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Meltan S, Panuganti B, Tarbox M. Evaluation and Management of Pruritus and Scabies in the Elderly Population. Clin Geriatr Med 2024; 40:91-116. [PMID: 38000864 DOI: 10.1016/j.cger.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
Pruritus is the most common dermatologic complaint in the geriatric population. Its growing prevalence coincides with the rapid growth of the elderly population (>65 years of age) in the United States. According to the US Census Bureau, 16.9% of the population, or more than 56 million adults 65 years and older, lived in the United States in 2022. Pruritus is a condition that accompanies a diverse array of underlying etiologic factors. The mechanism of normal itch impulse transmission has been recently elucidated. The itch sensation originates from epidermal/dermal receptors connected to unmyelinated, afferent C-fibers that transmit the impulse from the periphery.
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Affiliation(s)
- Shakira Meltan
- School of Medicine, Texas Tech University Health Sciences Center, TX, USA
| | | | - Michelle Tarbox
- Department of Dermatology, Texas Tech Health Science Center, 3601 4th Street, Stop 9400, Lubbock, TX 79430, USA.
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Lapteva M, Faro Barros J, Kalia YN. Cutaneous Delivery and Biodistribution of Cannabidiol in Human Skin after Topical Application of Colloidal Formulations. Pharmaceutics 2024; 16:202. [PMID: 38399256 PMCID: PMC10892191 DOI: 10.3390/pharmaceutics16020202] [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: 12/16/2023] [Revised: 01/19/2024] [Accepted: 01/27/2024] [Indexed: 02/25/2024] Open
Abstract
The objective of this study was to investigate the cutaneous delivery of cannabidiol (CBD) from aqueous formulations developed for the targeted local treatment of dermatological conditions. CBD was formulated using a proprietary colloidal drug delivery system (VESIsorb®) into an aqueous colloidal solution at 2% (ACS 2%) and two colloidal gels (CG 1% and CG 2%, which contained 1% and 2% CBD, respectively). Two basic formulations containing CBD (5% in propylene glycol (PG 5%) and a 6.6% oil solution (OS 6.6%)) and two marketed CBD products (RP1 and RP2, containing 1% CBD) were used as comparators. Cutaneous delivery and cutaneous biodistribution experiments were performed using human abdominal skin (500-700 µm) under infinite- and finite-dose conditions with 0.5% Tween 80 in the PBS receiver phase. The quantification of CBD in the skin samples was performed using a validated UHPLC-MS/MS method and an internal standard (CBD-d3). The cutaneous deposition of CBD under finite-dose conditions demonstrated the superiority of CG 1%, CG 2%, and ACS 2% over the marketed products; CG 1% had the highest delivery efficiency (5.25%). Cutaneous biodistribution studies showed the superiority of the colloidal systems in delivering CBD to the viable epidermis, and the upper and lower papillary dermis, which are the target sites for the treatment of several dermatological conditions.
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Affiliation(s)
- Maria Lapteva
- School of Pharmaceutical Sciences, University of Geneva, CMU-1 rue Michel Servet, 1211 Geneva, Switzerland (J.F.B.)
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, CMU-1 rue Michel Servet, 1211 Geneva, Switzerland
| | - Jonathan Faro Barros
- School of Pharmaceutical Sciences, University of Geneva, CMU-1 rue Michel Servet, 1211 Geneva, Switzerland (J.F.B.)
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, CMU-1 rue Michel Servet, 1211 Geneva, Switzerland
| | - Yogeshvar N. Kalia
- School of Pharmaceutical Sciences, University of Geneva, CMU-1 rue Michel Servet, 1211 Geneva, Switzerland (J.F.B.)
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, CMU-1 rue Michel Servet, 1211 Geneva, Switzerland
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Ingrasci G, Lipman ZM, Yosipovitch G. When topical therapy of atopic dermatitis fails: a guide for the clinician. Expert Rev Clin Immunol 2021; 17:1245-1256. [PMID: 34720031 DOI: 10.1080/1744666x.2021.2000390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION While topical medications are the first line of treatment for mild-to-moderate atopic dermatitis, they are ineffective in individuals with diffuse disease and moderate-to-severe atopic itch. For these individuals, as well as those who do not respond to topical treatments, systemic medicines are typically essential and helpful. AREAS COVERED We conducted a review of the literature to identify established systemic therapies, novel biologic agents, and recent advances in the pathophysiology of atopic dermatitis. The review discusses these data, which show that the majority of atopic itch medications now in development target the type 2 immune axis and brain sensitization, two main etiologies of atopic itch. We emphasize the evidence, efficacy, and side effect profiles of currently available systemic medications for atopic itch, as well as future potential for tailored therapy. EXPERT OPINION We give our professional opinion on the current state of knowledge about atopic eczema pathogenesis and the innovative targets and therapies for atopic itch that include MRGPRX2, periostin, gabaergic medicines, and JAK/STAT inhibitors. Additionally, we discuss patient populations that stand to benefit the most from targeting these molecules or utilizing these drugs, as well as those who may face a disproportionate weight of adverse effects.
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Affiliation(s)
- Giuseppe Ingrasci
- Department of Dermatology and Cutaneous Surgery Miami, University of Miami, Miami, FL, USA
| | - Zoe M Lipman
- Department of Dermatology and Cutaneous Surgery Miami, University of Miami, Miami, FL, USA
| | - Gil Yosipovitch
- Department of Dermatology and Cutaneous Surgery Miami, University of Miami, Miami, FL, USA
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Chronic itch induced by thalamic deep brain stimulation: a case for a central itch centre. J Transl Med 2021; 19:430. [PMID: 34656120 PMCID: PMC8520252 DOI: 10.1186/s12967-021-03110-y] [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: 06/07/2021] [Accepted: 10/06/2021] [Indexed: 11/28/2022] Open
Abstract
Background Central itch syndrome has been previously described in conditions such as stroke. The neurophysiology of central itch syndrome has been investigated in non-human primates but remains incompletely understood. Methods We report an observational study of a rare case of severe central itch following thalamic deep brain stimulation and postulate the location of the central itch centre in humans. Results The patient was a 47-year-old female, with congenital spinal malformations, multiple previous corrective spinal surgeries and a 30-year history of refractory neuropathic pain in her back and inferior limbs. Following multidisciplinary pain assessment and recommendation, she was referred for spinal cord stimulation, but the procedure failed technically due to scarring related to her multiple previous spinal surgeries. She was therefore referred to our centre and underwent bilateral deep brain stimulation (DBS) of the ventral posterolateral nucleus of the thalamus for management of her chronic pain. Four weeks after switching on the stimulation, the patient reported significant improvement in her pain but developed a full body progressive itch which was then complicated with a rash. Common causes of skin eczema were ruled out by multiple formal dermatological evaluation. A trial of unilateral “off stimulation” was performed showing improvement of the itchy rash. Standard and normalized brain atlases were used to localize the active stimulating contact within the thalamus at a location we postulate as the central itch centre. Conclusions Precise stereotactic imaging points to the lateral portion of the ventral posterolateral and posteroinferior nuclei of the thalamus as critical in the neurophysiology of itch in humans.
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Lipman ZM, Labib A, Yosipovitch G. Current Clinical Options for the Management of Itch in Atopic Dermatitis. Clin Cosmet Investig Dermatol 2021; 14:959-969. [PMID: 34377004 PMCID: PMC8349193 DOI: 10.2147/ccid.s289716] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/13/2021] [Indexed: 12/16/2022]
Abstract
Pruritus is the most burdensome and prevalent symptom in patients suffering from atopic dermatitis. Treating atopic itch has historically been a challenge due to multiple underlying mechanisms within its pathogenesis and an incomplete understanding of them. In recent years, our understanding of these mechanisms have increased tremendously and subsequently, new treatments have reached the market that target the pathophysiology of atopic itch from different angles. In addition, there are several promising new treatments currently in development and trials. In the current article, we discuss these currently available treatment options, their available evidence and efficacy, and highlight some of the more recent advancements in the field.
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Affiliation(s)
- Zoe M Lipman
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery and Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Angelina Labib
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery and Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Gil Yosipovitch
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery and Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
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Scalp Pruritus: Review of the Pathogenesis, Diagnosis, and Management. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1268430. [PMID: 30766878 PMCID: PMC6350598 DOI: 10.1155/2019/1268430] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 01/03/2019] [Indexed: 12/19/2022]
Abstract
Scalp pruritus is a frequent problem encountered in dermatological practice. This disorder is caused by various underlying diseases and is a diagnostic and therapeutic challenge. Scalp pruritus may be localized to the scalp or extended to other body areas. It is sometimes not only associated with skin diseases or specific skin changes, but also associated with lesions secondary to rubbing or scratching. Moreover, scalp pruritus may be difficult to diagnose and manage and may have a great impact on the quality of life of patients. It can be classified as dermatologic, neuropathic, systemic, and psychogenic scalp pruritus based on the potential underlying disease. A thorough evaluation of patients presenting with scalp pruritus is important. Taking history and performing physical examination and further investigations are essential for diagnosis. Therapeutic strategy comprises removal of the aggravating factors and appropriate treatment of the underlying condition. All treatments should be performed considering an individual approach. This review article focuses on the understanding of the pathophysiology and the diagnostic and therapeutic management of scalp pruritus.
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Shah B, Levenson JL. Use of psychotropic drugs in the dermatology patient: When to start and stop? Clin Dermatol 2018; 36:748-755. [DOI: 10.1016/j.clindermatol.2018.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Yosipovitch G, Ständer S, Kerby MB, Larrick JW, Perlman AJ, Schnipper EF, Zhang X, Tang JY, Luger T, Steinhoff M. Serlopitant for the treatment of chronic pruritus: Results of a randomized, multicenter, placebo-controlled phase 2 clinical trial. J Am Acad Dermatol 2018; 78:882-891.e10. [DOI: 10.1016/j.jaad.2018.02.030] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 01/30/2018] [Accepted: 02/04/2018] [Indexed: 02/06/2023]
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Pluskal T, Weng JK. Natural product modulators of human sensations and mood: molecular mechanisms and therapeutic potential. Chem Soc Rev 2018; 47:1592-1637. [PMID: 28933478 DOI: 10.1039/c7cs00411g] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Humans perceive physical information about the surrounding environment through their senses. This physical information is registered by a collection of highly evolved and finely tuned molecular sensory receptors. A multitude of bioactive, structurally diverse ligands have evolved in nature that bind these molecular receptors. The complex, dynamic interactions between the ligands and the receptors lead to changes in our sensory perception or mood. Here, we review our current knowledge of natural products and their derived analogues that interact specifically with human G protein-coupled receptors, ion channels, and nuclear hormone receptors to modulate the sensations of taste, smell, temperature, pain, and itch, as well as mood and its associated behaviour. We discuss the molecular and structural mechanisms underlying such interactions and highlight cases where subtle differences in natural product chemistry produce drastic changes in functional outcome. We also discuss cases where a single compound triggers complex sensory or behavioural changes in humans through multiple mechanistic targets. Finally, we comment on the therapeutic potential of the reviewed area of research and draw attention to recent technological developments in genomics, metabolomics, and metabolic engineering that allow us to tap the medicinal properties of natural product chemistry without taxing nature.
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Affiliation(s)
- Tomáš Pluskal
- Whitehead Institute for Biomedical Research, 455 Main Street, Cambridge, MA 02142, USA.
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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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Haddadi NS, Ostadhadi S, Shakiba S, Afshari K, Rahimi N, Foroutan A, Dehpour AR. Pharmacological evidence of involvement of nitric oxide pathway in anti-pruritic effects of sumatriptan in chloroquine-induced scratching in mice. Fundam Clin Pharmacol 2017; 32:69-76. [DOI: 10.1111/fcp.12317] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 06/30/2017] [Accepted: 08/11/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Nazgol-Sadat Haddadi
- Experimental Medicine Research Center; Tehran University of Medical Sciences; Poorsina St., Enghelab Ave.; Tehran Iran
- Department of Pharmacology; School of Medicine; Tehran University of Medical Sciences; Poorsina St., Enghelab Ave.; Tehran Iran
| | - Sattar Ostadhadi
- Experimental Medicine Research Center; Tehran University of Medical Sciences; Poorsina St., Enghelab Ave.; Tehran Iran
- Department of Pharmacology; School of Medicine; Tehran University of Medical Sciences; Poorsina St., Enghelab Ave.; Tehran Iran
- Brain and Spinal Cord Injury Research Center; Neuroscience Institute; Tehran University of Medical Sciences; Chamran highway Bagherkhan St., Imam Khomeini Hospital Tehran Iran
| | - Saeed Shakiba
- Experimental Medicine Research Center; Tehran University of Medical Sciences; Poorsina St., Enghelab Ave.; Tehran Iran
- Department of Pharmacology; School of Medicine; Tehran University of Medical Sciences; Poorsina St., Enghelab Ave.; Tehran Iran
| | - Khashayar Afshari
- Experimental Medicine Research Center; Tehran University of Medical Sciences; Poorsina St., Enghelab Ave.; Tehran Iran
- Department of Pharmacology; School of Medicine; Tehran University of Medical Sciences; Poorsina St., Enghelab Ave.; Tehran Iran
| | - Nastaran Rahimi
- Experimental Medicine Research Center; Tehran University of Medical Sciences; Poorsina St., Enghelab Ave.; Tehran Iran
- Department of Pharmacology; School of Medicine; Tehran University of Medical Sciences; Poorsina St., Enghelab Ave.; Tehran Iran
| | - Arash Foroutan
- Experimental Medicine Research Center; Tehran University of Medical Sciences; Poorsina St., Enghelab Ave.; Tehran Iran
- Department of Pharmacology; School of Medicine; Tehran University of Medical Sciences; Poorsina St., Enghelab Ave.; Tehran Iran
| | - Ahmad-Reza Dehpour
- Experimental Medicine Research Center; Tehran University of Medical Sciences; Poorsina St., Enghelab Ave.; Tehran Iran
- Department of Pharmacology; School of Medicine; Tehran University of Medical Sciences; Poorsina St., Enghelab Ave.; Tehran Iran
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Tarrasón G, Carcasona C, Eichhorn P, Pérez B, Gavaldà A, Godessart N. Characterization of the chloroquine-induced mouse model of pruritus using an automated behavioural system. Exp Dermatol 2017; 26:1105-1111. [DOI: 10.1111/exd.13392] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Gema Tarrasón
- Skin Biology and Pharmacology; Almirall R&D Center; Sant Feliu de Llobregat Barcelona Spain
| | - Carla Carcasona
- Skin Biology and Pharmacology; Almirall R&D Center; Sant Feliu de Llobregat Barcelona Spain
| | - Peter Eichhorn
- Pharmacokinetics and Metabolism; Almirall R&D Center; Sant Feliu de Llobregat Barcelona Spain
| | - Bibiana Pérez
- Pharmacokinetics and Metabolism; Almirall R&D Center; Sant Feliu de Llobregat Barcelona Spain
| | - Amadeu Gavaldà
- Skin Biology and Pharmacology; Almirall R&D Center; Sant Feliu de Llobregat Barcelona Spain
| | - Núria Godessart
- Skin Biology and Pharmacology; Almirall R&D Center; Sant Feliu de Llobregat Barcelona Spain
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Pereira MP, Pogatzki-Zahn E, Snels C, Vu TH, Üçeyler N, Loser K, Sommer C, Evers AWM, van Laarhoven AIM, Agelopoulos K, Ständer S. There is no functional small-fibre neuropathy in prurigo nodularis despite neuroanatomical alterations. Exp Dermatol 2017; 26:969-971. [DOI: 10.1111/exd.13343] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Manuel P. Pereira
- Department of Dermatology and Center for Chronic Pruritus; University Hospital Münster; Münster Germany
| | - Esther Pogatzki-Zahn
- Department of Anaesthesiology; Intensive Care and Pain Medicine; University Hospital Münster; Münster Germany
| | - Chantal Snels
- Health, Medical and Neuropsychology Unit; Institute of Psychology; University of Leiden; Leiden The Netherlands
| | - Thai-Ha Vu
- Department of Dermatology and Center for Chronic Pruritus; University Hospital Münster; Münster Germany
| | - Nurcan Üçeyler
- Department of Neurology; University of Würzburg; Würzburg Germany
| | - Karin Loser
- Department of Dermatology and Center for Chronic Pruritus; University Hospital Münster; Münster Germany
| | - Claudia Sommer
- Department of Neurology; University of Würzburg; Würzburg Germany
| | - Andrea Walburga Maria Evers
- Health, Medical and Neuropsychology Unit; Institute of Psychology; University of Leiden; Leiden The Netherlands
| | | | - 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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Ostadhadi S, Haddadi NS, Foroutan A, Azimi E, Elmariah S, Dehpour AR. Development of resistance to serotonin-induced itch in bile duct ligated mice. Clin Exp Pharmacol Physiol 2017; 44:680-685. [DOI: 10.1111/1440-1681.12752] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 02/14/2017] [Accepted: 02/22/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Sattar Ostadhadi
- Brain and Spinal Cord Injury Research Center; Neurosciences Institute; Tehran University of Medical Sciences; Tehran Iran
- Experimental Medicine Research Center; Tehran University of Medical Sciences; Tehran Iran
- Department of Pharmacology; School of Medicine; Tehran University of Medical Sciences; Tehran Iran
| | - Nazgol-Sadat Haddadi
- Experimental Medicine Research Center; Tehran University of Medical Sciences; Tehran Iran
- Department of Pharmacology; School of Medicine; Tehran University of Medical Sciences; Tehran Iran
| | - Arash Foroutan
- Brain and Spinal Cord Injury Research Center; Neurosciences Institute; Tehran University of Medical Sciences; Tehran Iran
- Experimental Medicine Research Center; Tehran University of Medical Sciences; Tehran Iran
| | - Ehsan Azimi
- Cutaneous Biology Research Center; Massachusetts General Hospital; Charlestown MA USA
| | - Sarina Elmariah
- Cutaneous Biology Research Center; Massachusetts General Hospital; Charlestown MA USA
| | - Ahmad-Reza Dehpour
- Brain and Spinal Cord Injury Research Center; Neurosciences Institute; Tehran University of Medical Sciences; Tehran Iran
- Experimental Medicine Research Center; Tehran University of Medical Sciences; Tehran Iran
- Department of Pharmacology; School of Medicine; Tehran University of Medical Sciences; Tehran Iran
- Faculty of Pharmacy; Tehran University of Medical Sciences; Tehran Iran
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Pinto ACVD, Wachholz PA, Masuda PY, Martelli ACC. Clinical, epidemiological and therapeutic profile of patients with brachioradial pruritus in a reference service in dermatology. An Bras Dermatol 2017; 91:549-51. [PMID: 27579762 PMCID: PMC4999125 DOI: 10.1590/abd1806-4841.201644767] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 08/25/2015] [Indexed: 11/22/2022] Open
Abstract
This is a cross-sectional study, conducted from May to November/2014, in a
dermatology reference unit, through review of medical records and interviews. In
a sample of 49 patients with brachioradial pruritus, we observed higher
prevalence of Caucasian (81.6%) and women (73.5 %), with a mean age of 56.1
years. Pruritus occurred in the topography of brachioradialis muscle in 87.8% of
cases; 59.2% of the sample reported worsening of pruritus with sun exposure; the
mean intensity of this symptom before treatment was 8.63. Therapy effectiveness
was described as "very good/good" in 79.2% of cases, and for 55.3% relapses were
categorized as "uncommon".
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Hodille E, Cuerq C, Badiou C, Bienvenu F, Steghens JP, Cartier R, Bes M, Tristan A, Plesa A, Le VTM, Diep BA, Lina G, Dumitrescu O. Delta Hemolysin and Phenol-Soluble Modulins, but Not Alpha Hemolysin or Panton-Valentine Leukocidin, Induce Mast Cell Activation. Front Cell Infect Microbiol 2016; 6:180. [PMID: 28018862 PMCID: PMC5149515 DOI: 10.3389/fcimb.2016.00180] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 11/24/2016] [Indexed: 11/13/2022] Open
Abstract
Mast cells are located at host interfaces, such as the skin, and contribute to the first-line defense against pathogens by releasing soluble mediators, including those that induce itching and scratching behavior. Here, we show that delta-hemolysin (Hld) and phenol soluble modulins (PSMs) PSMα1 and PSMα3, but not alpha-hemolysin (Hla) or Panton-Valentine leukocidin (PVL), induce dose-dependent tryptase, and lactate dehydrogenase (LDH) release by the HMC-1 human mast cell line. Using supernatants from isogenic strains, we verified that tryptase and LDH release was Hld- and PSMα-dependent. PSMα1 and Hld production was detected in 65 and 17% of human Staphylococcus aureus-infected skin abscess specimens, respectively, but they were produced in vitro by all clinical isolates. The results suggest that Hld and PSM-α1 produced in vivo during S. aureus skin infections induce the release of mast cell mediators responsible for itching and scratching behavior, which may enhance skin to skin transmission of S. aureus via the hands. As Hld and PSMs are upregulated by accessory gene regulator (agr), their association may contribute to the elective transmission of S. aureus strains with a functional agr system.
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Affiliation(s)
- Elisabeth Hodille
- Centre International de Recherche en Infectiologie, Institut National de la Santé et de la Recherche Médicale U1111, Université Lyon 1, Centre National de la Recherche Scientifique UMR5308, Ecole Normale Supérieure de LyonLyon, France; Hospices Civils de LyonLyon, France
| | - Charlotte Cuerq
- Hospices Civils de LyonLyon, France; Laboratoire de Biochimie, Centre de Biologie SudLyon, France
| | - Cédric Badiou
- Centre International de Recherche en Infectiologie, Institut National de la Santé et de la Recherche Médicale U1111, Université Lyon 1, Centre National de la Recherche Scientifique UMR5308, Ecole Normale Supérieure de Lyon Lyon, France
| | - Françoise Bienvenu
- Hospices Civils de LyonLyon, France; Laboratoire d'Immunologie, Centre de Biologie SudLyon, France
| | - Jean-Paul Steghens
- Hospices Civils de LyonLyon, France; Laboratoire de Biochimie, Centre de Biologie SudLyon, France
| | - Régine Cartier
- Hospices Civils de LyonLyon, France; Laboratoire de Biochimie, Groupement Hospitalier EstLyon, France
| | - Michèle Bes
- Centre International de Recherche en Infectiologie, Institut National de la Santé et de la Recherche Médicale U1111, Université Lyon 1, Centre National de la Recherche Scientifique UMR5308, Ecole Normale Supérieure de LyonLyon, France; Hospices Civils de LyonLyon, France; Centre National de Référence des StaphylocoquesBron, France
| | - Anne Tristan
- Centre International de Recherche en Infectiologie, Institut National de la Santé et de la Recherche Médicale U1111, Université Lyon 1, Centre National de la Recherche Scientifique UMR5308, Ecole Normale Supérieure de LyonLyon, France; Hospices Civils de LyonLyon, France; Centre National de Référence des StaphylocoquesBron, France
| | - Adriana Plesa
- Hospices Civils de LyonLyon, France; Laboratoire d'hématologie, Centre de Biologie SudLyon, France
| | - Vien T M Le
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California San Francisco, CA, USA
| | - Binh A Diep
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California San Francisco, CA, USA
| | - Gérard Lina
- Centre International de Recherche en Infectiologie, Institut National de la Santé et de la Recherche Médicale U1111, Université Lyon 1, Centre National de la Recherche Scientifique UMR5308, Ecole Normale Supérieure de LyonLyon, France; Hospices Civils de LyonLyon, France; Centre National de Référence des StaphylocoquesBron, France
| | - Oana Dumitrescu
- Centre International de Recherche en Infectiologie, Institut National de la Santé et de la Recherche Médicale U1111, Université Lyon 1, Centre National de la Recherche Scientifique UMR5308, Ecole Normale Supérieure de LyonLyon, France; Hospices Civils de LyonLyon, France; Centre National de Référence des StaphylocoquesBron, France
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Siemens W, Xander C, Meerpohl JJ, Buroh S, Antes G, Schwarzer G, Becker G. Pharmacological interventions for pruritus in adult palliative care patients. Cochrane Database Syst Rev 2016; 11:CD008320. [PMID: 27849111 PMCID: PMC6734122 DOI: 10.1002/14651858.cd008320.pub3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND This is an update of the original Cochrane review published in 2013 (Issue 6). Pruritus occurs in patients with disparate underlying diseases and is caused by different pathologic mechanisms. In palliative care patients, pruritus is not the most prevalent but is one of the most puzzling symptoms. It can cause considerable discomfort and affects patients' quality of life. OBJECTIVES To assess the effects of different pharmacological treatments for preventing or treating pruritus in adult palliative care patients. SEARCH METHODS For this update, we searched CENTRAL (the Cochrane Library), and MEDLINE (OVID) up to 9 June 2016 and Embase (OVID) up to 7 June 2016. In addition, we searched trial registries and checked the reference lists of all relevant studies, key textbooks, reviews and websites, and we contacted investigators and specialists in pruritus and palliative care regarding unpublished data. SELECTION CRITERIA We included randomised controlled trials (RCTs) assessing the effects of different pharmacological treatments, compared with a placebo, no treatment, or an alternative treatment, for preventing or treating pruritus in palliative care patients. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the identified titles and abstracts, performed data extraction and assessed the risk of bias and methodological quality. We summarised the results descriptively and quantitatively (meta-analyses) according to the different pharmacological interventions and the diseases associated with pruritus. We assessed the evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation) and created 10 'Summary of findings' tables. MAIN RESULTS In total, we included 50 studies and 1916 participants in the review. We added 10 studies with 627 participants for this update. Altogether, we included 39 different treatments for pruritus in four different patient groups.The overall risk of bias profile was heterogeneous and ranged from high to low risk. However, 48 studies (96%) had a high risk of bias due to low sample size (i.e. fewer than 50 participants per treatment arm). Using GRADE criteria, we downgraded our judgement on the quality of evidence to moderate in seven and to low in three comparisons for our primary outcome (pruritus), mainly due to imprecision and risk of bias.In palliative care participants with pruritus of different nature, the treatment with the drug paroxetine, a selective serotonin reuptake inhibitor, reduced pruritus by 0.78 points (numerical analogue scale from 0 to 10; 95% confidence interval (CI) -1.19 to -0.37; one RCT, N = 48, quality of evidence: moderate) compared to placebo.For participants suffering from uraemic pruritus (UP), gabapentin was more effective than placebo (visual analogue scale (VAS): 0 to 10), mean difference (MD) -5.91, 95% CI -6.87 to -4.96; two RCTs, N = 118, quality of evidence: moderate). The κ-opioid receptor agonist nalfurafine showed amelioration of UP (VAS 0 to 10, MD -0.95, 95% CI -1.32 to -0.58; three RCTs, N = 422, quality of evidence: moderate) and only few adverse events. Moreover, cromolyn sodium relieved UP participants from pruritus by 2.94 points on the VAS (0 to 10) (95% CI -4.04 to -1.83; two RCTs, N = 100, quality of evidence: moderate) compared to placebo.In participants with cholestatic pruritus (CP), data favoured rifampin (VAS: 0 to 100, MD -24.64, 95% CI -31.08 to -18.21; two RCTs, N = 42, quality of evidence: low) and flumecinol (RR > 1 favours treatment group; RR 1.89, 95% CI 1.05 to 3.39; two RCTs, N = 69, quality of evidence: low) and showed a low incidence of adverse events in comparison with placebo. The opioid antagonist naltrexone reduced pruritus for participants with CP (VAS: 0 to 10, MD -2.26, 95% CI -3.19 to -1.33; two RCTs, N = 52, quality of evidence: moderate) compared to placebo. However, effects in participants with UP were inconclusive (percentage difference -12.30%, 95% CI -25.82% to 1.22%, one RCT, N = 32). Furthermore, large doses of opioid antagonists (e.g. naltrexone) could be inappropriate in palliative care patients because of the risk of reducing analgesia.For participants with HIV-associated pruritus, it is uncertain whether drug treatment with hydroxyzine hydrochloride, pentoxifylline, triamcinolone or indomethacin reduces pruritus because the evidence was of very low quality (e.g. small sample size, lack of blinding). AUTHORS' CONCLUSIONS Different interventions tended to be effective for CP and UP. However, therapies for patients with malignancies are still lacking. Due to the small sample sizes in most meta-analyses and the heterogeneous methodological quality of the included trials, the results should be interpreted cautiously in terms of generalisability.
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Affiliation(s)
- Waldemar Siemens
- Faculty of Medicine, University of Freiburg, GermanyClinic for Palliative Care, Medical Center ‐ University of FreiburgRobert‐Koch‐Straße 3FreiburgGermany
| | - Carola Xander
- Faculty of Medicine, University of Freiburg, GermanyClinic for Palliative Care, Medical Center ‐ University of FreiburgRobert‐Koch‐Straße 3FreiburgGermany
| | - Joerg J Meerpohl
- Medical Center ‐ University of FreiburgCochrane GermanyBreisacher Straße 153FreiburgGermany79110
| | - Sabine Buroh
- University Medical CenterLibrary of the Center of SurgeryHugstetterstrasse 55FreiburgBaden‐WürttembergGermany79115
| | - Gerd Antes
- Medical Center ‐ University of FreiburgCochrane GermanyBreisacher Straße 153FreiburgGermany79110
| | - Guido Schwarzer
- Medical Center ‐ University of FreiburgCenter for Medical Biometry and Medical InformaticsStefan‐Meier‐Str. 26FreiburgGermanyD‐79104
| | - Gerhild Becker
- Faculty of Medicine, University of Freiburg, GermanyClinic for Palliative Care, Medical Center ‐ University of FreiburgRobert‐Koch‐Straße 3FreiburgGermany
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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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Zhu Y, Pan WH, Wang XR, Liu Y, Chen M, Xu XG, Liao WQ, Hu JH. Tryptase and protease-activated receptor-2 stimulate scratching behavior in a murine model of ovalbumin-induced atopic-like dermatitis. Int Immunopharmacol 2015; 28:507-12. [PMID: 26049029 DOI: 10.1016/j.intimp.2015.04.047] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 04/08/2015] [Accepted: 04/22/2015] [Indexed: 11/16/2022]
Abstract
The aim of the current study was to investigate the involvement of tryptase and protease-activated receptor-2 (PAR2) in the pathogenesis of itch using a recently developed murine model of atopic dermatitis (AD) elicited by epicutaneous sensitization with ovalbumin (OVA). We also examined whether tacrolimus exerts an antipruritic effect. Epicutaneous sensitization of BALB/c mice with OVA led to a significant increase in the number of scratches. Notably, PAR2 mRNA and protein levels as well as cutaneous levels of tryptase were significantly enhanced in epicutaneously sensitized mice. Pretreatment with the protease inhibitor, leupeptin, PAR2 antibody, and tacrolimus significantly reduced the number of degranulated mast cells and tryptase content, and consequently alleviated scratching behavior. Cetirizine (10mg/kg) exerted a significant inhibitory effect on the scratching behavior of mice, but did not affect the number of degranulated mast cells and induction of tryptase. Our results collectively suggest that tryptase and PAR2 are involved in OVA allergy-induced scratching behavior.
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Affiliation(s)
- Yu Zhu
- Department of Dermatology, Changzheng Hospital, Second Military Medical University, Shanghai, PR China; Institute of Medical Mycology, Shanghai, PR China
| | - Wei Hua Pan
- Department of Dermatology, Changzheng Hospital, Second Military Medical University, Shanghai, PR China; Institute of Medical Mycology, Shanghai, PR China
| | - Xiao Rong Wang
- Department of Obstetrics and Gynecology, Heilongjiang Provincial Corps Hospital, Chinese People's Armed Police Forces, Harbin, PR China
| | - Ying Liu
- Zhejiang Tongji Vocational College of Science and Technology, Hangzhou, PR China
| | - Min Chen
- Department of Dermatology, Changzheng Hospital, Second Military Medical University, Shanghai, PR China; Institute of Medical Mycology, Shanghai, PR China; Shanghai Key Laboratory of Molecular Medical Mycology, PR China; PLA Key Laboratory of Mycosis, PR China
| | - Xiao Guang Xu
- Institute of Medical Mycology, Shanghai, PR China; Shanghai Key Laboratory of Molecular Medical Mycology, PR China; PLA Key Laboratory of Mycosis, PR China
| | - Wan Qing Liao
- Institute of Medical Mycology, Shanghai, PR China; Shanghai Key Laboratory of Molecular Medical Mycology, PR China; PLA Key Laboratory of Mycosis, PR China.
| | - Jin Hong Hu
- Department of Pharmacy, Changhai Hospital, Second Military Medical University, Shanghai, PR China.
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Mediators of Chronic Pruritus in Atopic Dermatitis: Getting the Itch Out? Clin Rev Allergy Immunol 2015; 51:263-292. [DOI: 10.1007/s12016-015-8488-5] [Citation(s) in RCA: 200] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Papoiu AD, Chaudhry H, Hayes EC, Chan YH, Herbst KD. TriCalm(®) hydrogel is significantly superior to 2% diphenhydramine and 1% hydrocortisone in reducing the peak intensity, duration, and overall magnitude of cowhage-induced itch. Clin Cosmet Investig Dermatol 2015; 8:223-9. [PMID: 25941445 PMCID: PMC4416640 DOI: 10.2147/ccid.s78809] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Itch is one of the most frequent skin complaints and its treatment is challenging. From a neurophysiological perspective, two distinct peripheral and spinothalamic pathways have been described for itch transmission: a histaminergic pathway and a nonhistaminergic pathway mediated by protease-activated receptors (PAR)2 and 4. The nonhistaminergic itch pathway can be activated exogenously by spicules of cowhage, a tropical plant that releases a cysteine protease named mucunain that binds to and activates PAR2 and PAR4. Purpose This study was conducted to assess the antipruritic effect of a novel over-the-counter (OTC) steroid-free topical hydrogel formulation, TriCalm®, in reducing itch intensity and duration, when itch was induced with cowhage, and compared it with two other commonly used OTC anti-itch drugs. Study participants and methods This double-blinded, vehicle-controlled, randomized, crossover study recorded itch intensity and duration in 48 healthy subjects before and after skin treatment with TriCalm hydrogel, 2% diphenhydramine, 1% hydrocortisone, and hydrogel vehicle, used as a vehicle control. Results TriCalm hydrogel significantly reduced the peak intensity and duration of cowhage-induced itch when compared to the control itch curve, and was significantly superior to the two other OTC antipruritic agents and its own vehicle in antipruritic effect. TriCalm hydrogel was eight times more effective than 1% hydrocortisone and almost six times more effective than 2% diphenhydramine in antipruritic action, as evaluated by the reduction of area under the curve. Conclusion TriCalm hydrogel has a robust antipruritic effect against nonhistaminergic pruritus induced via the PAR2 pathway, and therefore it could represent a promising treatment option for itch.
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Affiliation(s)
| | | | | | - Yiong-Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kenneth D Herbst
- Department of Medicine, University of California, San Diego, San Diego, CA, USA
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Haruna T, Soga M, Morioka Y, Hikita I, Imura K, Furue Y, Yamamoto M, Imura C, Ikeda M, Yamauchi A, Deguchi M, Shichijo M, Arimura A, Yasui K. S-777469, a Novel Cannabinoid Type 2 Receptor Agonist, Suppresses Itch-Associated Scratching Behavior in Rodents through Inhibition of Itch Signal Transmission. Pharmacology 2015; 95:95-103. [DOI: 10.1159/000371890] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 01/06/2015] [Indexed: 11/19/2022]
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Andoh T, Kuraishi Y. Antipruritic mechanisms of topical E6005, a phosphodiesterase 4 inhibitor: inhibition of responses to proteinase-activated receptor 2 stimulation mediated by increase in intracellular cyclic AMP. J Dermatol Sci 2014; 76:206-13. [PMID: 25458869 DOI: 10.1016/j.jdermsci.2014.10.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 09/11/2014] [Accepted: 10/14/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND Phosphodiesterase 4 (PDE4), which catalyses the conversion of cyclic adenosine 3',5'-monophosphate (cAMP) to 5'-AMP, plays a critical role in the pathogenesis of inflammatory disorders. Pruritus is the main symptom of dermatitides, such as atopic dermatitis, and is very difficult to control. Recent studies have shown that the activation of proteinase-activated receptor 2 (PAR2) is involved in pruritus in dermatoses in humans and rodents. OBJECTIVE To investigate the inhibitory effect of E6005, a topically effective PDE4 inhibitor, on PAR2-associated itching in mice. METHODS Mice were given an intradermal injection of SLIGRL-NH2 (100 nmol/site), a PAR2 agonist peptide, into the rostral part of the back. E6005 and 8-bromo-cAMP were applied topically and injected intradermally, respectively, to the same site. Scratching bouts were observed as an itch-related behavior, and firing activity of the cutaneous nerve was electrophysiologically recorded. Keratinocytes were isolated from the skin of neonatal mice and cultured for in vitro experiments. The concentrations of cAMP and leukotriene B4 (LTB4) were measured by enzyme immunoassay. The distribution of PDE4 subtypes in the skin was investigated by immunostaining. RESULTS Topical E6005 and intradermal 8-bromo-cAMP significantly inhibited SLIGRL-NH2-induced scratching and cutaneous nerve firing. Topical E6005 increased cutaneous cAMP content. Topical E6005 and intradermal 8-bromo-cAMP inhibited cutaneous LTB4 production induced by SLIGRL-NH2, which has been shown to elicit LTB4-mediated scratching. E6005 and 8-bromo-cAMP inhibited SLIGRL-NH2-induced LTB4 production in the cultured murine keratinocytes also. PDE4 subtypes were mainly expressed in keratinocytes and mast cells in the skin. CONCLUSIONS The results suggest that topical E6005 treatment inhibits PAR2-associated itching. Inhibition of LTB4 production mediated by an increase in cAMP may be partly involved in the antipruritic action of E6005.
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Affiliation(s)
- Tsugunobu Andoh
- Department of Applied Pharmacology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama 930-0194, Japan
| | - Yasushi Kuraishi
- Department of Applied Pharmacology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama 930-0194, Japan.
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Kim K. Neuroimmunological mechanism of pruritus in atopic dermatitis focused on the role of serotonin. Biomol Ther (Seoul) 2014; 20:506-12. [PMID: 24009842 PMCID: PMC3762292 DOI: 10.4062/biomolther.2012.20.6.506] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 10/14/2012] [Accepted: 10/16/2012] [Indexed: 12/22/2022] Open
Abstract
Although pruritus is the critical symptom of atopic dermatitis that profoundly affect the patients' quality of life, controlling and management of prurirtus still remains as unmet needs mainly due to the distinctive multifactorial pathogenesis of pruritus in atopic dermatitis. Based on the distinct feature of atopic dermatitis that psychological state of patients substantially influence on the intensity of pruritus, various psychotropic drugs have been used in clinic to relieve pruritus of atopic dermatitis patients. Only several psychotropic drugs were reported to show real antipruritic effects in atopic dermatitis patients including naltrexone, doxepin, trimipramine, bupropion, tandospirone, paroxetine and fluvoxamine. However, the precise mechanisms of antipruritic effect of these psychotropic drugs are still unclear. In human skin, serotonin receptors and serotonin transporter protein are expressed on skin cells such as keratinocytes, melanocytes, dermal fibroblasts, mast cells, T cells, natural killer cells, langerhans cells, and sensory nerve endings. It is noteworthy that serotonergic drugs, as well as serotonin itself, showed immune-modulating effect. Fenfluramine, fluoxetine and 2, 5-dimethoxy-4-iodoamphetamine significantly decreased lymphocyte proliferation. It is still questionable whether these serotonergic drugs exert the immunosuppressive effects via serotonin receptor or serotonin transporter. All these clinical and experimental reports suggest the possibility that antipruritic effects of selective serotonin reuptake inhibitors in atopic dermatitis patients might be at least partly due to their suppressive effect on T cells. Further studies should be conducted to elucidate the precise mechanism of neuroimmunological interaction in pruritus of atopic dermatitis.
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Affiliation(s)
- Kwangmi Kim
- College of Pharmacy, Dankook University, Cheonan 330-714, Republic of Korea
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Indo Y. Nerve growth factor, pain, itch and inflammation: lessons from congenital insensitivity to pain with anhidrosis. Expert Rev Neurother 2014; 10:1707-24. [DOI: 10.1586/ern.10.154] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Xander C, Meerpohl JJ, Galandi D, Buroh S, Schwarzer G, Antes G, Becker G. Pharmacological interventions for pruritus in adult palliative care patients. Cochrane Database Syst Rev 2013:CD008320. [PMID: 23749733 DOI: 10.1002/14651858.cd008320.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pruritus is not the most prevalent but one of the most puzzling symptoms in palliative care patients. It can cause considerable discomfort and has a major impact on patients' quality of life. In the field of palliative care, pruritus is a symptom occurring in patients with disparate underlying diseases and based on different pathologic mechanisms but ending in the same phenomenon. The pathogenesis of pruritus is complex and not fully elucidated. Thus, it is still very difficult to treat pruritus effectively. Evidence-based treatment approaches are needed. OBJECTIVES The objective was to evaluate the efficacy of different pharmacological treatments for preventing or treating pruritus in adult palliative care patients. SEARCH METHODS A systematic literature search up to January 2012 was performed and it was updated in August 2012. The following databases were searched: The Cochrane Library (CENTRAL, DARE, CDSR) (2012, issue 8 of 12); MEDLINE (1950 to August 2012); EMBASE (1980 to August 2012) and three other databases. In addition, we searched trials registries and checked the reference lists of all relevant studies, key textbooks, reviews, and websites, and contacted investigators and specialists in pruritus and palliative care regarding unpublished data. SELECTION CRITERIA We included randomised controlled trials assessing the effects of different pharmacological treatments on preventing or treating pruritus in palliative care patients. DATA COLLECTION AND ANALYSIS Two review authors independently assessed identified titles and abstracts. Three independent review authors performed assessment of all potentially relevant studies, data extraction, assessment of risk of bias and methodological quality. Results were summarised descriptively according to the different pharmacological interventions and the type of underlying pruritus. Where possible, results were presented in meta-analyses. MAIN RESULTS In total, 38 reports comprising 40 studies and 1286 participants were included in the review. Altogether, 30 different treatments for pruritus in four different patient groups were included.The findings of this review indicated that the treatment of pruritus for palliative care patients is challenging and requires an individualistic approach. Results showed that effective therapeutic choices have to be guided by the pathophysiology of the pruritus. Various forms of pruritus occur, especially in the field of palliative care, and sometimes the origin of the pruritus is difficult to determine. Therefore, identifying the underlying cause of pruritus is of prime importance in order to develop tailored treatment plans, even if in palliative care the treatment is focused towards the symptom and not necessarily the underlying disease.Results show that in palliative care patients with pruritus of different natures, treatment with the drug paroxetine, a selective serotonin reuptake inhibitor, may be beneficial. For patients suffering from pruritus associated with HIV infection, indomethacin was described as the most effective drug, although the evidence was weak. For patients suffering from chronic kidney disease-associated pruritus, gabapentin may be an option. An alternative treatment for this patient group seems to be the κ-opioid receptor agonist nalfurafine, which has shown significant amelioration of pruritus and acceptable adverse effects. As they have exhibited a low incidence of adverse effects, rifampicin and flumecinol may be recommended for patients with cholestatic pruritus. The opioid antagonist naltrexone has been shown to offer a therapeutic alternative for patients suffering from uraemic or cholestatic pruritus. However, these drugs are often inappropriate in the palliative population because of the risk of reducing analgesia when giving high doses of naltrexone. AUTHORS' CONCLUSIONS The findings of this review indicate that the number of systemic and topical drugs used for the different subforms of pruritus is increasing. Different interventions have been shown to be effective in the treatment of pruritus of different origins. Nevertheless, an optimal therapy for pruritus is constrained due to the limited understanding of crucial itch mediators and receptors in the various subforms of itch. Ideal antipruritic therapies are still lacking, especially for palliative care patients.This systematic review also indicates that there is insufficient evidence to give any concrete recommendations regarding treatment of pruritus in palliative care patients. Due to the very small sample sizes and poor methodological quality of the majority of studies that were included, the results of this review need to be interpreted with caution. Furthermore, the generalizability is questionable. Additional studies, and particularly carefully designed treatment trials, are needed to provide valid evidence for adequate treatment of pruritus in palliative care patients.
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Affiliation(s)
- Carola Xander
- German Cochrane Centre, Institute of Medical Biometry and Medical Informatics, University Medical Center Freiburg, Freiburg,Germany.
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Ständer S, Stumpf A, Osada N, Wilp S, Chatzigeorgakidis E, Pfleiderer B. Gender differences in chronic pruritus: women present different morbidity, more scratch lesions and higher burden. Br J Dermatol 2013; 168:1273-80. [DOI: 10.1111/bjd.12267] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2013] [Indexed: 12/20/2022]
Affiliation(s)
- S. Ständer
- Competence Centre Chronic Pruritus; Department of Dermatology; University Hospital of Münster; Albert-Schweitzer-Campus 1; D-48149; Münster; Germany
| | - A. Stumpf
- Department of Psychosomatics and Psychotherapy; University Hospital of Münster; Albert-Schweitzer-Campus 1; D-48149; Münster; Germany
| | - N. Osada
- Department of Medical Informatics and Biomathematics; University Hospital of Münster; Albert-Schweitzer-Campus 1; D-48149; Münster; Germany
| | - S. Wilp
- Department of Clinical Radiology; University Hospital of Münster; Albert-Schweitzer-Campus 1; D-48149; Münster; Germany
| | - E. Chatzigeorgakidis
- Competence Centre Chronic Pruritus; Department of Dermatology; University Hospital of Münster; Albert-Schweitzer-Campus 1; D-48149; Münster; Germany
| | - B. Pfleiderer
- Department of Clinical Radiology; University Hospital of Münster; Albert-Schweitzer-Campus 1; D-48149; Münster; Germany
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Masuda PY, Martelli ACC, Wachholz PA, Akumatsu HT, Martins ALGP, Silva NM. Brachioradial pruritus -- descriptive analysis of Brazilian case series. J Dtsch Dermatol Ges 2013; 11:530-5. [PMID: 23280069 DOI: 10.1111/ddg.12009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 10/30/2012] [Indexed: 01/29/2023]
Abstract
BACKGROUND The epidemiology and clinical features of brachioradial pruritus are variably described in the literature. We sought to analyze these features in a large group of Brazilian patients. PATIENTS AND METHODS In a descriptive, observational study, we identified all patients with a final diagnosis of brachioradial pruritus seen over a one-year period and re-trospectively reviewed their records. The diagnosis was made after clinical-laboratory investigation had ruled out other causes of chronic pruritus. Demographic and clinical variables were collected along with pruritus characteristics, and analyzed using des-criptive statistics. RESULTS Forty-three patients were identified; their mean age was 55.9 years, with predominance of women (81.4%) and Caucasians (86%). In 52%, the pruritus worsened with heat and sun exposure; 58.1% had intermittent complaints; the ice-pack sign was present only in 20.9%. The arms involving dermatomes C5-C6-C7-C8 (62.8%) were the most affected sites, while psychoactive drugs were the most frequently prescribed therapy. CONCLUSIONS Although uncommon, brachioradial pruritus should not be neglected in dermatological diagnosis. This case series analysis indicated that Brazilian patients from a tropical climate show characteristics similar to those described in other series from more temperate regions.
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Affiliation(s)
- Paula Y Masuda
- Dermatology Service of Instituto Lauro de Souza Lima, Brazil
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Herman-Kideckel SM, Binkley K. Successful treatment of aquagenic pruritus with montelukast. J Cutan Med Surg 2012; 16:151-2. [PMID: 22713437 DOI: 10.1177/120347541201600304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Spradley JM, Davoodi A, Carstens MI, Carstens E. Effects of acute stressors on itch- and pain-related behaviors in rats. Pain 2012; 153:1890-1897. [PMID: 22770638 DOI: 10.1016/j.pain.2012.05.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 05/26/2012] [Accepted: 05/29/2012] [Indexed: 11/18/2022]
Abstract
Many acute stressors reduce pain, a phenomenon called stress-induced antinociception (SIA). Stress also is associated with increased scratching in chronic itch conditions. We investigated effects of acute stressors on facial itch and pain using a recently introduced rat model. Under baseline (no-swim) conditions, intradermal (id) cheek microinjection of the pruritogen serotonin (5-HT) selectively elicited hindlimb scratch bouts, whereas the algogen mustard oil (allyl isothiocyanate [AITC]) selectively elicited ipsilateral forepaw swipes, directed to the cheek injection site. To test effects of swim stress, rats received id cheek microinjection of 5-HT (1%), AITC (10%), or vehicle, and were then subjected to one of the following swim conditions: (1) weak SIA (W-SIA), (2) naltrexone-sensitive SIA (intermediate or I-SIA), or (3) naltrexone-insensitive SIA (strong or S-SIA). After the swim, we recorded the number of hindlimb scratch bouts and forelimb swipes directed to the cheek injection site, as well as facial grooming by both forepaws. Under S-SIA, AITC-evoked swiping and 5-HT-evoked scratching were both reduced. I-SIA reduced AITC-evoked swiping with no effect on 5-HT-evoked scratching. Facial grooming immediately post-swim was suppressed by S-SIA, but not I- or W-SIA. W-SIA tended to equalize scratching and swiping elicited by 5-HT and AITC compared with no-swim controls, suggesting altered itch and pain processing. Exercise (wheel-running), novelty, cold exposure, and fear (shaker table), key components of swim stress, differentially affected tail-flick latencies and 5-HT-evoked swiping and scratching behavior. Thus, itch and pain can be simultaneously suppressed by a combination of acute stress-related factors via an opioid-independent mechanism.
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Affiliation(s)
- Jessica Marie Spradley
- Department of Neurobiology, Physiology and Behavior, University of California-Davis, Davis, CA, USA
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Abstract
Itch/pruritus can be very distressing in palliative care population and often is difficult to treat. Conventional antihistamines lack efficacy. Cutaneous and central pathogenesis of itch is extremely complex and unclear, making its treatment challenging. Neuronal mechanisms have been identified in the pathophysiology of itch hence providing a myriad of therapeutic options. It has been established that pruritus and pain neuronal pathway interact with each other, hence neuropathic analgesics like gabapentin has shown to be efficacious antipruritic therapeutic option. Gabapentin impedes transmitting nociceptive sensations to brain, thus also suppressing pruritus. Gabapentin is safe and found to be effective in uremic pruritus, cancer/hematologic causes, opiod-induced itch, brachioradial pruritis, burns pruritus, and pruritus of unknown origin. Further research is required in this area to establish whether gabapentin is consistently effective.
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Affiliation(s)
- Sheeba Anand
- Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
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Curtis AR, Tegeler C, Burdette J, Yosipovitch G. Holistic approach to treatment of intractable central neuropathic itch. J Am Acad Dermatol 2011; 64:955-9. [DOI: 10.1016/j.jaad.2010.02.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Revised: 01/29/2010] [Accepted: 02/01/2010] [Indexed: 11/15/2022]
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Grundmann S, Ständer S. Chronic pruritus: clinics and treatment. Ann Dermatol 2011; 23:1-11. [PMID: 21738356 DOI: 10.5021/ad.2011.23.1.1] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 01/24/2011] [Accepted: 01/24/2011] [Indexed: 11/08/2022] Open
Abstract
Chronic pruritus, one of the main symptoms in dermatology, is often intractable and has a high impact on patient's quality of life. Beyond dermatologic disorders, chronic pruritus is associated with systemic, neurologic as well as psychologic diseases. The pathogenesis of acute and chronic (>6 weeks duration) pruritus is complex and involves in the skin a network of resident (e.g., sensory neurons) and transient inflammatory cells (e.g., lymphocytes). In the skin, several classes of histamine-sensitive or histamine-insensitve C-fibers are involved in itch transmission. Specific receptors have been discovered on cutaneous and spinal neurons to be exclusively involved in the processing of pruritic signals. Chronic pruritus is notoriously difficult to treat. Newer insights into the underlying pathogenesis of pruritus have enabled novel treatment approaches that target the pruritus-specific pathophysiological mechanism. For example, neurokinin-1 antagonists have been found to relieve chronic pruritus.
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Affiliation(s)
- Sonja Grundmann
- Department of Dermatology, Neurodermatology and Competence Center Chronic Pruritus, University Hospital Münster, Münster, Germany
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Misery L, Rahhali N, Ambonati M, Black D, Saint-Martory C, Schmitt AM, Taieb C. Evaluation of sensitive scalp severity and symptomatology by using a new score. J Eur Acad Dermatol Venereol 2011; 25:1295-8. [DOI: 10.1111/j.1468-3083.2010.03968.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Inhibitory effects of UV-based therapy on dry skin-inducible nerve growth in acetone-treated mice. J Dermatol Sci 2011; 62:91-7. [PMID: 21458246 DOI: 10.1016/j.jdermsci.2011.01.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 01/04/2011] [Accepted: 01/06/2011] [Indexed: 11/22/2022]
Abstract
BACKGROUND UV-based therapy has anti-pruritic effects in inflammatory skin diseases, such as atopic dermatitis and psoriasis. These anti-pruritic effects may be partly due to inhibition of intraepidermal nerve growth, but they have not been fully characterized. OBJECTIVE This study was performed to characterize the anti-nerve growth effects of UV-based therapies in acetone-treated mice as an acute dry skin model. METHODS Nerve fibers penetrate into the epidermis 24h after acetone treatment in mice, and nerve growth peaks 48h after acetone treatment. To investigate the effects of UV-based therapies on the epidermal nerve fibers, including combination treatment with corticosteroid ointment, the mice were treated with psoralen ultraviolet A (PUVA), PUVA and betamethasone valerate ointment (PUVA+BV), narrowband ultraviolet B (NB-UVB), or an excimer lamp. Each therapy was provided 24h after acetone treatment, and skin samples were taken 48h later. Nerve fiber densities and expression levels of nerve growth factor (NGF) and semaphorin 3A (Sema3A) in the epidermis were examined by immunohistochemistry. RESULTS Penetration of nerve fibers into the epidermis was observed in the acetone-treated mice, concomitant with increased NGF and decreased Sema3A levels in the epidermis. The acetone-induced intraepidermal nerve growth was significantly decreased by PUVA, PUVA+BV, NB-UVB, and excimer lamp treatments compared with controls. In addition, PUVA+BV and NB-UVB normalized the abnormal expression of NGF and Sema3A in the epidermis, but no such normalization was observed with excimer lamp treatment. CONCLUSION UV-based therapies, especially NB-UVB and excimer lamp treatments, may be effective therapeutic methods for pruritus involving epidermal hyperinnervation.
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De Filippis D, Luongo L, Cipriano M, Palazzo E, Cinelli MP, de Novellis V, Maione S, Iuvone T. Palmitoylethanolamide reduces granuloma-induced hyperalgesia by modulation of mast cell activation in rats. Mol Pain 2011; 7:3. [PMID: 21219627 PMCID: PMC3034677 DOI: 10.1186/1744-8069-7-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 01/10/2011] [Indexed: 11/10/2022] Open
Abstract
The aim of this study was to obtain evidences of a possible analgesic role for palmitoylethanolamide (PEA) in chronic granulomatous inflammation sustained by mast cell (MC) activation in rats at 96 hours. PEA (200-400-800 μg/mL), locally administered at time 0, reduced in a concentration-dependent manner the expression and release of NGF in comparison with saline-treated controls. PEA prevented nerve formation and sprouting, as shown by histological analysis, reduced mechanical allodynia, evaluated by Von Frey filaments, and inhibited dorsal root ganglia activation. These results were supported by the evidence that MCs in granuloma were mainly degranulated and closely localized near nerve fibres and PEA significantly reduced MC degranulation and nerves fibre formation. These findings are the first evidence that PEA, by the modulation of MC activation, controls pain perception in an animal model of chronic inflammation, suggesting its potential use for the treatment of all those painful conditions in which MC activation is an initial key step.
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Affiliation(s)
- Daniele De Filippis
- Department of Experimental Pharmacology, Faculty of Pharmacy, University of Naples Federico II, Via D, Montesano 49, Naples, 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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Induction of Prostaglandin D2 through the p38 MAPK Pathway Is Responsible for the Antipruritic Activity of Sertaconazole Nitrate. J Invest Dermatol 2010; 130:2448-56. [DOI: 10.1038/jid.2010.152] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Pereira U, Boulais N, Lebonvallet N, Lefeuvre L, Gougerot A, Misery L. Development of an in vitro coculture of primary sensitive pig neurons and keratinocytes for the study of cutaneous neurogenic inflammation. Exp Dermatol 2010; 19:931-5. [PMID: 20849537 DOI: 10.1111/j.1600-0625.2010.01119.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cutaneous neurogenic inflammation (CNI) is often associated with skin disorders. Activated sensory neurons secrete neuropeptides, such as substance P (SP), which initiate or aggravate inflammation in the skin. The discovery of new molecules acting on these neurons is hampered by the difficulty of reproducing the interactions between nerve endings and skin in vitro. We developed an in vitro model based on the coculture of porcine primary keratinocytes and sensory neurons, which mimics skin innervation. To test the relevance of this model, we compared the effects of different substances on CNI by measuring SP secretion in vitro using a sensitive enzyme immunoassay. Collectively, our results indicate that the use of porcine cells could be very useful to perform an in vitro model of CNI. By adding capsaicin, which induces the secretion of SP by neurons, to the culture, we show that our model mimics CNI in vitro, allowing us to screen for molecules that inhibit this inflammatory response. Such a model can be used to test the effects of different substances on CNI and may be useful for dermatological or cosmetic applications. Based on our screen, we found that extracts of Laminaria digitata and Vernonia sublutea inhibit CNI.
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Affiliation(s)
- Ulysse Pereira
- Laboratory of Nervous Factors and Tissue Structure EA 4326, University of Western Brittany, Brest, France
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Pereira U, Garcia-Le Gal C, Le Gal G, Boulais N, Lebonvallet N, Dorange G, Lefeuvre L, Gougerot A, Misery L. Effects of sangre de drago in an in vitro model of cutaneous neurogenic inflammation. Exp Dermatol 2010; 19:796-9. [DOI: 10.1111/j.1600-0625.2010.01090.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
IMPORTANCE OF THE FIELD Pruritus is the predominant symptom of skin disease. Owing to the poorly understood pathophysiology, the development of effective treatment modalities for pruritus has proven to be particularly difficult. At present, there is no universally accepted therapy for itch. The purpose of this review is to provide an update on the treatment of pruritus. AREAS COVERED IN THIS REVIEW An overview of current, emerging and possible future therapies for pruritus is provided. WHAT THE READER WILL GAIN Insights into possible treatment regimes for pruritus in different clinical scenarios. TAKE HOME MESSAGE The therapy of pruritus is challenging and at present takes on an individualistic approach. Recent advancements in the mechanisms that underlie this distressing symptom have identified new targets for future therapy.
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Affiliation(s)
- Tejesh Patel
- Division of Dermatology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Gencoglan G, Inanir I, Gunduz K. Therapeutic hotline: Treatment of prurigo nodularis and lichen simplex chronicus with gabapentin. Dermatol Ther 2010; 23:194-8. [PMID: 20415827 DOI: 10.1111/j.1529-8019.2010.01314.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Psychocutaneous conditions are frequently encountered in dermatology practice. Prurigo nodularis and lichen simplex chronicus are two frustrating conditions that are classified in this category. They are often refractory to classical treatment with topical corticosteroids and antihistamines. Severe, generalized exacerbations require systemic therapy. Phototherapy, erythromycine, retinoids, cyclosporine, azathiopurine, naltrexone, and psychopharmacologic agents (pimozide, selective serotonin reuptake inhibitor antidepressants) were tried with some success. Here five cases with lichen simplex chronicus and four cases with prurigo nodularis, who responded well to gabapentin, are presented.
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Affiliation(s)
- Gulsum Gencoglan
- Department of Dermatology, Medical Faculty of Celal Bayar University, Manisa, Turkey.
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Kueper T, Krohn M, Haustedt LO, Hatt H, Schmaus G, Vielhaber G. Inhibition of TRPV1 for the treatment of sensitive skin. Exp Dermatol 2010; 19:980-6. [DOI: 10.1111/j.1600-0625.2010.01122.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
Pruritus (itch) is a major characteristic and one of the most debilitating symptoms in allergic and atopic diseases and the diagnostic hallmark of atopic dermatitis. Pruritus is regularly defined as an unpleasant sensation provoking the desire to scratch. Although we achieved rather good knowledge about certain inducers of itch such as neuropeptides, amines, mu-opioids, cytokines and proteases, for example, less is known about the pathophysiological specifities among the different diseases, and the therapeutic consequences which may derive thereoff. This review dissects the role of mediators, receptors and itch inhibitors on peripheral nerve endings, dorsal root ganglia, the spinal cord and the CNS leading to the amplification or - vice versa - suppression of pruritus. As the treatment of pruritus in allergic and atopic skin disease is still not satisfactory, knowing these pathways and mechanisms may lead to novel therapeutic approaches against this frequently encountered skin symptom.
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Affiliation(s)
- J Buddenkotte
- Deparment of Dermatology, Boltzmann Institute for Cell- and Immunobiology of Skin, University Hospital Münster, Münster, Germany
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Ständer S, Siepmann D, Herrgott I, Sunderkötter C, Luger TA. Targeting the neurokinin receptor 1 with aprepitant: a novel antipruritic strategy. PLoS One 2010; 5:e10968. [PMID: 20532044 PMCID: PMC2881044 DOI: 10.1371/journal.pone.0010968] [Citation(s) in RCA: 198] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2010] [Accepted: 05/07/2010] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Chronic pruritus is a global clinical problem with a high impact on the quality of life and lack of specific therapies. It is an excruciating and frequent symptom of e.g. uncurable renal, liver and skin diseases which often does not respond to conventional treatment with e.g. antihistamines. Therefore antipruritic therapies which target physiological mechanisms of pruritus need to be developed. Substance P (SP) is a major mediator of pruritus. As it binds to the neurokinin receptor 1 (NKR1), we evaluated if the application of a NKR1 antagonist would significantly decrease chronic pruritus. METHODS AND FINDINGS Twenty hitherto untreatable patients with chronic pruritus (12 female, 8 male; mean age, 66.7 years) were treated with the NKR1 antagonist aprepitant 80 mg for one week. 16 of 20 patients (80%) experienced a considerable reduction of itch intensity, as assessed by the visual analog scale (VAS, range 0 to 10). Considering all patients, the mean value of pruritus intensity was significantly reduced from 8.4 VAS points (SD +/-1.7) before treatment to 4.9 VAS points (SD +/-3.2) (p<0.001, CI 1.913-5.187). Patients with dermatological diseases (e.g. atopic diathesis, prurigo nodularis) had the best profit from the treatment. Side-effects were mild (nausea, vertigo, and drowsiness) and only occurred in three patients. CONCLUSIONS The high response rate in patients with therapy refractory pruritus suggests that the NKR1 antagonist aprepitant may indeed exhibit antipruritic effects and may present a novel, effective treatment strategy based on pathophysiology of chronic pruritus. The results are promising enough to warrant confirming the efficacy of NKR1 antagonists in a randomized, controlled clinical trial.
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Affiliation(s)
- Sonja Ständer
- Department of Dermatology, Neurodermatology and Competence Center Pruritus, University of Münster, Münster, Germany.
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Low density of sympathetic nerve fibers relative to substance P-positive nerve fibers in lesional skin of chronic pruritus and prurigo nodularis. J Dermatol Sci 2010; 58:193-7. [DOI: 10.1016/j.jdermsci.2010.03.020] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Revised: 03/19/2010] [Accepted: 03/25/2010] [Indexed: 11/17/2022]
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Blome C, Augustin M, Siepmann D, Phan NQ, Rustenbach SJ, Ständer S. Measuring patient-relevant benefits in pruritus treatment: development and validation of a specific outcomes tool. Br J Dermatol 2010; 161:1143-8. [PMID: 19857211 DOI: 10.1111/j.1365-2133.2009.09328.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The assessment of patient-relevant benefit is gaining importance in evaluating treatments. The 'Patient Benefit Index, standard version' questionnaire (PBI-S) is a validated instrument to assess patients' treatment needs and benefits in skin diseases. Before therapy, the patient rates the importance of predefined treatment goals; after therapy, he rates the extent to which these goals have been achieved. Thus far, no such instrument has been developed specifically for pruritus. OBJECTIVES Development and validation of a patient-relevant benefit questionnaire in the treatment of pruritus. METHODS Fifty patients with pruritus were questioned on impairments due to pruritus and treatment needs. Four treatment objectives not already covered by the PBI-S were added to obtain a disease-specific instrument. This was tested for feasibility by 36 patients with pruritus and validated in a sample of 100 patients with pruritus. RESULTS The instrument was feasible in clinical practice. There were < 2% missing values. Cronbach's alpha of the needs questionnaire was 0.93. Convergent validity was demonstrated with respect to reduction of pruritus and quality of life. CONCLUSIONS The PBI for pruritus is a feasible, reliable and valid instrument that is highly accepted in daily routine for recording patient-reported benefit.
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Affiliation(s)
- C Blome
- CVderm-German Center for Health Services Research in Dermatology, Research Group Health Economics and Quality of Life Research, Department of Dermatology and Venereology, University Clinics of Hamburg, D-20246 Hamburg, Germany
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