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Zeidler C, Stander S, Rhoten S, Wratten S, Zhang D, Msihid J, Brookes E, Thomas R, Bahloul D. Validation of a scoring algorithm for the clinician-reported outcome tool 'prurigo activity and severity (PAS)' based on clinical studies of dupilumab in adults with prurigo Nodularis. J Eur Acad Dermatol Venereol 2024. [PMID: 38563058 DOI: 10.1111/jdv.19961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/16/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Prurigo nodularis (PN) also known as chronic prurigo, is a chronic inflammatory skin disease characterized by intensely itchy nodules/lesions which occur due to intensive scratching. PN management is, in part, based on clinician evaluations of PN lesions, which can be supported by clinician-reported outcomes (ClinRO) such as the Prurigo Activity and Severity (PAS) instrument. A 5-item version of PAS was included in recent phase-3 dupilumab PN trials (PRIME [NCT04183335]/PRIME2 [NCT04202679]). The PAS score was derived using the unweighted sum of 3-items of the 5-item PAS (range, 0-11; higher score indicates worse activity and severity): Item 2 (number of lesions), Item 5a (percentage of lesions with excoriations/crusts) and Item 5b (percentage of healed lesions) for use in clinical practice and for communication of treatment benefit to physicians. OBJECTIVES To evaluate the measurement properties of PAS score and derive within-patient (responder definition) and between-group improvement thresholds for interpreting changes in PAS score in patients with PN. METHODS The data source was the pooled treatment group, intention-to-treat (ITT) data from the phase-3 PRIME (NCT04183335) and PRIME2 (NCT04202679) studies evaluating the efficacy of dupilumab in adult patients with PN with ≥20 nodules and severe itch uncontrolled with topical therapies. PAS score reliability, validity and sensitivity to change were evaluated, and anchor- and distribution-based methods were applied to derive meaningful change thresholds. RESULTS The pooled ITT population included 311 patients (mean age 49.5 years, 65.3% female). Adequate to good psychometric properties were demonstrated for PAS score. The within-patient meaningful improvement threshold was estimated as 3.0 points (absolute change) and 37% (per cent change). A 1.7-point (absolute change) and 20% (per cent change) improvement were estimated to reflect a between-group meaningful change in PAS score. CONCLUSIONS PAS score is a simple, clinically relevant indicator of PN lesion activity and severity supported by suitable psychometric performance.
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Affiliation(s)
- Claudia Zeidler
- Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Sonja Stander
- Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
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Zeidler C, Kupfer J, Dalgard FJ, Bewley A, Evers AWM, Gieler U, Lien L, Sampogna F, Tomas Aragones L, Vulink N, Finlay AY, Legat FJ, Titeca G, Jemec GB, Misery L, Szabó C, Grivcheva Panovska V, Spillekom van Koulil S, Balieva F, Szepietowski JC, Reich A, Ferreira BR, Lvov A, Romanov D, Marron SE, Gracia Cazaña T, Elyas A, Altunay IK, Thompson AR, van Beugen S, Ständer S, Schut C. Dermatological patients with itch report more stress, stigmatization experience, anxiety and depression compared to patients without itch: Results from a European multi-centre study. J Eur Acad Dermatol Venereol 2024. [PMID: 38468596 DOI: 10.1111/jdv.19913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/23/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Itch as the most common symptom in dermatology has been shown to be related to psychological factors such as stress, anxiety and depression. Moreover, associations were found between perceived stigmatization and itch. However, studies investigating the differences between patients with dermatoses with and without itch regarding perceived stress, stigmatization, anxiety and depression are missing. Therefore, one of the aims of the second study of the European Society for Dermatology and Psychiatry (ESDaP study II) was to investigate these relationships in a large cohort of patients with different itchy dermatoses. RESULTS 3399 patients with 14 different itchy dermatoses were recruited at 22 centres in 17 European countries. They filled in questionnaires to assess perceived stigmatization, stress, signs of clinically relevant anxiety or depression, itch-related quality of life, the overall health status, itch duration, frequency and intensity. The most significant association between the severity of itching and the perception of stress was observed among individuals with rosacea (correlation coefficient r = 0.314). Similarly, the strongest links between itch intensity and experiences of stigmatization, anxiety, and depression were found in patients with seborrheic dermatitis (correlation coefficients r = 0.317, r = 0.356, and r = 0.400, respectively). Utilizing a stepwise linear regression analysis, it was determined that within the entire patient cohort, 9.3% of the variation in itch intensity could be accounted for by factors including gender, levels of anxiety, depression, and perceived stigmatization. Females and individuals with elevated anxiety, depression, and perceived stigmatization scores reported more pronounced itch intensities compared to those with contrary attributes. CONCLUSION This study underscores the connection between experiencing itch and its intensity and the psychological strain it places on individuals. Consequently, psychological interventions should encompass both addressing the itch itself and the interconnected psychological factors. In specific cases, it becomes imperative for dermatologists to direct individuals towards suitable healthcare resources to undergo further psychological assessment.
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Affiliation(s)
- C Zeidler
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - J Kupfer
- Institute of Medical Psychology, Justus-Liebig-University, Gießen, Germany
| | - F J Dalgard
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Dermatology and Venereology, Skåne University Hospital, Malmo, Sweden
| | - A Bewley
- Barts Health NHS Trust & Queen Mary University of London, London, UK
| | - A W M Evers
- Faculty of Social and Behavioural Sciences, Institute of Psychology, Unit Health, Medical and Neuropsychology, Leiden University, Leiden, The Netherlands
| | | | - L Lien
- Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
| | - F Sampogna
- Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy
| | - L Tomas Aragones
- Department of Psychology, University of Zaragoza, Zaragoza, Spain
- Aragon Psychodermatology Research Group Zaragoza, Zaragoza, Spain
| | - N Vulink
- Department of Psychiatry, Amsterdam UMC, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - A Y Finlay
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - F J Legat
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - G Titeca
- Clinique Notre Dame de Grâce, Gosselies, Belgium
| | - G B Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - L Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - C Szabó
- Institute of Psychology, University of Szeged, Szeged, Hungary
| | - V Grivcheva Panovska
- School of Medicine, PHI University Clinic of Dermatology, University St Cyril and Methodius, Skopje, North Macedonia
| | - S Spillekom van Koulil
- Radboud Institute for Health Sciences, Department of Medical Psychology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - F Balieva
- Department of Dermatology, Stavanger University Hospital, Stavanger, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - A Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszów University, Rzeszów, Poland
| | - B R Ferreira
- Centre for Philosophy of Science of the University of Lisbon, Lisbon, Portugal
- Department of Dermatology, Coimbra Hospital and University Centre, Portugal
- University of Brest, Lien, France
| | - A Lvov
- Central State Medical Academy of Department of Presidential Affairs, Moscow, Russia
- Medical Research and Educational Centre, Lomonosov Moscow State University, Moscow, Russia
| | - D Romanov
- Department of Psychiatry and Psychosomatics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Department of Boundary Mental Conditions and Psychosomatic Disorders, Mental Health Research Centre, Moscow, Russia
- International Institute of Psychosomatic Health, Moscow, Russia
| | - S E Marron
- Aragon Psychodermatology Research Group Zaragoza, Zaragoza, Spain
- Department of Dermatology, University Hospital Miguel Servet, Zaragoza, Spain
| | - T Gracia Cazaña
- Department of Dermatology, University Hospital Miguel Servet, Zaragoza, Spain
| | - A Elyas
- Department of Dermatology, Skåne University Hospital, Malmö, Sweden
| | - I K Altunay
- Şişli Hamidiye Etfal Training and Research Hospital, Dermatology and Venereology Clinic, University of Health Sciences, Istanbul, Turkey
| | - A R Thompson
- South Wales Clinical Psychology Training Programme, Cardiff & Vale University Health Board & School of Psychology, Cardiff University, Cardiff, UK
| | - S van Beugen
- Faculty of Social and Behavioural Sciences, Institute of Psychology, Unit Health, Medical and Neuropsychology, Leiden University, Leiden, The Netherlands
| | - S Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - C Schut
- Institute of Medical Psychology, Justus-Liebig-University, Gießen, Germany
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Metz M, Zeidler C, Hawro T, Pereira M, Maurer M, Bonnekoh H, Krause K, Pritchard T, Kwatra SG, Ständer S, Weller K. Development and Validation of a Patient-Reported Outcome Measure to Assess Disease Control in Chronic Prurigo. JAMA Dermatol 2024; 160:187-193. [PMID: 38231506 PMCID: PMC10794972 DOI: 10.1001/jamadermatol.2023.5519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/08/2023] [Indexed: 01/18/2024]
Abstract
Importance Chronic prurigo (CPG), including prurigo nodularis, is a difficult disease to treat and considerably affects patients' quality of life. Helping patients obtain control of CPG is a major treatment goal. Objective To develop and validate the Prurigo Control Test (PCT), a tool for assessing disease control in CPG, and to identify a cutoff value for controlled disease to aid treatment decisions. Design, Setting, and Participants This qualitative study followed the current recommendations for patient-reported outcome measure development in the generation and validation of the PCT. The final PCT was obtained after item generation, followed by reduction and selection, and was then tested for internal consistency and test-retest reliability, convergent validity, known-group validity, screening accuracy, and banding. The item-generation phase resulted in an unselected list of 69 potential PCT items. Impact analysis, interitem correlation, and review for content (face) validity resulted in final set of 5 PCT items. The validation study was performed among patients across 2 expert centers in Germany. Data were analyzed from February 2017 to November 2019. Main Outcomes and Measures A 5-item PCT with a recall period of 2 weeks was developed. A cutoff value of 10 points or higher was determined as suitable for identifying patients with well-controlled vs poorly controlled CPG. Results Of the 95 patients included in the validation study, the median (range) age was 63 (19-87) years, 50 patients (53%) were women, and the median (range) disease duration was 72 (9-774) months. The validation study yielded good internal consistency reliability (Cronbach α, 0.86) and a high degree of convergent validity. The PCT demonstrated good known-group validity and could discriminate between patients who differed in prurigo control. Test-retest reliability was high, and the intraclass correlation coefficient was 0.94, indicating excellent reproducibility. Conclusions and Relevance This qualitative study showed that the PCT is able to assess disease control in patients with CPG. Its retrospective approach, brevity, and simple scoring likely make the PCT suitable for clinical practice and trials.
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Affiliation(s)
- Martin Metz
- Institute of Allergology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Claudia Zeidler
- Center for Chronic Pruritus, Department of Dermatology, University Hospital Münster, Münster, Germany
| | - Tomasz Hawro
- Institute and Comprehensive Centre for Inflammation Medicine, Department of Dermatology, Allergology and Venereology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Manuel Pereira
- Institute of Allergology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Marcus Maurer
- Institute of Allergology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Hanna Bonnekoh
- Institute of Allergology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Immunology and Allergology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Karoline Krause
- Institute of Allergology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Thomas Pritchard
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Shawn G. Kwatra
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Sonja Ständer
- Center for Chronic Pruritus, Department of Dermatology, University Hospital Münster, Münster, Germany
| | - Karsten Weller
- Institute of Allergology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Müller S, Zeidler C, Ständer S. Chronic Prurigo Including Prurigo Nodularis: New Insights and Treatments. Am J Clin Dermatol 2024; 25:15-33. [PMID: 37717255 PMCID: PMC10796623 DOI: 10.1007/s40257-023-00818-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/19/2023]
Abstract
Chronic prurigo (CPG) is a neuroinflammatory, fibrotic dermatosis that is defined by the presence of chronic pruritus (itch lasting longer than 6 weeks), scratch-associated pruriginous skin lesions and history of repeated scratching. Patients with CPG experience a significant psychological burden and a notable impairment in their quality of life. Chronic prurigo of nodular type (CNPG; synonym: prurigo nodularis) represents the most common subtype of CPG. As CNPG is representative for all CPG subtypes, we refer in this review to both CNPG and CPG. We provide an overview of the clinical characteristics and assessment of CPG, the burden of disease and the underlying pathophysiology including associated therapeutic targets. The information provided results from a PubMed search for the latest publications and a database search for current clinical trials (ClinicalTrials.gov, EU Clinical Trials Register [European Medicines Agency]; using the following terms or combinations of terms: 'chronic prurigo', 'prurigo', 'prurigo nodularis', 'pathophysiology', 'therapy', 'biologics', 'treatment'). Dupilumab is the first authorized systemic therapy by the European Medicines Agency (EMA) and the US Food and Drug Administration (FDA) for CNPG to date. Topical and systemic agents that are currently under investigation in clinical randomized, placebo-controlled phase II and III trials such as biologics (e.g., nemolizumab, vixarelimab/KPL-716, barzolvolimab/CDX-0159), small molecules (ruxolitinib cream, povorcitinib/INCB054707, abrocitinib) and the opioid modulator nalbuphine are highlighted. In the last past 15 years, several milestones have been reached regarding the disease understanding of CPG such as first transcriptomic analysis, first terminology, first guideline, and first therapy approval in 2022, which contributed to improved medical care of affected patients. The broad range of identified targets, current case observations and initiated trials offers the possibility of more drug approvals in the near future.
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Affiliation(s)
- Svenja Müller
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany
| | - Claudia Zeidler
- Department of Dermatology, Center for Chronic Pruritus, University Hospital Münster, Von-Esmarch-Str. 58, 48149, Münster, Germany
| | - Sonja Ständer
- Department of Dermatology, Center for Chronic Pruritus, University Hospital Münster, Von-Esmarch-Str. 58, 48149, Münster, Germany.
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Renkhold L, Wiegmann H, Pfleiderer B, Süer A, Zeidler C, Pereira MP, Schmelz M, Ständer S, Agelopoulos K. Scratching increases epidermal neuronal branching and alters psychophysical testing responses in atopic dermatitis and brachioradial pruritus. Front Mol Neurosci 2023; 16:1260345. [PMID: 37795274 PMCID: PMC10546039 DOI: 10.3389/fnmol.2023.1260345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/25/2023] [Indexed: 10/06/2023] Open
Abstract
Background Chronic scratching imposes a major stress on the skin and can lead to itch intensity worsening, and consequently, patients may enter an itch-scratch cycle. This repetitive mechanical stress can result in lichenification, worsening of epidermal barrier function, and enhanced cutaneous inflammation. Furthermore, a reduction of intraepidermal nerve fibers was previously described in lichenification. Aim The aim of this study was to investigate the influence of chronic scratching on the epidermal neuroanatomy and on sensory changes, in particular the prevalence of hyperknesis and alloknesis in patients after mechanical, chemical, and electrical stimuli. Methods Analyses were performed on pruritic lichenified (chronically scratched), pruritic non-lichenified (not chronically scratched), and non-pruritic non-lesional (unaffected) skin areas of patients with inflammatory pruritus, i.e., atopic dermatitis (n = 35), and neuropathic pruritus, i.e., brachioradial pruritus (n = 34) vs. healthy matched controls (n = 64). Our fine-grained spatial skin characterization enabled specifically studying the differential effects of chronic scratching in inflammatory and neuropathic itch. Results Analysis of intraepidermal nerve fiber density showed rarefaction of fibers in all three skin areas of patients compared with healthy controls in both diagnoses. Even more, the two pruritic areas had significantly less nerve fibers than the unaffected skin, whereas electrically induced itch was massively increased. Epidermal branching of the remaining nerve fibers in lichenified/chronically scratched skin was increased, particularly in patients with brachioradial pruritus, which may contribute to the pronounced local neuronal sensitivity. Hyperknesis and alloknesis were found to increase independently of lichenification. Conclusion Our results indicate that chronic scratching may not affect intraepidermal nerve fiber density but leads to a stronger branching pattern of intraepidermal nerve fibers, which may contribute to local hypersensitivity. The increased sensitivity in the pruritic areas suggests mechanisms of peripheral sensitization, whereas the increased sensation of electrically and chemically induced itch in unaffected skin indicates central sensitization for itch.
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Affiliation(s)
- Lina Renkhold
- Department of Dermatology and Centre for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Henning Wiegmann
- Department of Dermatology and Centre for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Bettina Pfleiderer
- Clinic of Radiology, Medical Faculty, University Hospital Münster, University of Münster, Münster, Germany
| | - Aysenur Süer
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Claudia Zeidler
- Department of Dermatology and Centre for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Manuel P. Pereira
- Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Martin Schmelz
- Department of Experimental Pain Research, MCTN, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Sonja Ständer
- Department of Dermatology and Centre for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Konstantin Agelopoulos
- Department of Dermatology and Centre for Chronic Pruritus, University Hospital Münster, Münster, Germany
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Augustin M, Zeidler C, von Kiedrowski R, Metz M, Darsow U, Raap U, Legat FJ, Sebastian M, Weisshaar E, Ständer S. Indication for systemic therapy in chronic prurigo: Annotated checklist for practice. J Dtsch Dermatol Ges 2023. [PMID: 37723931 DOI: 10.1111/ddg.15152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Affiliation(s)
- Matthias Augustin
- Section Pruritus Medicine, Department of Dermatology Center of Chronic Pruritus (KCP), University Hospital Münster, Von-Esmarch-Straße 58, 48149, Münster
| | - Claudia Zeidler
- Section Pruritus Medicine, Department of Dermatology Center of Chronic Pruritus (KCP), University Hospital Münster, Von-Esmarch-Straße 58, 48149, Münster
| | - Ralph von Kiedrowski
- Section Pruritus Medicine, Department of Dermatology Center of Chronic Pruritus (KCP), University Hospital Münster, Von-Esmarch-Straße 58, 48149, Münster
| | - Martin Metz
- Section Pruritus Medicine, Department of Dermatology Center of Chronic Pruritus (KCP), University Hospital Münster, Von-Esmarch-Straße 58, 48149, Münster
| | - Ulf Darsow
- Section Pruritus Medicine, Department of Dermatology Center of Chronic Pruritus (KCP), University Hospital Münster, Von-Esmarch-Straße 58, 48149, Münster
| | - Ulrike Raap
- Section Pruritus Medicine, Department of Dermatology Center of Chronic Pruritus (KCP), University Hospital Münster, Von-Esmarch-Straße 58, 48149, Münster
| | - Franz Josef Legat
- Section Pruritus Medicine, Department of Dermatology Center of Chronic Pruritus (KCP), University Hospital Münster, Von-Esmarch-Straße 58, 48149, Münster
| | - Michael Sebastian
- Section Pruritus Medicine, Department of Dermatology Center of Chronic Pruritus (KCP), University Hospital Münster, Von-Esmarch-Straße 58, 48149, Münster
| | - Elke Weisshaar
- Section Pruritus Medicine, Department of Dermatology Center of Chronic Pruritus (KCP), University Hospital Münster, Von-Esmarch-Straße 58, 48149, Münster
| | - Sonja Ständer
- Section Pruritus Medicine, Department of Dermatology Center of Chronic Pruritus (KCP), University Hospital Münster, Von-Esmarch-Straße 58, 48149, Münster
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Wiegmann H, Ständer S, Bobko S, Renkhold L, Lotts T, Zeidler C, Pereira M, Agelopoulos K. Non-Neuronal Kappa Opioid Pathway Profiling in the Skin of Different Chronic Pruritus-Associated Dermatoses. J Invest Dermatol 2023; 143:1845-1848.e2. [PMID: 36871658 DOI: 10.1016/j.jid.2023.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/06/2023] [Accepted: 02/16/2023] [Indexed: 03/06/2023]
Affiliation(s)
- Henning Wiegmann
- 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
| | - Svetlana Bobko
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany; Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology, Moscow, Russia
| | - Lina Renkhold
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Tobias Lotts
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Claudia Zeidler
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Manuel Pereira
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Konstantin Agelopoulos
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
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Witte F, Zeidler C, Ständer S. [Management of pruritus in the elderly]. Dermatologie (Heidelb) 2023; 74:670-677. [PMID: 37599291 DOI: 10.1007/s00105-023-05207-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Chronic pruritus (CP), a frequent (20.3%) symptom in the elderly, increases with age. It has a significant impact on the quality of life, ranking among the 50 most burdensome diseases worldwide (Global Burden of Disease Study). OBJECTIVES The aim is to provide an overview of the symptom CP in the elderly and to improve differentiation of underlying conditions and management of this entity. MATERIALS AND METHODS A literature search in PubMed was performed, using the terms 'pruritus', 'elderly' and 'gerontodermatology'. RESULTS The main causes of CP in the elderly are the physiologic aging process (xerosis cutis, immunosenescence, neuropathy), the increase in potentially pruritic diseases with increasing age (diabetes mellitus, chronic renal failure), and polypharmacy. Therapeutic options relate to causes, severity of pruritus, and individual patient factors (multimorbidity, impaired organ function). The recently updated S2k guideline 'Diagnosis and therapy of chronic pruritus' is helpful. CONCLUSION CP in the elderly is challenging for both patients and physicians. Not only the difficulty of identifying the underlying cause, but the complexity of treatment and its tolerability and practicability determines these patients' further burden.
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Affiliation(s)
- F Witte
- Klinik für Hautkrankheiten, Kompetenzzentrum chronischer Pruritus, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland.
| | - C Zeidler
- Klinik für Hautkrankheiten, Kompetenzzentrum chronischer Pruritus, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland
| | - S Ständer
- Klinik für Hautkrankheiten, Kompetenzzentrum chronischer Pruritus, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland
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9
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Augustin M, Zeidler C, von Kiedrowski R, Metz M, Darsow U, Raap U, Legat FJ, Sebastian M, Weisshaar E, Ständer S. Indikation zur Systemtherapie bei chronischer Prurigo: Kommentierte Checkliste für die Praxis. J Dtsch Dermatol Ges 2023; 21:822-824. [PMID: 37427739 DOI: 10.1111/ddg.15152_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Affiliation(s)
- Matthias Augustin
- Sektion Pruritusmedizin der Klinik für Hautkrankheiten, Kompetenzzentrum Chronischer Pruritus (KCP), Universitätsklinikum Münster Von-Esmarch-Str. 58 48149, Münster
| | - Claudia Zeidler
- Sektion Pruritusmedizin der Klinik für Hautkrankheiten, Kompetenzzentrum Chronischer Pruritus (KCP), Universitätsklinikum Münster Von-Esmarch-Str. 58 48149, Münster
| | - Ralph von Kiedrowski
- Sektion Pruritusmedizin der Klinik für Hautkrankheiten, Kompetenzzentrum Chronischer Pruritus (KCP), Universitätsklinikum Münster Von-Esmarch-Str. 58 48149, Münster
| | - Martin Metz
- Sektion Pruritusmedizin der Klinik für Hautkrankheiten, Kompetenzzentrum Chronischer Pruritus (KCP), Universitätsklinikum Münster Von-Esmarch-Str. 58 48149, Münster
| | - Ulf Darsow
- Sektion Pruritusmedizin der Klinik für Hautkrankheiten, Kompetenzzentrum Chronischer Pruritus (KCP), Universitätsklinikum Münster Von-Esmarch-Str. 58 48149, Münster
| | - Ulrike Raap
- Sektion Pruritusmedizin der Klinik für Hautkrankheiten, Kompetenzzentrum Chronischer Pruritus (KCP), Universitätsklinikum Münster Von-Esmarch-Str. 58 48149, Münster
| | - Franz Josef Legat
- Sektion Pruritusmedizin der Klinik für Hautkrankheiten, Kompetenzzentrum Chronischer Pruritus (KCP), Universitätsklinikum Münster Von-Esmarch-Str. 58 48149, Münster
| | - Michael Sebastian
- Sektion Pruritusmedizin der Klinik für Hautkrankheiten, Kompetenzzentrum Chronischer Pruritus (KCP), Universitätsklinikum Münster Von-Esmarch-Str. 58 48149, Münster
| | - Elke Weisshaar
- Sektion Pruritusmedizin der Klinik für Hautkrankheiten, Kompetenzzentrum Chronischer Pruritus (KCP), Universitätsklinikum Münster Von-Esmarch-Str. 58 48149, Münster
| | - Sonja Ständer
- Sektion Pruritusmedizin der Klinik für Hautkrankheiten, Kompetenzzentrum Chronischer Pruritus (KCP), Universitätsklinikum Münster Von-Esmarch-Str. 58 48149, Münster
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10
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Zeidler C, Raap U, Witte F, Ständer S. Clinical aspects and management of chronic itch. J Allergy Clin Immunol 2023; 152:1-10. [PMID: 37178730 DOI: 10.1016/j.jaci.2023.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/11/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023]
Abstract
Chronic pruritus (CP) (ie, itch that persists for more than 6 weeks) poses significant challenges to patients' health and quality of life. It is a common reason for visits to dermatologists and general practitioners and can be caused by a range of conditions, including systemic diseases such as chronic kidney disease or liver diseases, malignancies, neuropathic conditions, and dermatoses such as atopic dermatitis. CP often does not develop in parallel with the course of the disease and can become an entity of its own, which must be treated with antipruritic drugs, even if the underlying cause is already under therapy. Depending on the etiology of CP, different pathways in the pathogenesis have been analyzed recently, following which new treatments have been developed and tested in randomized controlled trials. This article discusses the recent results of these studies and highlights how best to manage health care for patients with CP.
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Affiliation(s)
- Claudia Zeidler
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Ulrike Raap
- University Clinic of Dermatology and Allergy, University of Oldenburg, Oldenburg, Germany
| | - Felix Witte
- 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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11
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Van Beugen S, Schut C, Kupfer J, Bewley AP, Finlay AY, Gieler U, Thompson AR, Grazia-Cazaña T, Balieva F, Ferreira BR, Jemec GB, Lien L, Misery L, Marron SE, Ständer S, Zeidler C, Szabó C, Szepietowski JC, Reich A, Elyas A, Altunay IK, Legat FJ, Grivcheva-Panovska V, Romanov DV, Lvov AN, Titeca G, Sampogna F, Vulink NC, Tomás-Aragones L, Evers AWM, Dalgard FJ. Perceived Stigmatization among Dermatological Outpatients Compared with Controls: An Observational Multicentre Study in 17 European Countries. Acta Derm Venereol 2023; 103:adv6485. [PMID: 37345973 DOI: 10.2340/actadv.v103.6485] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/30/2023] [Indexed: 06/23/2023] Open
Abstract
Perceived stigmatization places a large psychosocial burden on patients with some skin conditions. Little is known about the experience of stigmatization across a wide range of skin diseases. This observational cross-sectional study aimed to quantify perceived stigmatization and identify its predictors among patients with a broad spectrum of skin diseases across 17 European countries. Self-report questionnaires assessing perceived stigmatization and its potential predictors were completed by 5,487 dermatology outpatients and 2,808 skin-healthy controls. Dermatological diagnosis, severity, and comorbidity were clinician-assessed. Patients experienced higher levels of perceived stigmatization than controls (p < 0.001, d = 0.26); patients with psoriasis, atopic dermatitis, alopecia, and bullous disorders were particularly affected. Multivariate regression analyses showed that perceived stigmatization was related to sociodemographic (lower age, male sex, being single), general health-related (higher body mass index, lower overall health), disease-related (higher clinician-assessed disease severity, presence of itch, longer disease duration), and psychological (greater distress, presence of suicidal ideation, greater body dysmorphic concerns, lower appearance satisfaction) variables. To conclude, perceived stigmatization is common in patients with skin diseases. Factors have been identified that will help clinicians and policymakers to target vulnerable patient groups, offer adequate patient management, and to ultimately develop evidence-based interventions.
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Affiliation(s)
- Sylvia Van Beugen
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands.
| | - Christina Schut
- Institute of Medical Psychology, Justus-Liebig-University Gießen, Gießen, Germany
| | - Jörg Kupfer
- Institute of Medical Psychology, Justus-Liebig-University Gießen, Gießen, Germany
| | | | - Andrew Y Finlay
- Institute of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Uwe Gieler
- Department of Dermatology, Justus-Liebig- University Giessen and Vitos Klinik, Giessen, Germany
| | - Andrew R Thompson
- South Wales Clinical Psychology Programme, Cardiff & Vale University Health Board, & School of Psychology, Cardiff University, UK
| | - Tamara Grazia-Cazaña
- Miguel Servet University Hospital, IIS Aragón, Universidad de Zaragoza, Zaragoza, Spain
| | - Flora Balieva
- Department of Dermatology, Stavanger University Hospital, Stavanger, Norway
| | - Bárbara R Ferreira
- Department of Dermatology, Coimbra University Hospital, Coimbra, Portugal
| | - Gregor B Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
| | - Laurent Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - Servando E Marron
- Department of Dermatology, University Hospital Miguel Servet, Aragon Psychodermatology Research Group (GAI+PD), Zaragoza, Spain
| | - Sonja Ständer
- Department of Dermatology, University Clinic Münster, Münster, Germany
| | - Claudia Zeidler
- Department of Dermatology, University Clinic Münster, Münster, Germany
| | - Csanád Szabó
- Institute of Psychology, University of Szeged, Szeged, Hungary
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Adam Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszów, Poland
| | - Amna Elyas
- Department of Dermatology and Venereology, Skåne University Hospital, Malmo, Sweden
| | - Ilknur K Altunay
- University of Health Sciences. Hamidiye Etfal Research and Training Hospital, Department of Dermatology and Venereology, Istanbul, Turkey
| | - Franz J Legat
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Vesna Grivcheva-Panovska
- University St Cyril and Methodius, School of Medicine, PHI University Clinic of Dermatology Skopje, N. Macedonia
| | - Dmitry V Romanov
- Department of Psychiatry and Psychosomatics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Andrey N Lvov
- Department of Dermatovenereology and Cosmetology, Central State Medical Academy of department of presidential affairs, Moscow, Russia
| | - Géraldine Titeca
- Department of Dermatology/ Clinique Notre Dame de Grâce, Gosselies, Belgium
| | | | - Nienke C Vulink
- Department of Psychiatry, Amsterdam UMC, location AMC, Amsterdam, the Netherlands
| | | | - Andrea W M Evers
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
| | - Florence J Dalgard
- Department of Dermatology and Venereology, Skåne University Hospital, Malmo, Sweden
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12
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Agelopoulos K, Renkhold L, Wiegmann H, Dugas M, Süer A, Zeidler C, Schmelz M, Pereira MP, Ständer S. Transcriptomic, Epigenomic, and Neuroanatomic Signatures Differ in Chronic Prurigo, Atopic Dermatitis, and Brachioradial Pruritus. J Invest Dermatol 2023; 143:264-272.e3. [PMID: 36075451 DOI: 10.1016/j.jid.2022.08.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/28/2022] [Accepted: 08/05/2022] [Indexed: 01/25/2023]
Abstract
Scratching and scratch-induced injuries, including neuroanatomical alterations, are key characteristics of chronic pruritus entities of different origins. The aim of this study was to link gene expression (array hybridization, qPCR) with DNA methylation (array hybridization) and neuroanatomy (PGP9.5 staining) in chronic nodular prurigo (CNPG), atopic dermatitis (AD), brachioradial pruritus (BRP), and matched healthy controls. Specific signatures of gene expression and DNA methylation clearly discriminated pruritic lesional skin from nonpruritic skin in CNPG and from healthy skin of volunteers, respectively. Although intraepidermal nerve fiber density was indiscriminately reduced, the level of epidermal branching, assessed by a semiquantitative pattern analysis, differentiated the entities (CNPG > BRP > AD). Correspondingly, repellent SEMA3A showed the highest expression in AD, whereas axonal growth-promoting nerve GF was most prominent in CNPG and BRP. Overexpression of genes for nerve fiber regeneration (NELL2/NFKB/ARTN) was found in AD and CNPG but not in BRP. Our findings suggest that differential branching patterns rather than mere innervation density separate chronic itch conditions and reflect disease-specific local expression profiles. In pruritic dermatoses (AD and CNPG), nerve injury and subsequent sprouting may primarily result from chronic scratching, whereas genuine neuropathy is expected to underlie BRP.
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Affiliation(s)
- Konstantin Agelopoulos
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany.
| | - Lina Renkhold
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Henning Wiegmann
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Martin Dugas
- Institute of Medical Informatics, University of Münster, Münster, Germany; Institute of Medical Informatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Aysenur Süer
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Claudia Zeidler
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Martin Schmelz
- Department of Experimental Pain Research, Mannheim Centre for Translational Neuroscience, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Manuel P Pereira
- 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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13
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Jäger KC, Löser CR, Zeidler C, Pereira MP, Dippel E, Ständer S. [Naloxone as rescue therapy for acute, severe pruritus]. Dermatologie (Heidelb) 2023; 74:122-125. [PMID: 36107202 DOI: 10.1007/s00105-022-05050-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 01/28/2023]
Abstract
This article presents the case of a patient with massive pruritus sine materia. Naloxone was proven as quick and effective therapy which led to a complete reduction of itching.
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Affiliation(s)
- Katharina C Jäger
- Hautklinik, Klinikum Ludwigshafen, Bremserstr. 79, 67063, Ludwigshafen am Rhein, Deutschland.
| | - Christoph R Löser
- Hautklinik, Klinikum Ludwigshafen, Bremserstr. 79, 67063, Ludwigshafen am Rhein, Deutschland
| | - Claudia Zeidler
- Klinik für Hautkrankheiten, Universitätsklinikum Münster, Münster, Deutschland
| | - Manuel P Pereira
- Klinik für Hautkrankheiten, Universitätsklinikum Münster, Münster, Deutschland
| | - Edgar Dippel
- Hautklinik, Klinikum Ludwigshafen, Bremserstr. 79, 67063, Ludwigshafen am Rhein, Deutschland
| | - Sonja Ständer
- Klinik für Hautkrankheiten, Universitätsklinikum Münster, Münster, Deutschland
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14
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Pereira MP, Weisshaar E, Halvorsen JA, Wallengren J, Legat FJ, Garcovich S, Savk E, Reich A, Bozek A, Lvov A, Bobko S, Metz M, Streit M, Misery L, Brenaut E, Serra-Baldrich E, Gonçalo M, Szepietowski JC, Augustin M, Nau T, Zeidler C, Ständer S. Chronic prurigo: Insufficient disease control in spite of high healthcare usage. J Eur Acad Dermatol Venereol 2023; 37:e808-e812. [PMID: 36682045 DOI: 10.1111/jdv.18903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/16/2023] [Indexed: 01/23/2023]
Affiliation(s)
- Manuel P Pereira
- Department of Dermatology, Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Elke Weisshaar
- Division of Occupational Dermatology, Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Jon Anders Halvorsen
- Department of Dermatology, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Joanna Wallengren
- Department of Dermatology and Venereology, Lund University, Skane University Hospital, Lund, Sweden
| | - Franz J Legat
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | | | - Ekin Savk
- Department of Dermatology, Aydın Adnan Menderes University, Aydın, Turkey
| | - Adam Reich
- Department of Dermatology, University of Rzeszów, Rzeszów, Poland
| | - Agnieszka Bozek
- Department of Dermatology, University of Rzeszów, Rzeszów, Poland
| | - Andrey Lvov
- Department of Dermatovenereology and Cosmetology, Central State Medical Academy of Department of Presidential Affairs, Moscow, Russia.,Medical Research and Educational Center, Lomonosov Moscow State University, Moscow, Russia
| | - Svetlana Bobko
- Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology, Moscow, Russia
| | - Martin Metz
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Markus Streit
- Department of Dermatology, Kantonsspital Aarau, Aarau, Switzerland
| | - Laurent Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - Emilie Brenaut
- Department of Dermatology, University Hospital of Brest, Brest, France
| | | | - Margarida Gonçalo
- Department of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Matthias Augustin
- Competence Center for Healthcare Research in Dermatology (CVderm), Institute for Healthcare Research in Dermatology and Nursing (IVDP), University Hospital of Hamburg-Eppendorf, Hamburg, Germany
| | - Teresa Nau
- Department of Dermatology, Center for Chronic Pruritus, University Hospital Münster, Münster, Germany.,Department of Dermatology and Allergy, Technical University of Munich, School of Medicine, Munich, Germany
| | - Claudia Zeidler
- Department of Dermatology, Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Sonja Ständer
- Department of Dermatology, Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
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15
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Zeidler C, Pereira MP, Ständer S. Brachioradial pruritus successfully treated with intravenous naloxone. J Eur Acad Dermatol Venereol 2023; 37:e87-e89. [PMID: 35986712 DOI: 10.1111/jdv.18553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/17/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Claudia Zeidler
- Department of Dermatology, Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Manuel P Pereira
- Department of Dermatology, Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Sonja Ständer
- Department of Dermatology, Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
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16
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Von Martial S, Kok L, Gründel S, Augustin M, Blome C, Zeidler C, Steinbrink K, Ständer S, Tsianakas A. Introduction of a Specific Dermatological Rehabilitation Programme for Patients with Chronic Pruritus: A Pilot Study. Acta Derm Venereol 2022; 102:adv00831. [PMID: 36317589 PMCID: PMC10508275 DOI: 10.2340/actadv.v102.2930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2022] [Indexed: 11/07/2022] Open
Abstract
Chronic pruritus is a common symptom, associated with several severe medical conditions, great psychological burden, and reduced quality of life. It also poses socio-economic challenges concerning patients' work loss and healthcare costs. In Germany, medical rehabilitation programmes represent an integral part of the medical care of patients with chronic inflammatory skin diseases. However, such programmes play only a rudimentary role in the treatment of other dermatological diseases, such as dermatological oncology, genetic skin diseases, and chronic pruritus. Therefore, a specific antipruritic dermatological rehabilitation programme was developed in cooperation between the Department of Dermatology of the Medical Rehabilitation Center Bad Bentheim and the Center for Chronic Pruritus of the University Hospital of Muenster, Germany. This prospective study compared short-term patient-reported outcomes (n = 121) at the beginning and end of the rehabilitation programme. The majority of subjects had chronic pruritus on primary diseased, inflamed skin. Significant improvements in pruritus intensity (p ≤ 0.001), quality of life (p ≤ 0.001), anxiety symptoms (p ≤ 0.001) and depression (p ≤ 0.001), as well as an overall patient-relevant benefit (Patient Benefit Index 2.6 ± 1.06) and treatment-related patients' satisfaction, were shown. This suggests that implementation of this standardized rehabilitation programme for treatment of patients with chronic pruritus was successful.
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Affiliation(s)
- Sophia Von Martial
- Fachklinik Bad Bentheim, Department of Dermatology and Allergology, Am Bade 1, DE-48455 Bad Bentheim, Germany
| | - Lisa Kok
- Fachklinik Bad Bentheim, Department of Dermatology and Allergology, Am Bade 1, DE-48455 Bad Bentheim, Germany
| | - Sonja Gründel
- Fachklinik Bad Bentheim, Department of Dermatology and Allergology, Am Bade 1, DE-48455 Bad Bentheim, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christine Blome
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Claudia Zeidler
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Kerstin Steinbrink
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Sonja Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Athanasios Tsianakas
- Fachklinik Bad Bentheim, Department of Dermatology and Allergology, Am Bade 1, DE-48455 Bad Bentheim, Germany.
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17
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Ständer S, Zeidler C, Augustin M, Darsow U, Kremer AE, Legat FJ, Koschmieder S, Kupfer J, Mettang T, Metz M, Nast A, Raap U, Schneider G, Ständer H, Streit M, Schut C, Weisshaar E. S2k guideline: Diagnosis and treatment of chronic pruritus. J Dtsch Dermatol Ges 2022; 20:1387-1402. [DOI: 10.1111/ddg.14830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/25/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Sonja Ständer
- Center for Chronic Pruritus (KCP) Department of Dermatology University Hospital Münster Münster Germany
| | - Claudia Zeidler
- Center for Chronic Pruritus (KCP) Department of Dermatology University Hospital Münster Münster Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Ulf Darsow
- Department of Dermatology and Allergology Biederstein Faculty of Medicine Technical University of Munich Munich Germany
| | - Andreas E. Kremer
- Department of Gastroenterology and Hepatology University Hospital Zürich Zürich Switzerland
- Department of Medicine 1 Department of Gastroenterology Pneumology and Endocrinology Friedrich‐Alexander‐University Erlangen‐Nürnberg Erlangen Germany
| | - Franz J. Legat
- Department of Dermatology and Venereology Medical University of Graz Graz Austria
| | - Steffen Koschmieder
- Department of Hematology Oncology Hemostaseology and Stem Cell Transplantation (Med. Clinic IV) Faculty of Medicine RWTH Aachen University Aachen Germany
| | - Jörg Kupfer
- Institute of Medical Psychology Justus Liebig University Giessen Germany
| | - Thomas Mettang
- KfH Kidney Center und DKD Helios Klinik Wiesbaden Germany
| | - Martin Metz
- Institute of Allergology Charité, Universitätsmedizin Berlin Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP Allergology and Immunology Berlin Germany
| | - Alexander Nast
- Division of Evidence Based Medicine (DEBM) Department of Dermatology Venereology and Allergology Charité – Universitätsmedizin Berlin Berlin Germany
| | - Ulrike Raap
- University Hospital of Dermatology and Allergy Medical Center Oldenburg Oldenburg Germany
| | - Gudrun Schneider
- Department for Psychosomatic Medicine and Psychotherapy University Hospital Münster Münster Germany
| | - Hartmut Ständer
- Dermatology Bad Bentheim Office of Dermatology at Paulinenkrankenhaus Bad Bentheim and Department of Dermatology Medical Center Dortmund Dortmund Germany
| | | | - Christina Schut
- Institute of Medical Psychology Justus Liebig University Giessen Germany
| | - Elke Weisshaar
- Devision of Occupational Dermatology Department of Dermatology University Medical Center Heidelberg Heidelberg Germany
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18
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Ständer S, Zeidler C, Augustin M, Darsow U, Kremer AE, Legat FJ, Koschmieder S, Kupfer J, Mettang T, Metz M, Nast A, Raap U, Schneider G, Ständer H, Streit M, Schut C, Weisshaar E. S2k Leitlinie: Diagnostik und Therapie des chronischen Pruritus. J Dtsch Dermatol Ges 2022; 20:1386-1402. [DOI: 10.1111/ddg.14830_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 12/12/1912] [Accepted: 05/25/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Sonja Ständer
- Kompetenzzentrum Chronischer Pruritus (KCP) Klinik für Hautkrankheiten Universitätsklinikum Münster Münster Deutschland
| | - Claudia Zeidler
- Kompetenzzentrum Chronischer Pruritus (KCP) Klinik für Hautkrankheiten Universitätsklinikum Münster Münster Deutschland
| | - Matthias Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP) Universitätsklinik Eppendorf Hamburg Deutschland
| | - Ulf Darsow
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein Klinikum rechts der Isar Technische Universität München München Deutschland
| | - Andreas E. Kremer
- Klinik für Gastroenterologie und Hepatologie Universitätsspital Zürich Zürich Schweiz
- Medizinische Klinik 1 Klinik für Gastroenterologie Pneumologie und Endokrinologie Universitätsklinikum Erlangen und Friedrich‐Alexander‐Universität Erlangen‐Nürnberg Erlangen Deutschland
| | - Franz J. Legat
- Universitätsklinik für Dermatologie und Venerologie Medizinische Universität Graz Graz Österreich
| | - Steffen Koschmieder
- Klinik für Hämatologie Onkologie Hämostaseologie und Stammzelltransplantation (Med. Klinik IV) Medizinische Fakultät RWTH Uniklinik Aachen Aachen Deutschland
| | - Jörg Kupfer
- Institut für Medizinische Psychologie Justus‐Liebig‐Universität Gießen Gießen Deutschland
| | - Thomas Mettang
- KfH Nierenzentrum und DKD Helios Klinik Wiesbaden Deutschland
| | - Martin Metz
- Institut für Allergieforschung Charité, Universitätsmedizin Berlin Berlin Deutschland
- Fraunhofer Institut für Translationale Medizin und Pharmakologie ITMP Allergologie und Immunologie Berlin Deutschland
| | - Alexander Nast
- Division of Evidence Based Medicine (DEBM) Klinik für Dermatologie Venerologie und Allergologie Charité – Universitätsmedizin Berlin Berlin Deutschland
| | - Ulrike Raap
- Universitätsklinik für Dermatologie und Allergologie Klinikum Oldenburg Oldenburg Deutschland
| | - Gudrun Schneider
- Klinik für Psychosomatische Medizin und Psychotherapie Universitätsklinikum Münster Münster Deutschland
| | - Hartmut Ständer
- Dermatologie Bad Bentheim Praxis für Dermatologie im Paulinenkrankenhaus Bad Bentheim und Hautklinik Klinikum Dortmund gGmbH Dortmund Deutschland
| | | | - Christina Schut
- Institut für Medizinische Psychologie Justus‐Liebig‐Universität Gießen Gießen Deutschland
| | - Elke Weisshaar
- Sektion Berufsdermatologie Hautklinik Universitätsklinikum Heidelberg Heidelberg Deutschland
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19
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Zeidler C, Pereira M. Chronische Prurigo. Dermatologie (Heidelb) 2022; 73:613. [PMID: 35925240 DOI: 10.1007/s00105-022-05021-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Claudia Zeidler
- Klinik für Hautkrankheiten, Universitätsklinikum Münster, Münster, Deutschland.
| | - Manuel Pereira
- Klinik für Hautkrankheiten, Universitätsklinikum Münster, Münster, Deutschland
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20
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Schut C, Zeidler C, Schneider G. [Relevance of demographic and psychological factors in pruritus]. Dermatologie (Heidelb) 2022; 73:620-624. [PMID: 35925238 DOI: 10.1007/s00105-022-05016-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Pruritus is a frequent phenomenon in patients in dermatology. The severity of pruritus often cannot be explained by the severity of the underlying disease or chronification processes alone. Especially then, demographic and psychological variables should also be considered as moderators of the intensity of pruritus. PURPOSE Are there associations between sex, age, emotional and cognitive factors and pruritus intensity in patients with chronic pruritus (CP) and skin-healthy control subjects? MATERIAL AND METHODS Recently published studies on the abovenamed moderators of pruritus were searched for in PubMed, collated and the results are summarized. RESULTS It was found that women reported a higher intensity of pruritus than men. In addition, negative emotions such as fear, disgust, and anger are positively associated with pruritus in patients with CP. There are also associations between cognitive factors, such as attention, catastrophizing, and pruritus. CONCLUSION The associations between both demographic and psychological factors and pruritus should be considered in the diagnostics and treatment of pruritus. A psychological intervention as a complementary treatment should be considered whenever patients report associations between psychological experiences and pruritus and/or automatic or extensive scratching.
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Affiliation(s)
- Christina Schut
- Institut für Med. Psychologie, Justus-Liebig-Universität, Klinikstr. 29, 35392, Gießen, Deutschland.
| | - Claudia Zeidler
- Kompetenzzentrum chronischer Pruritus, Klinik für Hautkrankheiten, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48159, Münster, Deutschland
| | - Gudrun Schneider
- Sektion für Psychosomatische Medizin und Psychotherapie, Klinik für Psychische Gesundheit, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1 (Geb. A9), 48149, Münster, Deutschland
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21
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Abstract
Chronic prurigo is an inflammatory dermatosis defined by the presence of chronic pruritus and single to multiple symmetrically distributed pruriginous lesions such as nodules, papules, and plaques. Various dermatological, systemic, neurological, and/or psychiatric diseases are associated with chronic prurigo. The care of these patients is very complex due to the multifactorial character and also because of the sometimes very pronounced consequences such as an impairment of quality of life with sleep disorders. Furthermore, there are no approved therapies. The current guideline-based treatment recommendations include topical application of steroids, capsaicin, calcineurin inhibitors, phototherapy, and systemic use of gabapentinoids, μ‑opioid receptor antagonists, immunosuppressants, or dupilumab. Results from randomized controlled trials and case series on new therapies including biologics (e.g., nemolizumab) and Janus kinase inhibitors are promising. This article provides an overview of currently available treatment options and discusses the latest data on the efficacy of future therapies.
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Affiliation(s)
- Claudia Zeidler
- Kompetenzzentrum Chronischer Pruritus (KCP), Klinik für Hautkrankheiten, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland.
| | - Manuel Pedro Pereira
- Kompetenzzentrum Chronischer Pruritus (KCP), Klinik für Hautkrankheiten, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland
| | - Sonja Ständer
- Kompetenzzentrum Chronischer Pruritus (KCP), Klinik für Hautkrankheiten, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland
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22
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Schut C, Dalgard FJ, Bewley A, Evers AWM, Gieler U, Lien L, Sampogna F, Ständer S, Tomás-Aragonés L, Vulink N, Finlay AY, Legat FJ, Titeca G, Jemec GB, Misery L, Szabó C, Grivcheva-Panovska V, Spillekom-van Koulil S, Balieva F, Szepietowski JC, Reich A, Roque Ferreira B, Lvov A, Romanov D, Marron SE, Gracia-Cazaña T, Svensson A, Altunay IK, Thompson AR, Zeidler C, Kupfer J. BI24: An insight into the protective role of biologics in
COVID
‐19 infections: a single‐centre case series. Br J Dermatol 2022. [PMID: 35041211 PMCID: PMC9349390 DOI: 10.1111/bjd.21366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Christina Schut
- Institute of Medical Psychology, Justus-Liebig-University, Gießen, Germany
| | - Florence J Dalgard
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Dermatology and Venereology, Skåne University Hospital, Malmo, Sweden
| | - Anthony Bewley
- Barts Health NHS Trust & Queen Mary University of London, London, UK
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Department, Leiden University, Leiden, the Netherlands
| | | | - Lars Lien
- Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
| | | | - Sonja Ständer
- Department of Dermatology and Centre for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Lucía Tomás-Aragonés
- Department of Psychology, University of Zaragoza, Zaragoza, Spain
- Aragon Psychodermatology Research Group Zaragoza, Zaragoza, Spain
| | - Nienke Vulink
- Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Andrew Y Finlay
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Franz J Legat
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | | | - Gregor B Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Laurent Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - Csanád Szabó
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - Vesna Grivcheva-Panovska
- University St Cyril and Methodius, School of Medicine, PHI University Clinic of Dermatology, Skopje, North Macedonia
| | - Saskia Spillekom-van Koulil
- Radboud Institute for Health Sciences, Department of Medical Psychology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Flora Balieva
- Department of Dermatology, Stavanger University Hospital, Stavanger, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Adam Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszów University, Rzeszów, Poland
| | - Bárbara Roque Ferreira
- Centre for Philosophy of Science of the University of Lisbon, Lisbon, Portugal
- Department of Dermatology, Centre Hospitalier de Mouscron, Mouscron, Belgium
- University of Brest, Lien, France
| | - Andrey Lvov
- Central State Medical Academy of Department of Presidential Affairs, Moscow, Russia
- Medical Research and Educational Centre, Lomonosov Moscow State University, Moscow, Russia
| | - Dmitry Romanov
- Department of Psychiatry and Psychosomatics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Department of Boundary Mental Conditions and Psychosomatic Disorders, Mental Health Research Centre, Moscow, Russia
- Moscow Scientific and Practical Centre of Dermatology, Venereology and Cosmetology of Moscow City Health Department, Moscow, Russia
| | - Servando E Marron
- Aragon Psychodermatology Research Group Zaragoza, Zaragoza, Spain
- Department of Dermatology, University Hospital Miguel Servet, Zaragoza, Spain
| | | | - Ake Svensson
- Department of Dermatology, Skåne University Hospital, Malmö, Sweden
| | - Ilknur K Altunay
- University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Dermatology and Venereology Clinic, Istanbul, Turkey
| | - Andrew R Thompson
- South Wales Clinical Psychology Training Programme, Cardiff & Vale University Health Board & School of Psychology, Cardiff University, Cardiff, UK
| | - Claudia Zeidler
- Department of Dermatology and Centre for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Joerg Kupfer
- Institute of Medical Psychology, Justus-Liebig-University, Gießen, Germany
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23
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Süer A, Riepenhausen S, Storck M, Greulich L, Zeidler C, Ständer S, Dugas M. ODM-DQA-Reporter: A Generic Approach to Assess and Monitor Basic Data Quality of Medical Research Data in Operational Data Model (ODM) Format. Stud Health Technol Inform 2022; 290:983-984. [PMID: 35673167 DOI: 10.3233/shti220229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A generic approach for assessment and continuous monitoring of data quality in ODM-based research data has been developed. The focus is on the two data quality indicators completeness and syntactic correctness. The main idea is to enable the generation of a data quality report without additional programming effort.
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Affiliation(s)
- Ayşenur Süer
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Sarah Riepenhausen
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Michael Storck
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Leonard Greulich
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Claudia Zeidler
- Department of Dermatology and Center for Chronic Pruritus (KCP), University Hospital Münster, Münster, Germany
| | - Sonja Ständer
- Department of Dermatology and Center for Chronic Pruritus (KCP), University Hospital Münster, Münster, Germany
| | - Martin Dugas
- Institute of Medical Informatics, University of Münster, Münster, Germany
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24
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Zeidler A, Dannenmann B, Klimiankou M, Zeidler C, Skokowa J, Welte K. New Insights into the pathophysiology of cyclic
neutropenia. KLINISCHE PADIATRIE 2022. [DOI: 10.1055/s-0042-1748701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- A Zeidler
- University Hospital Tübingen, Tübingen,
Germany
| | | | | | - C Zeidler
- Medial School Hannover, Hannover, Germany
| | - J Skokowa
- University Hospital Tübingen, Tübingen,
Germany
| | - K Welte
- University Hospital Tübingen, Tübingen,
Germany
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25
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Ritter MU, Nasri M, Dannenmann B, Kaufmann MM, Zeidler KA, Zeidler C, Klimiankou M, Cathomen T, Welte K, Skokowa J. A selection free ex vivo gene therapy approach to congenital
neutropenia causing HAX1 mutations. KLINISCHE PADIATRIE 2022. [DOI: 10.1055/s-0042-1748736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- MU Ritter
- Innere Medizin 2, Universitätsklinikum Tübingen,
Germany
| | - M Nasri
- Innere Medizin 2, Universitätsklinikum Tübingen,
Germany
| | - B Dannenmann
- Innere Medizin 2, Universitätsklinikum Tübingen,
Germany
| | | | - KA Zeidler
- Allgemeine Pädiatrie, Hämatologie, Onkologie,
Universitätsklinikum Tübingen, Germany
| | - C Zeidler
- Klinik für Pädiatrische Hämatologie und
Onkologie, Medizinische Hochschule Hannover, Germany
| | - M Klimiankou
- Innere Medizin 2, Universitätsklinikum Tübingen,
Germany
| | - T Cathomen
- ITG, Universitätsklinikum Freiburg, Germany
| | - K Welte
- Allgemeine Pädiatrie, Hämatologie, Onkologie,
Universitätsklinikum Tübingen, Germany
| | - J Skokowa
- Innere Medizin 2, Universitätsklinikum Tübingen,
Germany
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26
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Klimiankou M, Kandabarau S, Zeidler C, Pogozhykh D, Hettich-Woggon I, Hähnel K, Welte K, Skokowa J. Clonal Hematopoiesis in Patients with Severe Congenital
Neutropenia. KLINISCHE PADIATRIE 2022. [DOI: 10.1055/s-0042-1748698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | | | - C Zeidler
- Severe Chronic Neutropenia International Registry (SCNIR), Hannover
Medical School, Germany
| | - D Pogozhykh
- Severe Chronic Neutropenia International Registry (SCNIR), Hannover
Medical School, Germany
| | | | - K Hähnel
- University Hospital Tübingen, Tübingen,
Germany
| | - K Welte
- University Children's Hospital Tübingen,
Tübingen, Germany
| | - J Skokowa
- University Hospital Tübingen, Tübingen,
Germany
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27
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Dannenmann B, Klimiankou M, Oswald B, Solovyeva A, Mardan J, Zeidler C, Welte K, Skokowa J. HiPSC disease modelling to study leukemia development in HAX1 vs
ELANE associated congenital neutropenia. KLINISCHE PADIATRIE 2022. [DOI: 10.1055/s-0042-1748743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- B Dannenmann
- Department of Oncology, Hematology, Immunology, Rheumatology and
Pulmonology, University Hospital Tübingen, Germany
| | - M Klimiankou
- Department of Oncology, Hematology, Immunology, Rheumatology and
Pulmonology, University Hospital Tübingen, Germany
| | - B Oswald
- Department of Oncology, Hematology, Immunology, Rheumatology and
Pulmonology, University Hospital Tübingen, Germany
| | - A Solovyeva
- Department of Oncology, Hematology, Immunology, Rheumatology and
Pulmonology, University Hospital Tübingen, Germany
| | - J Mardan
- Department of Oncology, Hematology, Immunology, Rheumatology and
Pulmonology, University Hospital Tübingen, Germany
| | - C Zeidler
- Department of Oncology, Hematology, Immunology, Rheumatology and
Pulmonology, University Hospital Tübingen, Germany
| | - K Welte
- University Children’s Hospital Tübingen,
Germany
| | - J Skokowa
- Department of Oncology, Hematology, Immunology, Rheumatology and
Pulmonology, University Hospital Tübingen, Germany
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28
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Borbarán-Bravo N, Deordieva E, Bräuning S, Dannenmann B, Doll L, ElGamacy M, Zeidler C, Bajoghly B, Maschan A, Shcherbina A, Welte K, Skokowa J, Klimiankou M. A new inherited syndrome with severe neutropenia and neurological
involvement due to autosomal recessive COPZ1 mutation. KLINISCHE PADIATRIE 2022. [DOI: 10.1055/s-0042-1748704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- N Borbarán-Bravo
- University Hospital Tübingen, Division of Translational
Oncology, Department of Hematology, Oncology, Clinical Immunology and
Rheumatology, University Hospital Tübingen, Germany
| | - E Deordieva
- University Hospital Tübingen, Division of Translational
Oncology, Department of Hematology, Oncology, Clinical Immunology and
Rheumatology, University Hospital Tübingen, Germany
- Dmitry Rogachev National Research Center of pediatric Hematology,
Oncology and Immunology, Moscow, Russia
| | - S Bräuning
- University Hospital Tübingen, Division of Translational
Oncology, Department of Hematology, Oncology, Clinical Immunology and
Rheumatology, University Hospital Tübingen, Germany
| | - B Dannenmann
- University Hospital Tübingen, Division of Translational
Oncology, Department of Hematology, Oncology, Clinical Immunology and
Rheumatology, University Hospital Tübingen, Germany
| | - L Doll
- University Hospital Tübingen, Division of Translational
Oncology, Department of Hematology, Oncology, Clinical Immunology and
Rheumatology, University Hospital Tübingen, Germany
| | - M ElGamacy
- University Hospital Tübingen, Division of Translational
Oncology, Department of Hematology, Oncology, Clinical Immunology and
Rheumatology, University Hospital Tübingen, Germany
- Max Planck Institute for Developmental Biology, Tübingen,
Germany
- Friedrich Miescher Laboratory of the Max Planck Society
Tübingen, Germany
| | - C Zeidler
- Department of Pediatric Hematology/Oncology, Klinderklinik,
Hannover, Germany
| | - B Bajoghly
- University Hospital Tübingen, Division of Translational
Oncology, Department of Hematology, Oncology, Clinical Immunology and
Rheumatology, University Hospital Tübingen, Germany
| | - A Maschan
- Dmitry Rogachev National Research Center of pediatric Hematology,
Oncology and Immunology, Moscow, Russia
| | - A Shcherbina
- Dmitry Rogachev National Research Center of pediatric Hematology,
Oncology and Immunology, Moscow, Russia
| | - K Welte
- University Hospital Tübingen, Division of Translational
Oncology, Department of Hematology, Oncology, Clinical Immunology and
Rheumatology, University Hospital Tübingen, Germany
| | - J Skokowa
- University Hospital Tübingen, Division of Translational
Oncology, Department of Hematology, Oncology, Clinical Immunology and
Rheumatology, University Hospital Tübingen, Germany
| | - M Klimiankou
- University Hospital Tübingen, Division of Translational
Oncology, Department of Hematology, Oncology, Clinical Immunology and
Rheumatology, University Hospital Tübingen, Germany
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29
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Abstract
Pruritus in pregnancy is a common and burdensome symptom that may be a first sign of a pregnancy-specific pruritic disease (atopic eruption of pregnancy, polymorphic eruption of pregnancy, pemphigoid gestationis, and intrahepatic cholestasis in pregnancy) or a dermatosis coinciding with pregnancy by chance. Despite its high prevalence, pruritus is often underrated by physicians, and data regarding the safety profiles of drugs for pruritus are very limited. In this review, we illustrate the epidemiology, possible pathophysiology, clinical characteristics, and diagnostic workup of various pregnancy-related diseases and discuss antipruritic treatments. The prevalence of pruritus in pregnancy demonstrates the importance of symptom recognition and the need for an holistic approach, taking into account both the potential benefits for the patient and the potential risks to the fetus.
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Affiliation(s)
- Aleksandra A Stefaniak
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Von Esmarch Str 58, 48149, Münster, Germany.
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wrocław, Poland.
| | - Manuel P Pereira
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Von Esmarch Str 58, 48149, Münster, Germany
| | - Claudia Zeidler
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Von Esmarch Str 58, 48149, Münster, 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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30
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Ständer S, Garbe C, Hagenström K, Petersen J, Zeidler C, Augustin M. Healthcare Utilization and Treatment Patterns in Patients with Chronic Prurigo and Chronic Pruritus in Germany. Dermatology 2022; 238:753-761. [PMID: 35176747 DOI: 10.1159/000520863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/24/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To date, there have been no large studies describing real-world treatment of chronic prurigo (CPG) and pruritus (CPR) in Germany. OBJECTIVE To determine the healthcare utilization, treatment patterns, and costs associated with CPG and CPR in Germany. METHODS Retrospective analysis using anonymized claims data (German DAK-Gesundheit), based on a 40% sample of all insured adults of the DAK-Gesundheit on December 31, 2010 (N = 2,006,003). RESULTS Patients with CPR (prevalence 2.2%) most commonly visited general medicine/general practitioners (GPs, 80.1%), followed by gynecologists (66.1%) and dermatologists (51.1%). Patients with CPG (prevalence 0.2%) most commonly visited dermatologists (85.7%), GPs (78.1%), and ophthalmologists (47.2%). Of adult patients, 44% received at least one drug prescription. Two thirds of patients with a drug prescription received ≥1 topical drug (66.2%), and 54.3% ≥1 systemic drug (total costs of approximately EUR 550,000 and 2,500,000, respectively). Of patients with CPG, 33.8% received ≥1 systemic and 45.1% ≥1 topical drug prescription (costs of approximately EUR 360,000 vs. 105,000). Of patients with CPR, 23.5% received ≥1 systemic and 28.6% ≥1 topical drug prescription (costs of approximately EUR 2,000,000 vs. 500,000). Of patients with CPG, 5.8% received ≥1 phototherapy application vs. 1.2% of patients with CPR. CONCLUSIONS These findings reflect the reality of care and can form a basis for the identification of overuse, underuse, and misuse in order to design CPG and CPR healthcare more effectively and efficiently.
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Affiliation(s)
- Sonja Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Claudia Garbe
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kristina Hagenström
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jana Petersen
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Claudia Zeidler
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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31
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Pereira MP, Zeidler C, Ständer S. Improvement of chronic nodular prurigo with baricitinib. J Eur Acad Dermatol Venereol 2022; 36:e486-e488. [PMID: 35138657 DOI: 10.1111/jdv.17991] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/13/2022] [Accepted: 02/04/2022] [Indexed: 11/28/2022]
Affiliation(s)
- M P Pereira
- 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
| | - S Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
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Schut C, Dalgard FJ, Bewley A, Evers AWM, Gieler U, Lien L, Sampogna F, Ständer S, Tomas-Aragones L, Vulink N, Finlay AY, Legat FJ, Titeca G, Jemec GB, Misery L, Szabó C, Grivcheva-Panovska V, Spillekom-van Koulil S, Balieva F, Szepietowski JC, Reich A, Roque Ferreira B, Lvov A, Romanov D, Marron SE, Gracia-Cazaña T, Svensson Å, Altunay IK, Thompson A, Zeidler C, Kupfer J. Body dysmorphia in common skin diseases: Results of an observational, cross-sectional multi-centre study among dermatological out-patients in 17 European countries. Br J Dermatol 2022; 187:115-125. [PMID: 35041211 DOI: 10.1111/bjd.21021] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/20/2021] [Accepted: 01/15/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Body dysmorphic disorder (BDD) is a common psychiatric disorder associated with high costs for healthcare systems as patients may repeatedly ask for different, often not effective interventions. BDD symptoms are more prevalent in patients with dermatological conditions than the general population, but there are no large sample studies comparing the prevalence of BDD symptoms between patients with dermatological conditions and healthy skin controls. OBJECTIVES To compare the prevalence of BDD symptoms between patients with different dermatological conditions and healthy skin controls and to describe sociodemographic, physical and psychological factors associated with BDD symptoms to identify patients who may have a particularly high chance of having this condition. METHODS This observational cross-sectional, comparative multi-centre study included 8295 participants: 5487 consecutive patients with different skin diseases (56% female) recruited among dermatological out-patients at 22 clinics in 17 European countries and 2808 healthy skin controls (66% female). All patients were examined by a dermatologist. BDD symptoms were assessed by the Dysmorphic Concern Questionnaire (DCQ). Sociodemographic data, information on psychological factors and physical conditions were collected. Each patient was given a dermatological diagnosis according to ICD-10 by a dermatologist. RESULTS The participation rate of invited dermatological patients was 82.4% on average across all centres. BDD symptoms were five times more prevalent in patients with dermatological conditions than in healthy skin controls (10.5% vs. 2.1%). Patients with hyperhidrosis, alopecia and vitiligo had a more than eleven-fold increased chance (adjusted Odds Ratio (OR) > 11) of having BDD symptoms compared to healthy skin controls, and patients with atopic dermatitis, psoriasis, acne, hidradenitis suppurativa, prurigo and bullous diseases had a more than six-fold increased chance (adjusted OR > 6) of having BDD symptoms. Using a logistic regression model, BDD symptoms were significantly related to lower age, female sex, higher psychological stress and feelings of stigmatisation. CONCLUSIONS This study reveals that clinical BDD symptoms are significantly associated with common dermatological diseases. As such symptoms are associated with higher levels of psychological distress and multiple unhelpful consultations, general practitioners and dermatologists should consider BDD and refer patients when identified to an appropriate service for BDD screening and management.
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Affiliation(s)
- Christina Schut
- Institute of Medical Psychology, Justus-Liebig-University, Gießen, Germany
| | - Florence J Dalgard
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Dermatology and Venereology, Skåne University Hospital, Malmo, Sweden
| | - Anthony Bewley
- Barts Health NHS Trust & Queen Mary University of London, UK
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Department, Leiden University, The Netherlands
| | | | - Lars Lien
- Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway.,Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
| | | | - Sonja Ständer
- Department of Dermatology and Centre for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Lucia Tomas-Aragones
- Department of Psychology, University of Zaragoza, Spain.,Aragon Psychodermatology Research Group Zaragoza, Spain
| | - Nienke Vulink
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Andrew Y Finlay
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Franz J Legat
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | | | - Gregor B Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Laurent Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - Csanád Szabó
- Department of Dermatology and Allergology, University of Szeged, Hungary
| | - Vesna Grivcheva-Panovska
- University St. Cyril and Methodius, School of Medicine, PHI University Clinic of Dermatology Skopje, N. Macedonia
| | - Saskia Spillekom-van Koulil
- Radbout Institute for Health Sciences, Department of Medical Psychology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Flora Balieva
- Department of Dermatology, Stavanger University Hospital, Stavanger, Norway.,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Poland
| | - Adam Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, Poland
| | - Bárbara Roque Ferreira
- Centre for Philosophy of Science of the University of Lisbon, Portugal.,Department of Dermatology, Centre Hospitalier de Mouscron, Belgium.,University of Brest, Lien, France
| | - Andrey Lvov
- Central State Medical Academy of Department of Presidential Affairs, Moscow, Russia.,Medical Research and Educational Centre, Lomonosov Moscow State University, Moscow, Russia
| | - Dmitry Romanov
- Department of Psychiatry and Psychosomatics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,Department of Boundary Mental Conditions and Psychosomatic Disorders, Mental Health Research Centre, Moscow, Russia.,Moscow Scientific and Practical Centre of Dermatology, Venereology and Cosmetology of Moscow City Health Department, Moscow, Russia
| | - S E Marron
- Aragon Psychodermatology Research Group Zaragoza, Spain.,Department of Dermatology, University Hospital Miguel Servet, Zaragoza, Spain
| | | | - Å Svensson
- Department of Dermatology, Skane University Hospital, Malmö, Sweden
| | - Ilknur K Altunay
- University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Dermatology and Venereology Clinic, Istanbul, Turkey
| | - Andrew Thompson
- South Wales Clinical Psychology Training Programme, Cardiff & Vale University Health Board & School of Psychology, Cardiff University, Cardiff, UK
| | - Claudia Zeidler
- Department of Dermatology and Centre for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Joerg Kupfer
- Institute of Medical Psychology, Justus-Liebig-University, Gießen, Germany
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Ständer S, Zeidler C, Pereira M, Szepietowski JC, McLeod L, Qin S, Williams N, Sciascia T, Augustin M. Worst Itch Numerical Rating Scale for Prurigo Nodularis: A Psychometric Evaluation. J Eur Acad Dermatol Venereol 2021; 36:573-581. [PMID: 34908192 DOI: 10.1111/jdv.17870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/03/2021] [Accepted: 11/11/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Study TR03 evaluated the safety and efficacy of nalbuphine ER for prurigo nodularis (PN) (NCT02174419). OBJECTIVE We conducted supplementary analyses to assess the psychometric properties of the Worst Itch Numeric Rating Scale (WI-NRS), the TR03 primary endpoint. METHODS Study TR03 was a double-blind, placebo-controlled, phase 2 trial in PN patients with documented scores ≥5 on the WI-NRS (0 [no itch]-10 [worst itch imaginable]) on ≥5 of 7 days before baseline. Using TR03 data, the WI-NRS's psychometric properties, including reliability, validity, and ability to detect change, were evaluated. A responder threshold was estimated to facilitate interpretation of WI-NRS score changes. RESULTS Among 62 treated patients, improvements in mean [SD] (median) WI-NRS scores were observed between baseline (8.2 [1.21] (8.1)) and Week 10 (5.8 [2.43] (6.0)). The WI-NRS had an intraclass correlation coefficient of 0.96 (95% confidence interval, 0.93-0.98) in 42 patients who had stable Itch verbal rating scale (VRS) scores from Week 9-10, supporting strong test-retest reliability. Construct validity was supported, with strong correlations at Week 10 with Average Itch NRS (r=0.87) and Itch VRS single-day/weekly mean scores (r=0.81/0.89) and moderate correlations with ItchyQoLTM total/domain scores (r=0.41-0.43). The WI-NRS discriminated between predefined severity subgroups based on the Itch VRS and detected changes in itching severity (effect-size estimate: -2.05; standardized response mean: -1.21). An anchor-based threshold based on a two-category improvement in the single-day Itch VRS suggests a responder threshold of ≥3.8 points (~40% improvement). CONCLUSIONS The WI-NRS demonstrates good measurement properties, supporting its use in evaluating treatment change in PN.
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Affiliation(s)
- S Ständer
- University Hospital Münster, Münster
| | - C Zeidler
- University Hospital Münster, Münster
| | - M Pereira
- University Hospital Münster, Münster
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | | | | | | | | | - M Augustin
- University Medical Center Hamburg-Eppendorf
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Weisshaar E, Szepietowski JC, Bernhard JD, Hait H, Legat FJ, Nattkemper L, Reich A, Sadoghi B, Sciascia TR, Zeidler C, Yosipovitch G, Ständer S. Efficacy and safety of oral nalbuphine extended release in prurigo nodularis: results of a phase 2 randomized controlled trial with an open-label extension phase. J Eur Acad Dermatol Venereol 2021; 36:453-461. [PMID: 34780095 DOI: 10.1111/jdv.17816] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/22/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Treatment of prurigo nodularis (PN) is challenging and new treatment options are needed. OBJECTIVE To evaluate the efficacy and safety of two oral doses of the kappa opioid agonist and mu opioid antagonist nalbuphine extended release (NAL-ER) tablets in a phase 2, multicentre, randomized, double-blind, placebo-controlled trial with an open-label, 50-week extension phase. METHODS Subjects with moderate-to-severe PN were randomized to NAL-ER 81 mg (NAL-ER81) or 162 mg (NAL-ER162) tablets twice-daily or placebo for 8 weeks of stable dosing following a 2-week titration period. Subjects completing Week 10 with a Worst Itch Numerical Rating Scale (WI-NRS) score ≥5 at the time of rollover (or during the observation period) were eligible for open-label treatment. RESULTS Of 63 randomized subjects, 62 were treated and comprised the modified intent-to-treat population (MITT), 50 completed 10 weeks of treatment. In the MITT analysis, 8 subjects (44.4%) treated with NAL-ER162 (P = 0.32) and 6 (27.3%) treated with NAL-ER81 (P = 0.78) achieved ≥30% reduction from baseline in 7-day WI-NRS at Week 10 (primary efficacy endpoint) vs. 8 (36.4%) in the placebo group. Itch reduction was significant among 8/12 (66.7%) subjects completing Week 10 treated with NAL-ER162 vs. placebo (8/20, 40.0%; P = 0.03). Additionally, 6 subjects (33.3%) treated with NAL-ER162 and 3 (13.6%) treated with NAL-ER81 achieved ≥50% reduction from baseline in 7-day WI-NRS at Week 10 (coprimary endpoint). Extended open-label treatment was associated with further improvements in itch reduction and favourable changes in PN lesion activity as assessed by Prurigo Activity Score. Adverse events occurred predominantly during dose titration and were of mild-to-moderate severity. The safety profile did not change with extended open-label treatment. CONCLUSION In adult subjects with PN, oral treatment with NAL-ER 162 mg twice daily provided measurable anti-pruritic efficacy in subjects completing ≥10 weeks of treatment and was well tolerated (ClinicalTrials.gov: NCT02174419).
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Affiliation(s)
- E Weisshaar
- Occupational Dermatology, Department of Dermatology, Heidelberg University Hospital, Heidelberg, Germany
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - J D Bernhard
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA
| | - H Hait
- Trevi Therapeutics, Inc., New Haven, CT, USA
| | - F J Legat
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - L Nattkemper
- Department of Dermatology, Miller School of Medicine and Miami Itch Center, Miami, FL, USA
| | - A Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszów University, Rzeszów, Poland
| | - B Sadoghi
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | | | - C Zeidler
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - G Yosipovitch
- Department of Dermatology, Miller School of Medicine and Miami Itch Center, Miami, FL, USA
| | - S Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
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Pereira MP, Zeidler C, Ständer S. Improvement of Chronic Kidney Disease-Associated Pruritus After Treatment With Intravenous Naloxone. JAMA Dermatol 2021; 157:1380-1381. [PMID: 34586358 DOI: 10.1001/jamadermatol.2021.3829] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Manuel P Pereira
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Claudia Zeidler
- 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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36
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Schneider G, Zeidler C, Pereira MP, Ständer S. One third of Chronic Prurigo patients scratch automatically and in the absence of itch - a naturalistic study of 1142 patients. J Eur Acad Dermatol Venereol 2021; 36:e297-e300. [PMID: 34705294 DOI: 10.1111/jdv.17777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/01/2021] [Accepted: 10/22/2021] [Indexed: 01/31/2023]
Affiliation(s)
- G Schneider
- Section for Psychosomatic Medicine and Psychotherapy, Department of Mental Health, University Hospital Münster, Münster, Germany.,Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - C Zeidler
- Center for Chronic Pruritus, University Hospital Münster, Münster, Germany.,Department of Dermatology, University Hospital Münster, Münster, Germany
| | - M P Pereira
- Center for Chronic Pruritus, University Hospital Münster, Münster, Germany.,Department of Dermatology, University Hospital Münster, Münster, Germany
| | - S Ständer
- Center for Chronic Pruritus, University Hospital Münster, Münster, Germany.,Department of Dermatology, University Hospital Münster, Münster, Germany
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37
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Pereira MP, Zeidler C, Ständer S. Clinical characteristics of chronic nodular prurigo are independent of Fitzpatrick skin type: a European prospective cross-sectional study. J Eur Acad Dermatol Venereol 2021; 36:e225-e227. [PMID: 34661933 DOI: 10.1111/jdv.17756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/15/2021] [Indexed: 11/28/2022]
Affiliation(s)
- M P Pereira
- 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
| | - S Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
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38
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Nau TG, Rau V, Zeidler C, Ständer S, Pereira MP. Hand Pruritus: Clinical Profile, Functional Impairment and Disease-related Burden in a Prospective Cohort Study of 395 Patients. Acta Derm Venereol 2021; 101:adv00562. [PMID: 34515798 PMCID: PMC9425562 DOI: 10.2340/00015555-3925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Human hands are complex structures essential for a variety of functions in everyday life. This study prospectively investigated the clinical features of hand pruritus and the resulting functional impairment and disease-related burden in 395 patients with chronic pruritus (210 females, median age 59 years). Moderate to very severe hand pruritus was reported by 91.2% of patients, while 79% perceived additional sensory symptoms, such as burning, pain or tingling. A long duration of pruritus occurred in most cases (>6 months: 71.4%). A considerable proportion of patients showed moderate to severe impairment in the use of their hands (40.2%), performance of daily activities (65.0%) and quality of life (45.2%). Disease severity and burden is particularly high when both the palms and the backs of the hands are affected, and when pain is present simultaneously. Pruritus located on the hands is impairing and burdensome due to the functional relevance of the hands in everyday life.
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Affiliation(s)
- Teresa Gabriele Nau
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
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Pereira MP, Görg M, Zeidler C, Ständer S. Periumbilical neuropathic pruritus in an infant: presentation of a spinal intramedullary neoplasm. J Eur Acad Dermatol Venereol 2021; 36:e132-e133. [PMID: 34551166 DOI: 10.1111/jdv.17696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- M P Pereira
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - M Görg
- 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
| | - S Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
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Pereira MP, Farcas A, Zeidler C, Ständer S. Chronic Pruritus of Unknown Origin: Clinical Profile and Disease-Related Burden. Acta Derm Venereol 2021; 101:adv00550. [PMID: 34405244 PMCID: PMC9425595 DOI: 10.2340/00015555-3892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Chronic pruritus of unknown origin is established when no underlying origin for pruritus can be determined. This retrospective cohort study aimed to determine the clinical profile and disease-related burden of chronic pruritus of unknown origin. A total of 263 patients (female/male: 154/109, median age 55 years) were included. Moderate to severe itch intensities were recorded (median average itch: 5.5/10, n = 200; median worst itch: 7.5/10, n = 199). In most cases pruritus lasted longer than 1 year (77.6%), occurred daily (68.2%), occurred in attacks (72.8%), and was often accompanied by dysaesthesias, such as burning, tingling and stinging. Quality of life was moderately impaired, while 22.2% and 12.4% of patients showed pathological anxiety and depression scores. Scratch lesions were associated with higher intensities of itch and greater impairment of quality of life, while women were more burdened by the disease than men. Chronic pruritus of unknown origin may occur at any age and the majority of patients endure severe itch with substantial disease-related burden.
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Affiliation(s)
- Manuel P Pereira
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Von- Esmarch-Str. 58, DE-48149 Münster, Germany. E-mail:
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Zeidler C, Pereira MP, Ständer S. Chronic Prurigo: Similar Clinical Profile and Burden Across Clinical Phenotypes. Front Med (Lausanne) 2021; 8:649332. [PMID: 34268319 PMCID: PMC8277241 DOI: 10.3389/fmed.2021.649332] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 06/07/2021] [Indexed: 11/13/2022] Open
Abstract
Chronic prurigo is a debilitating skin disease characterized by the presence of chronic pruritus and scratching-related pruriginous lesions. The pruriginous lesions can differ in their clinics what has recently been categorized into different clinical phenotypes. The most common one is chronic nodular prurigo (syn. prurigo nodularis); other phenotypes are papular, plaque, umbilicated, and linear prurigo. A comparison between these phenotypes regarding similarities and differences has not yet been performed. In this explorative analysis, itch characteristics, scratching behavior, and disease burden of the nodular, papular, plaque, and umbilicated prurigo were investigated in 1,128 patients. Patients with nodular and plaque prurigo were younger than patients with papular and umbilicated prurigo. The shortest duration of the underlying pruritus was found in papular and umbilicated prurigo, the longest in plaque prurigo. Itch intensity, impairment of sleep, mood and the quality of life did not differ. These findings confirm that the clinical phenotypes of chronic prurigo belong to a spectrum of one disease with similar disease characteristics and can be categorized under the umbrella term of chronic prurigo. Future clinical trials should include all phenotypes of chronic prurigo.
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Affiliation(s)
- Claudia Zeidler
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Manuel Pedro Pereira
- 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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Görg M, Zeidler C, Pereira MP, Ständer S. Generalisierter chronischer Pruritus bei Fibromyalgie. J Dtsch Dermatol Ges 2021; 19:909-911. [PMID: 34139073 DOI: 10.1111/ddg.14498_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Max Görg
- Kompetenzzentrum chronischer Pruritus (KCP), Klinik für Hautkrankheiten, Universitätsklinikum Münster
| | - Claudia Zeidler
- Kompetenzzentrum chronischer Pruritus (KCP), Klinik für Hautkrankheiten, Universitätsklinikum Münster
| | - Manuel P Pereira
- Kompetenzzentrum chronischer Pruritus (KCP), Klinik für Hautkrankheiten, Universitätsklinikum Münster
| | - Sonja Ständer
- Kompetenzzentrum chronischer Pruritus (KCP), Klinik für Hautkrankheiten, Universitätsklinikum Münster
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Görg M, Zeidler C, Pereira MP, Ständer S. Generalized chronic pruritus with fibromyalgia. J Dtsch Dermatol Ges 2021; 19:909-911. [PMID: 33768611 DOI: 10.1111/ddg.14498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Max Görg
- Kompetenzzentrum chronischer Pruritus (KCP), Klinik für Hautkrankheiten, Universitätsklinikum Münster
| | - Claudia Zeidler
- Kompetenzzentrum chronischer Pruritus (KCP), Klinik für Hautkrankheiten, Universitätsklinikum Münster
| | - Manuel P Pereira
- Kompetenzzentrum chronischer Pruritus (KCP), Klinik für Hautkrankheiten, Universitätsklinikum Münster
| | - Sonja Ständer
- Kompetenzzentrum chronischer Pruritus (KCP), Klinik für Hautkrankheiten, Universitätsklinikum Münster
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Gabes M, Zeidler C, Ständer S, Chen SC, Apfelbacher CJ. Refinement and validation of the ItchyQoL using classical test theory and item response theory resulted in a reduction of the response categories from a 5-point to a 3-point scale. Br J Dermatol 2021; 185:548-554. [PMID: 33763849 DOI: 10.1111/bjd.20082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND The ItchyQoL is an itch-specific patient-reported outcome measure used to assess quality of life in patients with chronic pruritus (CP). OBJECTIVES We aimed to assess and extend the psychometric properties of the ItchyQoL using classical test theory (CTT) and item response theory (IRT). METHODS Item characteristic curves were analysed to investigate whether the response categories were functioning optimally. Confirmatory factor analyses were carried out on the ItchyQoL prior to and after rescoring of the response categories. We conducted a Rasch analysis for the ItchyQoL with revised response options and assessed the mean fit residuals in addition to the assumptions of unidimensionality and local independence. RESULTS In total, 551 patients with CP from nine European countries completed the 22 items of the ItchyQoL. IRT analysis supported the revision of response options from five points to three. This revision was supported by excellent structural validity using CTT. The overall fit to the Rasch model was adequate. Unidimensionality was supported by the ItchyQoL overall scale and by the single subscales; however, local independence was violated in eight cases. CONCLUSIONS We suggest a revision of the response categories of the ItchyQoL from a 5-point to a 3-point scale. When this revision was applied, the ItchyQoL showed excellent structural validity according to CTT and IRT/Rasch. The calculation of an overall ItchyQoL sum score is allowed.
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Affiliation(s)
- M Gabes
- Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdeburg, Germany.,Medical Sociology, Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - C Zeidler
- Department of Dermatology and Center for Chronic Pruritus, University Hospital of Münster, Münster, Germany
| | - S Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital of Münster, Münster, Germany
| | - S C Chen
- Department of Dermatology, Duke University School of Medicine, Durham, NC, 27710, USA
| | - C J Apfelbacher
- Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdeburg, Germany
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45
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Kimel M, Zeidler C, Kwon P, Revicki D, Ständer S. Validation of Psychometric Properties of the Itch Numeric Rating Scale for Pruritus Associated With Prurigo Nodularis: A Secondary Analysis of a Randomized Clinical Trial. JAMA Dermatol 2021; 156:1354-1358. [PMID: 32936233 DOI: 10.1001/jamadermatol.2020.3071] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance There is an unmet need for psychometrically sound instruments to measure pruritus associated with prurigo nodularis (PN). Objective To evaluate the psychometric properties of the itch numeric rating scale (itch NRS), both the Worst Itch Numeric Rating Scale (WI-NRS) and the Average Itch Numeric Rating Scale (AI-NRS). Design, Setting, and Participants This secondary analysis is based on a secondary end point of a phase 2 randomized clinical trial of serlopitant for treatment of pruritus associated with PN. This randomized, double-blind, placebo-controlled study was conducted at 15 sites in Germany. Eligible patients were aged 18 to 80 years and had generalized PN for more than 6 weeks that was refractory to previous antipruritic therapies. Patients were required to have a visual analog scale itch score of 7 or higher at screening. Data were collected from July 2014 to June 2016 and analyzed from June 2016 to January 2017. Main Outcomes and Measures The itch NRS (AI-NRS and WI-NRS) was correlated together with the following measures: the electronic verbal rating scale (eVRS) for itch self-categorization, average itch visual analog scale (AI-VAS), worst itch visual analog scale (WI-VAS), the pruritus-specific quality-of-life rating instrument ItchyQoL, Dermatology Life Quality Index (DLQI), and Prurigo Activity and Severity Score (items 7b and 7a: percentage healed prurigo lesions and percentage of prurigo lesions with excoriations). Results There were 123 participants in this study; the mean (SD) age of participants was 57.3 (11.58) years, and 58 (47.2%) were male. Strong associations (r ≥ 0.5) were observed between itch NRS items (WI-NRS and AI-NRS) and AI-VAS (24 hours) at weeks 2, 4, and 8 (r = 0.72-0.90; P < .001). Similar strong associations were also observed between itch NRS items and WI-VAS (24 hours) and eVRS for itch severity across weeks 2, 4, and 8 (r = 0.65-0.92; all P < .001). Strong correlations were seen between change scores for WI-NRS and WI-VAS and AI-VAS (r = 0.76 and 0.70, respectively; both P < .001). Similar findings were seen for AI-NRS, where correlations between change scores for WI-VAS and AI-VAS were 0.71 and 0.72, respectively (both P < .001). Analyses for the itch NRS items also showed that test-retest reliability was acceptable and provided evidence of acceptable convergent validity based on the eVRS and visit verbal rating score for itch self-categorization, ItchyQoL, and DLQI. Conclusions and Relevance Results from this secondary analysis show that the itch NRS items WI-NRS and AI-NRS have good psychometric properties for pruritus associated with PN and should be considered acceptable tools for assessing pruritus in future clinical trials of PN. Trial Registration ClinicalTrials.gov Identifier: NCT02196324.
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Affiliation(s)
| | - Claudia Zeidler
- Center for Chronic Pruritus, Department of Dermatology, University Hospital Münster, Münster, Germany
| | - Paul Kwon
- Menlo Therapeutics Inc, Redwood City, California
| | | | - Sonja Ständer
- Center for Chronic Pruritus, Department of Dermatology, University Hospital Münster, Münster, Germany
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46
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Zeidler C, Pereira MP, Augustin M, Spellman M, Ständer S. Investigator's Global Assessment of Chronic Prurigo: A New Instrument for Use in Clinical Trials. Acta Derm Venereol 2021; 101:adv00401. [PMID: 33236125 PMCID: PMC9366679 DOI: 10.2340/00015555-3701] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Chronic prurigo is a pruritic disease characterized by the development of pruriginous lesions due to scratching. The number of lesions is representative of the stage of the disease, while the presence of excoriations reflects the scratching activity. Aim of this study was to validate a new developed tool for the objective assessment of chronic prurigo. Investigator’s Global Assessment scales for stage and activity were completed for 187 patients with chronic prurigo, who also reported patient-reported outcomes for itch intensity and quality of life. To assess the reliability and objectivity of the Investigator’s Global Assessment, 5 independent raters completed the Investigator’s Global Assessment scales for 8 patients twice. The scores increased with increased intensity of pruritus. The Investigator’s Global Assessment stage scales correlated strongly with each other (Kendall’s-tau-b 0.62) and moderately with the Investigator’s Global Assessment activity scale (Kendall’s-tau-b 0.47). Intra-rater test–retest reliability was excellent for all items, while the congruence among raters was very good for Investigator’s Global Assessment – chronic prurigo activity (Kendall’s W 0.84) and good for Investigator’s Global Assessment stage scales (Kendall’s W 0.747). Investigator’s Global Assessment – chronic prurigo stage and activity are thus the best Investigator’s Global Assessment instruments for use in assessing chronic prurigo.
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Affiliation(s)
- Claudia Zeidler
- Center for Chronic Pruritus, Department of Dermatology, University Hospital Münster, Von- Esmarch-Str. 58, DE-48149 Münster, Germany. E-mail:
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47
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Pereira MP, Zeidler C, Wallengren J, Halvorsen JA, Weisshaar E, Garcovich S, Misery L, Brenaut E, Şavk 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, Nau T, Hoffmann V, Steinke S, Greiwe I, Dugas M, Augustin M, Ständer S. Chronic Nodular Prurigo: A European Cross-sectional Study of Patient Perspectives on Therapeutic Goals and Satisfaction. Acta Derm Venereol 2021; 101:adv00403. [PMID: 33320272 PMCID: PMC9366694 DOI: 10.2340/00015555-3726] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Chronic nodular prurigo is characterized by recalcitrant itch. Patient perspectives on therapeutic goals, satisfaction with therapy and efficacy of therapeutic regimens for this condition are unknown. This questionnaire study examined these issues in 406 patients with chronic nodular prurigo from 15 European dermatological centres. Improvements in itch, skin lesions and sleep were the most important goals. Emollients, topical corticosteroids and antihistamines were the most frequently used treatments, while a minority of patients were prescribed potent medications, such as systemic immunosuppressants and gabapentinoids. Most patients were not satisfied with their previous therapy (56.8%), while 9.8% did not receive any therapy despite having active disease. A substantial number of respondents (28.7%) considered none of the therapeutic options effective. Although chronic nodular prurigo is a severe disease, most patients were not treated with potent systemic drugs, which may contribute to the high levels of dissatisfaction and disbelief in available therapies. Specific guidelines for chronic nodular prurigo and the development of novel therapies are necessary to improve care.
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Affiliation(s)
- Manuel P Pereira
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Von- Esmarch-Str. 58, DE-48149 Münster, Germany. E-mail:
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48
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Storck M, Sandmann S, Bruland P, Pereira MP, Steinke S, Riepe C, Soto-Rey I, Garcovich S, Augustin M, Blome C, Bobko S, Legat FJ, Potekaev N, Lvov A, Misery L, Weger W, Reich A, Şavk E, Streit M, Serra-Baldrich E, Szepietowski JC, Dugas M, Ständer S, Zeidler C. Pruritus Intensity Scales across Europe: a prospective validation study. J Eur Acad Dermatol Venereol 2021; 35:1176-1185. [PMID: 33411947 DOI: 10.1111/jdv.17111] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/01/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chronic pruritus (CP) is a subjective symptom, and it is necessary to assess its intensity with validated patient-reported outcome tools in order to allow determination of the treatment course. OBJECTIVES So far, the itch intensity scales were validated in small cohorts and in single languages. Here, we report the validation of the numerical rating scale, the verbal rating scale and the visual analogue scale for the worst and average pruritus intensity in the last 24h in several languages across Europe and across different pruritic dermatoses. METHODS After professional translation, the intensity scales were digitized for use as a tablet computer application. Validation was performed in clinics for Dermatology in Austria, France, Germany, Italy, Poland, Russia, Spain, Switzerland and Turkey. RESULTS A total of 547 patients with contact dermatitis, chronic nodular prurigo, psoriasis vulgaris, lichen planus or cutaneous T-cell lymphoma were included. The intensity scales showed a high level of reproducibility and inter-correlations with each other. The correlation with the Dermatology Life Quality Index was weak to strong in nearly all countries and dermatoses with the exception of France and patients with chronic nodular prurigo, for which no statistically significant correlations were found. CONCLUSIONS The numerical rating scale, the verbal rating scale und the visual analogue scales are valid instruments with good reproducibility and internal consistency in German (Germany, Austria, Switzerland), French, Italian, Polish, Russian, Spanish and Turkish for different pruritic dermatoses. VAS worst was the best reproducible and consistent measuring instrument in all countries.
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Affiliation(s)
- M Storck
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - S Sandmann
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - P Bruland
- Institute of Medical Informatics, University of Münster, Münster, Germany.,inIT - Institute Industrial IT, Ostwestfalen-Lippe University of Applied Sciences, Lemgo, Germany
| | - M P Pereira
- 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
| | - C Riepe
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - I Soto-Rey
- Institute of Medical Informatics, University of Münster, Münster, Germany.,IT-Infrastructure for Translational Medical Research, Faculty of Applied Computer Science, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - S Garcovich
- Dermatology, F. Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Blome
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Bobko
- Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology, Moscow, Russia
| | - F J Legat
- Department of Dermatology, Medical University of Graz, Graz, Austria.,Das Kurhaus, Bad Gleichenberg, Austria
| | - 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
| | - L Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - W Weger
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - A Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszów, Poland
| | - E Şavk
- Department of Dermatology, Aydin Adnan Menderes University, Aydin, Turkey
| | - M Streit
- Department of Dermatology, Kantonsspital Aarau, Aarau, Switzerland
| | - E Serra-Baldrich
- Cutaneous Allergy Unit, Department of Dermatology, Hospital Sant Pau, Universitat Autònoma, Barcelona, Barcelona, Spain
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - 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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49
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Lipman ZM, Magnolo N, Golpanian RS, Storck M, Yosipovich G, Zeidler C. Comparison of itch characteristics and sleep in patients with brachioradial pruritus and notalgia paresthetica: A retrospective analysis from 2 itch centers. JAAD Int 2020; 2:96-97. [PMID: 34409357 PMCID: PMC8362268 DOI: 10.1016/j.jdin.2020.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Zoe M Lipman
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami, Florida
| | - Nina Magnolo
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Germany
| | - Rachel S Golpanian
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami, Florida
| | - Michael Storck
- Institute for Medical Informatics and Center for Chronic Pruritus, University Hospital Münster, Germany
| | - Gil Yosipovich
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami, Florida
| | - Claudia Zeidler
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Germany
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50
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Zeidler C, Pereira MP, Dugas M, Augustin M, Storck M, Weyer-Elberich V, Schneider G, Ständer S. The burden in chronic prurigo: patients with chronic prurigo suffer more than patients with chronic pruritus on non-lesional skin: A comparative, retrospective, explorative statistical analysis of 4,484 patients in a real-world cohort. J Eur Acad Dermatol Venereol 2020; 35:738-743. [PMID: 32924186 DOI: 10.1111/jdv.16929] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/05/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Chronic prurigo (CPG) is known as a high burdensome disease characterized by severe pruritus and multiple pruriginous lesions. Interestingly, the disease-specific burden is not well established and there are no data which compare the impact of CPG with chronic pruritus (CP) on non-lesional skin (CP-NL). OBJECTIVES To address this issue, we analysed datasets from 4484 patients with either CPG or CP-NL. METHODS Demographic medical data and additional information collected by validated patient reported outcome tools were analysed. The visual analogue scale and numerical rating scale (NRS) were used for assessing the pruritus intensity, the ItchyQoL for patients' quality of life, the Hospital Anxiety and Depression Scale and the Patient Needs Questionnaire' as a part of Patient Benefit Index for Pruritus for measuring the importance of 27 patient needs in terms of treatment goals. The Neuroderm questionnaire was used to assess the history of pruritus characteristics and the impact on sleep. RESULTS Patients with CPG suffered longer and with a higher intensity from pruritus [NRS worst the last 24 h, CPG 6.0 (4.0;8.0) vs. CP-NL 3.0 (5.0;7.0), P < 0.001]. In them, pruritus occurred more often and the whole day and night which led to more loss in sleeping hours [CPG 3.0 h (2.0;4.0) vs. CP-NL 2.0 h (1.0;4.0), P < 0.001]. Patients with CPG showed higher scores for depression [HADS-D, CPG 6.0 (3.0;10.0) vs. CP-NL 5.0 (2.0;8.0), P < 0.001], more impaired quality of life [ItchyQol; CPG: 72.6 (61.6;83.6) vs. CP-NL 59.4 (48.4;70.4), P < 0.001] and higher weighted needs in the predefined treatment goals. DISCUSSION Not only the presence of severe pruritus and pruriginous lesions but also sleep disorders and other mental symptoms may contribute to a higher burden in patients with CPG when compared with patients with CP-NL.
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Affiliation(s)
- C Zeidler
- Center for Chronic Pruritus, University Hospital Münster, Muenster, Germany
| | - M P Pereira
- Center for Chronic Pruritus, University Hospital Münster, Muenster, Germany
| | - M Dugas
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - M Augustin
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - M Storck
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - V Weyer-Elberich
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - G Schneider
- Department of Psychosomatics and Psychotherapy, University Hospital Münster, Muenster, Germany
| | - S Ständer
- Center for Chronic Pruritus, University Hospital Münster, Muenster, Germany
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