect cannot be established in this type of study, there is a disturbance of the inflammatory-neuroendocrine axis (interleukins-serotonin). PN is characterized by higher IL-6 and lower serotonin and greater depression severity than healthy controls. Findings of this study may have an influence on the treatment of PN.
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Affiliation(s)
- Deepthi Konda
- Department of Dermatology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Laxmisha Chandrashekar
- Department of Dermatology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India.
| | - Medha Rajappa
- Department of Biochemistry, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Shivanand Kattimani
- Department of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Devinder Mohan Thappa
- Department of Dermatology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - P H Ananthanarayanan
- Department of Biochemistry, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
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Warlich B, Fritz F, Osada N, Bruland P, Stumpf A, Schneider G, Dugas M, Pfleiderer B, St�nder S. Health-Related Quality of Life in Chronic Pruritus: An Analysis Related to Disease Etiology, Clinical Skin Conditions and Itch Intensity. Dermatology 2015; 231:253-9. [DOI: 10.1159/000437206] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 06/22/2015] [Indexed: 11/19/2022] Open
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Roubille C, Richer V, Starnino T, McCourt C, McFarlane A, Fleming P, Siu S, Kraft J, Lynde C, Pope J, Gulliver W, Keeling S, Dutz J, Bessette L, Bissonnette R, Haraoui B. Evidence-based Recommendations for the Management of Comorbidities in Rheumatoid Arthritis, Psoriasis, and Psoriatic Arthritis: Expert Opinion of the Canadian Dermatology-Rheumatology Comorbidity Initiative. J Rheumatol 2015; 42:1767-80. [DOI: 10.3899/jrheum.141112] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2015] [Indexed: 01/04/2023]
Abstract
Objective.Comorbidities such as cardiovascular diseases (CVD), cancer, osteoporosis, and depression are often underrecognized in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), or psoriasis (PsO). Recommendations may improve identification and treatment of comorbidities. The Canadian Dermatology-Rheumatology Comorbidity Initiative reviewed the literature to develop practical evidence-based recommendations for management of comorbidities in patients with RA, PsA, and PsO.Methods.Eight main topics regarding comorbidities in RA, PsA, and PsO were developed. MEDLINE, EMBASE, and the Cochrane Library (1960–12/2012), together with abstracts from major rheumatology and dermatology congresses (2010–2012), were searched for relevant publications. Selected articles were analyzed and metaanalyses performed whenever possible. A meeting including rheumatologists, dermatologists, trainees/fellows, and invited experts was held to develop consensus-based recommendations using a Delphi process with prespecified cutoff agreement. Level of agreement was measured using a 10-point Likert scale (1 = no agreement, 10 = full agreement) and the potential effect of recommendations on daily clinical practice was considered. Grade of recommendation (ranging from A to D) was determined according to the Oxford Centre for Evidence-Based Medicine evidence levels.Results.A total of 17,575 articles were identified, of which 407 were reviewed. Recommendations were synthesized into 19 final recommendations ranging mainly from grade C to D, and relating to a large spectrum of comorbidities observed in clinical practice: CVD, obesity, osteoporosis, depression, infections, and cancer. Level of agreement ranged from 80.9% to 95.8%.Conclusion.These practical evidence-based recommendations can guide management of comorbidities in patients with RA, PsA, and PsO and optimize outcomes.
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Kálmán LJ, Gonda X, Kemény L, Rihmer Z, Janka Z. [Psychological and biological background of the correlation between psoriasis and stress]. Orv Hetil 2014; 155:939-48. [PMID: 24918176 DOI: 10.1556/oh.2014.29897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Stress is considered as a major contributor to the development and exacerbation of psoriasis by a significant proportion of patients and dermatologists. As both stressor and its effects are subject-dependent, thus extremely difficult to measure, our understanding of the exact role of stress in disease development was limited for a long time. In the past decade several new studies were carried out which expanded our knowledge on the pathophysiologic processes linking stress to psoriasis via with their objective measurements and the applied new techniques. The authors review the current literature of both psychological (alexithymia, personality, affect) and biological (cortisol, epinephrine, neurogenic inflammation) factors influencing stress perception and response in psoriasis. Results of recent investigations support previous reports about the interaction between stress and psoriasis with objective evidence. Knowing how effective stress-reducing psychopharmacologic and psychotherapeutic interventions are in the treatment of psoriasis the authors hope that this review contributes to a wider acceptance of the psychosomatic attitude in everyday dermatologic practice.
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Affiliation(s)
- L János Kálmán
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Klinikai Központ Pszichiátriai Klinika Szeged Kálvária sgt. 57. 6722 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Klinikai Központ Bőrgyógyászati és Allergológiai Klinika Szeged
| | - Xénia Gonda
- Semmelweis Egyetem, Általános Orvostudományi Kar Kútvölgyi Klinikai Tömb, Klinikai és Kutatási Mentálhigiénés Osztály Budapest Országos Pszichiátriai és Adiktológiai Intézet Budapest MTA-SE Neuropszichofarmakológiai Kutatócsoport Budapest
| | - Lajos Kemény
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Klinikai Központ Bőrgyógyászati és Allergológiai Klinika Szeged
| | - Zoltán Rihmer
- Semmelweis Egyetem, Általános Orvostudományi Kar Kútvölgyi Klinikai Tömb, Klinikai és Kutatási Mentálhigiénés Osztály Budapest Országos Pszichiátriai és Adiktológiai Intézet Budapest
| | - Zoltán Janka
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Klinikai Központ Pszichiátriai Klinika Szeged Kálvária sgt. 57. 6722
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Daudén E, Castañeda S, Suárez C, García-Campayo J, Blasco A, Aguilar M, Ferrándiz C, Puig L, Sánchez-Carazo J. Clinical practice guideline for an integrated approach to comorbidity in patients with psoriasis. J Eur Acad Dermatol Venereol 2012; 27:1387-404. [DOI: 10.1111/jdv.12024] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Daudén E, Castañeda S, Suárez C, García-Campayo J, Blasco A, Aguilar M, Ferrándiz C, Puig L, Sánchez-Carazo J. Abordaje integral de la comorbilidad del paciente con psoriasis. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103 Suppl 1:1-64. [DOI: 10.1016/s0001-7310(12)70001-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Schneider G, Heuft G, Hockmann J. Determinants of social anxiety and social avoidance in psoriasis outpatients. J Eur Acad Dermatol Venereol 2011; 27:383-6. [DOI: 10.1111/j.1468-3083.2011.04307.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Saraceno R, Chiricozzi A, Nisticò SP, Tiberti S, Chimenti S. An occlusive dressing containing betamethasone valerate 0.1% for the treatment of prurigo nodularis. J DERMATOL TREAT 2011; 21:363-6. [PMID: 20536273 DOI: 10.3109/09546630903386606] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Prurigo nodularis is a distressing condition characterized by the presence of multiple nodules associated with intense pruritus. OBJECTIVE To assess the clinical efficacy and safety of betamethasone valerate 0.1% tape and a moisturizing itch-relief cream in prurigo nodularis. METHODS Twelve patients were enrolled in this pilot comparison of betamethasone valerate 0.1% tape versus a moisturizing itch-relief cream containing feverfew. The study period was 4 weeks. Clinical evaluation was performed weekly. RESULTS Eleven subjects completed the 4 weeks of therapy. The mean visual analogue scale (VAS) for pruritus at baseline was 8.75 for both sides of the body. The side treated with betamethasone valerate 0.1% tape showed a higher clinical response (VAS score at week 4: 3.9; p < 0.005) compared with the side treated with moisturizing itch-relief cream (VAS score at week 4: 5.6; p < 0.005). CONCLUSION Both treatments were effective. However, the occlusive dressing enhanced the efficacy of the treatment, preventing scratching.
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Affiliation(s)
- Rosita Saraceno
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy.
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Cassano N, Tessari G, Vena GA, Girolomoni G. Chronic pruritus in the absence of specific skin disease: an update on pathophysiology, diagnosis, and therapy. Am J Clin Dermatol 2010; 11:399-411. [PMID: 20866115 DOI: 10.2165/11317620-000000000-00000] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Chronic pruritus is a major and distressing symptom of many cutaneous and systemic diseases and can significantly impair the patient's quality of life. Pruritus perception is the final result of a complex network involving dedicated nerve pathways and brain areas, and an increasing number of peripheral and central mediators are thought to be involved. Itch is associated with most cutaneous disorders and, in these circumstances, its management overlaps with that of the skin disease. Itch can also occur without associated skin diseases or primary skin lesions, but only with nonspecific lesions secondary to rubbing or scratching. Chronic itch with no or minimal skin changes can be secondary to important diseases, such as neurologic disorders, chronic renal failure, cholestasis, systemic infections, malignancies, and endocrine disorders, and may also result from exposure to some drugs. The search for the cause of pruritus usually requires a meticulous step-by-step assessment involving careful history taking as well as clinical examination and laboratory investigations. Few evidence-based treatments for pruritus are available. Topical therapy, oral histamine H(1) receptor antagonists, and phototherapy with UV radiation can target pruritus elicitation in the skin, whereas antiepileptic drugs, opioid receptor antagonists, and antidepressants can block signal processing in the CNS.
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Affiliation(s)
- Nicoletta Cassano
- Second Dermatology Clinic, MIDIM Department, University of Bari, Bari, Italy
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Dazzi C, Erma D, Piccinno R, Veraldi S, Caccialanza M. Psychological factors involved in prurigo nodularis: A pilot study. J DERMATOL TREAT 2010; 22:211-4. [PMID: 20666670 DOI: 10.3109/09546631003674321] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Emotional stresses and psychological disorders seem to be concurrent factors in some cases of prurigo nodularis (PN), a chronic skin condition with a difficult therapeutic approach. In order to improve the therapeutic strategies, we performed a psychometric study on 20 patients affected by generalized and histological proven PN. Specific questionnaires were employed to examine the hypotheses (General Health Questionnaire, State Trait Anxiety Inventory - form Y, Beck Depression Inventory-II, and Eysenck Personality Questionnaire). The results show that symptoms of anxiety and depression associated with PN are more severe than in the control group and that some specific traits of personality are more frequently represented in such subjects. The results of our study represent a first attempt to analyze the psychological problems and the personality dimensions which seem to characterize PN patients. Such evidence supports the importance of a psychological approach in the clinical management of PN, which should always include psychological assessment and treatment together with the other therapeutic options.
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Affiliation(s)
- Carla Dazzi
- Dipartimento di Psicologia dello Sviluppo e della Socializzazione, Università degli Studi di Padova, Italy
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Székely H, Pónyai G, Temesvári E, Berczi L, Hársing J, Kárpáti S, Herszényi L, Tulassay Z, Juhász M. Association of collagenous colitis with prurigo nodularis. Eur J Gastroenterol Hepatol 2009; 21:946-51. [PMID: 19398916 DOI: 10.1097/meg.0b013e328321b0e7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The etiology and pathogenesis of collagenous colitis (CC) is poorly understood and probably multifactorial; many potential pathophysiological mechanisms have been described, although none have been conclusively proved. Circumstantial evidence suggests that CC appears as an autoimmune response to a luminal or epithelial antigen of unknown origin. Infections and certain drugs (e.g. NSAID, lansoprazole) may act as triggers for an immune-mediated process. CC is characterized clinically by chronic watery, nonbloody diarrhea with normal endoscopic appearance and without radiological abnormalities, but specific microscopic changes in the colon. Histopathology is featured by the presence of a thickened subepithelial collagen band adjacent to the basal membrane. Up to 40% of patients with CC have associated diseases of autoimmune or inflammatory origin, such as thyroid disease, coeliac disease, rheumatoid arthritis, diabetes mellitus, Sjögren's syndrome, CREST syndrome, scleroderma, pernicious anemia, and sarcoidosis. Prurigo nodularis is a chronic condition characterized by intensely pruritic, lichenified, or excoriated papules and nodules of unknown etiology. It is assumed to represent a cutaneous reaction pattern to repeated scrubbing or scratching caused by pruritus. We report a case of CC and prurigo nodularis. To our knowledge, this association has not been reported earlier.
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Affiliation(s)
- Hajnal Székely
- 2nd Department of Internal Medicine, Semmelweis University, Budapest, Hungary
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Schneider G, Ständer S, Burgmer M, Driesch G, Heuft G, Weckesser M. Significant differences in central imaging of histamine-induced itch between atopic dermatitis and healthy subjects. Eur J Pain 2008; 12:834-41. [PMID: 18203636 DOI: 10.1016/j.ejpain.2007.12.003] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Revised: 11/13/2007] [Accepted: 12/05/2007] [Indexed: 11/16/2022]
Abstract
BACKGROUND/AIM This is the first investigation of the central processing of itch in the brain in 8 subjects with atopic dermatitis (AD) in comparison to 6 healthy controls (HC), comparing histamine-induced itch related activations in the frontal, prefrontal, parietal, cingulate cortex, thalamus, basal ganglia and cerebellum. METHODS We employed 1% histamine-dihydrochlorid-iontophoresis of the left hand, recorded H2(15)O-PET-scans and perception of itch intensity on a numeric rating scale. RESULTS There was no significant difference in perceived itch intensity between AD and HC. Significant increase in rCBF was found in HC in the contralateral somatosensory and motor cortex, midcingulate gyrus, and ipsilateral prefrontal cortex; in AD: in the contralateral thalamus, somatosensory, motor and prefrontal cortex and cerebellum, in the ipsilateral precentral, prefrontal, orbitofrontal cortex, insula, pallidum and cerebellum. More brain sites were activated in AD than in HC. Activation in AD was significantly higher in the contralateral thalamus, ipsilateral caudate and pallidum. CONCLUSIONS We interpret our findings as possible central correlates of changes in the motor system in subjects with chronic itch, with activation of the basal ganglia possibly correlating to the vicious itch-scratch-circle in subjects with chronic itching skin diseases. However, further neuroimaging studies in healthy subjects and also in different skin diseases are needed to understand the complex mechanisms of the processing of itch.
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Affiliation(s)
- Gudrun Schneider
- Department of Psychosomatics and Psychotherapy, University of Münster, Domagkstr. 22, D-48149 Münster, Germany.
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