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Pereira MP, Gutsche A, 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, Goncalo M, Szepietowski JC, Augustin M, Zeidler C, Ständer S. Chronic nodular prurigo: Association between comorbidities, itch and quality of life. J Eur Acad Dermatol Venereol 2024. [PMID: 38736376 DOI: 10.1111/jdv.20038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/02/2024] [Indexed: 05/14/2024]
Affiliation(s)
- M P Pereira
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | - A Gutsche
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | - E Weisshaar
- Division of Occupational Dermatology, Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - J A Halvorsen
- Department of Dermatology, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - J Wallengren
- Department of Dermatology and Venereology, Skane University Hospital, Lund University, Lund, Sweden
| | - F J Legat
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - S Garcovich
- Catholic University of the Sacred Heart, Rome, Italy
| | - E Savk
- Department of Dermatology, Aydın Adnan Menderes University, Aydın, Turkey
| | - A Reich
- Department of Dermatology, University of Rzeszów, Rzeszów, Poland
| | - A Bozek
- Department of Dermatology, University of Rzeszów, Rzeszów, Poland
| | - A 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
| | - S Bobko
- Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology, Moscow, Russia
| | - M Metz
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
| | - M Streit
- Department of Dermatology, Kantonsspital Aarau, Aarau, Switzerland
| | - L Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - E Brenaut
- Department of Dermatology, University Hospital of Brest, Brest, France
| | | | - M Goncalo
- Department of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - M 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
| | - C Zeidler
- Department of Dermatology, Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - S Ständer
- Department of Dermatology, Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
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2
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Pereira MP, Metz M. [Chronic prurigo]. Dermatologie (Heidelb) 2023; 74:889-898. [PMID: 37721563 DOI: 10.1007/s00105-023-05222-6] [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: 08/10/2023] [Indexed: 09/19/2023]
Abstract
Chronic prurigo is a very debilitating skin condition characterized by the development of multiple pruriginous nodules, papules or plaques due to a prolonged scratching behavior as a result of chronic itch. Patients often experience anxiety, depression or sleep impairment leading to a substantial decrease in quality of life. Due to the complex pathophysiology and diversity in clinical presentation, managing chronic prurigo remains a challenge. Disease-specific guidelines provide appropriate diagnostic measures and recommend a step-wise therapeutic approach. With the increase of pharmaceutical interest in chronic prurigo, several innovative therapies including monoclonal antibodies and small molecules are currently being investigated for chronic prurigo. This continuing medical education (CME) article provides an overview on various aspects of chronic prurigo, especially on epidemiology, pathophysiology, clinical presentation, diagnostic and therapeutic approach, and innovate therapeutic options.
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Affiliation(s)
- Manuel P Pereira
- Institut für Allergieforschung, Charité - Universitätsmedizin Berlin, Hindenburgdamm 27, 12203, Berlin, Deutschland.
- Fraunhofer Institut für Translationale Medizin und Pharmakologie ITMP, Allergologie und Immunologie, Berlin, Deutschland.
| | - Martin Metz
- Institut für Allergieforschung, Charité - Universitätsmedizin Berlin, Hindenburgdamm 27, 12203, Berlin, Deutschland
- Fraunhofer Institut für Translationale Medizin und Pharmakologie ITMP, Allergologie und Immunologie, Berlin, Deutschland
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3
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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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4
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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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5
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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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6
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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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7
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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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8
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Dehghan Nayyeri M, Missler M, Ritterbach R, Sundermann B, Wulms N, Süer A, Dugas M, Pereira MP, Ständer S, Schmelz M, Pfleiderer B. Altered resting-state functional connectivity of default mode network in brachioradial pruritus. J Eur Acad Dermatol Venereol 2022; 36:2214-2223. [PMID: 35796634 DOI: 10.1111/jdv.18411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/15/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with chronic pruritus (CP) have a low quality of life, thus it is important to gain a better understanding of the underlying processes. Previous functional magnetic resonance imaging studies at rest (rs-fMRI) have shown that mainly areas associated with the default mode network (DMN), sensorimotor (SMN), frontoparietal (FPN) and salience networks (SN) are involved in the processing of itch in patients with chronic pruritus (CP), as well as the cortico-striatal circuit, which is involved in the motoric preparation of scratching. rs-fMRI studies on functional connectivity (FC) patterns of resting-state networks (RSNs) in patients with inflammatory atopic dermatitis (AD) or with neuropathic brachioradial pruritus (BRP) compared to healthy controls (HC) are lacking. OBJECTIVES The main goals of this study were to investigate whether functional connectivity within networks and areas associated with itch detection and processing are altered in patients with AD and BRP compared to matched healthy controls by rsfMRI, respectively. METHODS Patients with AD (n = 28) and with BRP (n = 28) were compared to corresponding matched healthy controls by rsfMRI. Group specific RSNs were identified by independent component analysis (ICA) and between-group differences in the RSNs were analyzed by dual regression technique. Seed-based functional connectivity was analyzed in several itch-related brain regions belonging to the DMN, SN and FPN, respectively. RESULTS ICA and seed-based analyses revealed decreased functional connectivity in BRP compared to HC specially within the DMN including the precuneus and cingulate cortex. For AD patients in comparison to HC, as well as when BRP and AD patients when compared directly, no significant FC differences at rest were seen. CONCLUSIONS Our findings point towards decreased FC particularly in the DMN at rest in patients with BRP. These results seem to indicate that central connectivity patterns at rest differentially encode itch in BRP and AD.
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Affiliation(s)
- Mahboobeh Dehghan Nayyeri
- Clinic of Radiology, University Hospital Muenster, Medical Faculty, University of Muenster, Muenster, Germany.,Department of Psychosomatic Medicine and Psychotherapy, LVR Clinic, Medical Faculty of the Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Miriam Missler
- Clinic of Radiology, University Hospital Muenster, Medical Faculty, University of Muenster, Muenster, Germany
| | - Rebecca Ritterbach
- Clinic of Radiology, University Hospital Muenster, Medical Faculty, University of Muenster, Muenster, Germany
| | - Benedikt Sundermann
- Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus, Medical Campus, University of Oldenburg, Oldenburg, Germany.,Research Center Neurosensory Science, University of Oldenburg, Oldenburg, Germany
| | - Niklas Wulms
- Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany
| | - Aysenur Süer
- Institute of Medical Informatics, University of Muenster, Muenster, Germany
| | - Martin Dugas
- Institute of Medical Informatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Manuel P Pereira
- Center for Chronic Pruritus, Department of Dermatology, University Hospital Muenster, Germany
| | - Sonja Ständer
- Center for Chronic Pruritus, Department of Dermatology, University Hospital Muenster, Germany
| | - Martin Schmelz
- Department of Experimental Pain Research, MCTN, Medical Faculty Mannheim, Heidelberg of University, Mannheim, Germany
| | - Bettina Pfleiderer
- Clinic of Radiology, University Hospital Muenster, Medical Faculty, University of Muenster, Muenster, Germany.,Otto Creutzfeld Center for Cognitive and Behavioral Neuroscience, Muenster, Germany
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9
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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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10
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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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11
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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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12
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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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13
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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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14
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Abstract
We report a case of a 57-year-old slightly obese woman with localized itch on the arms accompanied by stinging and burning sensations. A few excoriations were observed upon clinical examination. The MRI examination of the cervical spine revealed a meningioma at C5/C6 level. The diagnosis of brachioradial pruritus due to compression of the cervical myelon was further supported by a positive ice-pack sign. Disc herniation or prolapse, foraminal stenosis and degenerative alterations constitute other possible causes of brachioradial pruritus.
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Affiliation(s)
- Julia Wermelt
- 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
| | - Manuel P Pereira
- Kompetenzzentrum chronischer Pruritus (KCP), Klinik für Hautkrankheiten, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland
| | - Manoj Mannil
- Kompetenzzentrum chronischer Pruritus (KCP), Klinik für Hautkrankheiten, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland
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15
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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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16
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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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17
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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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18
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Augustin M, Garbe C, Hagenström K, Petersen J, Pereira MP, Ständer S. Prevalence, incidence and presence of comorbidities in patients with prurigo and pruritus in Germany: A population-based claims data analysis. J Eur Acad Dermatol Venereol 2021; 35:2270-2276. [PMID: 34192369 DOI: 10.1111/jdv.17485] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 03/05/2021] [Revised: 06/07/2021] [Accepted: 06/17/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND There are currently no published population-based data on prurigo and pruritus epidemiology in Germany. OBJECTIVES We present the prevalence, incidence and comorbidity frequency of prurigo and pruritus in Germany. METHODS This was a retrospective healthcare research study based on anonymized routine data from the German health insurance company DAK-Gesundheit. Evaluations were carried out for 2 006 003 adults who were insured as of 31 December 2010. Prurigo and pruritus diagnoses were based on International Classification of Diseases, Tenth Revision, German Modification (ICD-10-GM) codes. RESULTS Prevalence was determined to be 0.21% (adjusted for sex and age 0.19%) for prurigo and 2.21% (adjusted 2.14%) for pruritus in 2010. The adjusted rates extrapolated to the total German population in 2010 show that 130 685 adults would have received a prurigo diagnosis and 1 461 024 a diagnosis of pruritus. In 2011, incidence of new prurigo and pruritus cases was 0.13% (adjusted 0.12%, extrapolated 77 263 cases) and 1.51% (adjusted 1.46%, extrapolated 978 885), respectively. Adults with prurigo suffered most frequently from hypertension (35.16%), hyperlipidaemia (24.95%) and depression (21.97%); all were reported more frequently in patients with prurigo compared with the general population (P < 0.001). Similarly, adults with pruritus suffered most frequently from hypertension (31.28%), hyperlipidaemia (23.52%) and depression (18.91%) compared with patients without pruritus (P < 0.001). CONCLUSIONS Our data show that prurigo is a relatively rare but significant disease and that pruritus is frequent and very variable in appearance, and both have a high comorbidity burden.
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Affiliation(s)
- M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - C Garbe
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - K Hagenström
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - J Petersen
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - M P Pereira
- 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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19
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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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20
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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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21
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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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22
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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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23
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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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24
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Pereira MP, Ziehfreund S, Rueth M, Ewering T, Legat FJ, Lambert J, Elberling J, Misery L, Brenaut E, Papadavid E, Garcovich S, Evers AWM, Halvorsen JA, Szepietowski JC, Reich A, Gonçalo M, Lvov A, Bobko S, Serra-Baldrich E, Wallengren J, Savk E, Leslie T, Ständer S, Zink A. Google search trends for itch in Europe: a retrospective longitudinal study. J Eur Acad Dermatol Venereol 2021; 35:1362-1370. [PMID: 33295009 DOI: 10.1111/jdv.17077] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/10/2020] [Accepted: 10/21/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Itch is a common symptom in the general population. Affected individuals often do not seek medical consultation and rely on Internet searches to obtain information regarding their itch. OBJECTIVES The aim of this study was to attain insights into common concerns of the general population regarding itch can by analysing itch-related Internet search behaviour. METHODS Google AdWords Keyword Planner was used to assess search volumes for itch-related terms in 15 European countries between September 2014 and August 2018. All identified keywords were qualitatively categorized. Itch-related terms were descriptively analysed and are shown as number of searches/100 000 inhabitants. RESULTS The search volume for the keyword 'itch' per 100 000 inhabitants was highest in Northern Europe, followed by Eastern, Central and Southern Europe. In 4/15 countries, itch was searched for more often in the autumn/winter months compared to in the spring/summer months. Most itch-related terms were related to dermatological conditions such as inflammatory skin diseases (e.g. psoriasis, atopic dermatitis), allergic or immunologic conditions (e.g. urticaria), and infectious diseases or infestations (e.g. scabies). In terms of body location, genitoanal itch dominated the searches. Symptoms and signs related to itch, possible non-dermatological aetiologies, and treatment options were also among the most searched terms. CONCLUSIONS These analyses provided for the first time insights into the search behaviour patterns related to itch across Europe. People from Northern and Eastern Europe are more likely to seek online information regarding itch. Causes for the itch, especially dermatological conditions, and genitoanal itch are the most important concerns for Internet users. This unconventional and inexpensive method identifies medical needs of people beyond the medical setting, including people who do not seek medical consultation. Accordingly, the data could be used to guide public health interventions and manage respective inhabitants' medical needs.
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Affiliation(s)
- M P Pereira
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - S Ziehfreund
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - M Rueth
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - T Ewering
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - F J Legat
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - J Lambert
- Department of Dermatology, University Hospital of Antwerp, University of Antwerp, Antwerp, Belgium
| | - J Elberling
- Department of Dermatology, University Hospital Gentofte, Copenhagen, Denmark
| | - L Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - E Brenaut
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - E Papadavid
- Department of Dermatology and Venereology, University of Athens Medical School, Attikon Hospital, Athens, Greece
| | - S Garcovich
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A W M Evers
- Department of Health, Medical and Neuropsychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - J A Halvorsen
- Department of Dermatology, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Poland
| | - A Reich
- Department of Dermatology, University of Rzeszów, Rzeszów, Poland
| | - M Gonçalo
- Department of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - A Lvov
- Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology, Moscow, Russia
| | - S Bobko
- Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology, Moscow, Russia
| | | | - J Wallengren
- Department of Clinical Sciences Lund, Dermatology and Venereology, Lund University, Lund, Sweden.,Skane University Hospital, Lund, Sweden
| | - E Savk
- Department of Dermatology, Aydin Adnan Menderes University, Aydın, Turkey
| | | | - S Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - A Zink
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
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25
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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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Gründel S, Pereira MP, Storck M, Osada N, Schneider G, Ständer S, Zeidler C. Analysis of 325 Patients with Chronic Nodular Prurigo: Clinics, Burden of Disease and Course of Treatment. Acta Derm Venereol 2020; 100:adv00269. [PMID: 32556359 PMCID: PMC9234994 DOI: 10.2340/00015555-3571] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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 nodular prurigo presents with multiple pruriginous nodules and severe pruritus. This study aims to explore the treatment course and regimens in patients with chronic nodular prurigo and to analyse predictive factors contributing to therapeutic success. A total of 325 patients with chronic nodular prurigo (male 37.5%) were analysed concerning demographic data, pruritus intensity, medical history, psychological impairment, quality of life, treatment duration, regimens and outcome. These parameters were compared with 325 sex- and age-matched patients with chronic pruritus on non-lesional skin. Treatment success was dependent on duration and regime of treatment and independent of age, sex and initial itch intensity. Non-responders displayed a higher percentage of inflamed nodules, a higher portion of excoriated nodules and a higher impairment of quality of life and mood factors before initiation of treatment. Gabapentinoids and immunosuppressants proved to be the most successful therapeutic agents. Compared with patients with chronic pruritus, those with chronic nodular prurigo needed longer duration of therapy.
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Affiliation(s)
- Sonja Gründel
- Center for Chronic Pruritus, Department of Dermatology, University Hospital Münster, Münster, Germany
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Pereira MP, Hoffmann V, Weisshaar E, Wallengren J, Halvorsen JA, Garcovich S, Misery L, Brenaut E, Savk E, Potekaev N, Lvov A, Bobko S, Szepietowski JC, Reich A, Bozek A, Legat FJ, Metz M, Streit M, Serra-Baldrich E, Gonçalo M, Storck M, Greiwe I, Nau T, Steinke S, Dugas M, Ständer S, Zeidler C. Chronic nodular prurigo: clinical profile and burden. A European cross-sectional study. J Eur Acad Dermatol Venereol 2020; 34:2373-2383. [PMID: 32078192 DOI: 10.1111/jdv.16309] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/27/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Chronic nodular prurigo (CNPG) is a condition characterized by chronic itch, a prolonged scratching behaviour and the presence of pruriginous nodules. A comprehensive understanding of this condition, especially regarding its clinical characteristics and impact on quality of life is still lacking. OBJECTIVES Aim of this pan-European multicentre cross-sectional study was to establish the clinical profile of CNPG, including its associated burden. METHODS Fifteen centres from 12 European countries recruited CNPG patients presenting at the centre or using the centres' own databases. Patients were asked to complete a questionnaire in paper or electronic format. Demography, current co-morbidities, underlying disease, itch intensity, additional sensory symptoms, quality of life, highest burden and emotional experience of itch were assessed. RESULTS A total of 509 patients (210 male, median age: 64 years [52; 72]) were enrolled. Of these, 406 reported itch and CNPG lesions in the previous 7 days and qualified to complete the whole questionnaire. We recorded moderate to severe worst itch intensity scores in the previous 24 h. Scores were higher in patients with lower educational levels and those coming from Eastern or Southern Europe. Most patients experience itch often or always (71%) and report that their everyday life is negatively affected (53%). Itch intensity was considered to be the most burdensome aspect of the disease by 49% of the patients, followed by the visibility of skin lesions (21%) and bleeding of lesions (21%). The majority of patients was unaware of an underlying condition contributing to CNPG (64%), while psychiatric diseases were the conditions most often mentioned in association with CNPG (19%). CONCLUSIONS This multicentre cross-sectional study shows that itch is the dominant symptom in CNPG and reveals that the profile of the disease is similar throughout Europe.
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Affiliation(s)
- M P Pereira
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - V Hoffmann
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - E Weisshaar
- Occupational Medicine, Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - J Wallengren
- Department of Clinical Sciences Lund, Dermatology and Venereology and Skane University Hospital, Lund, Sweden
| | - J A Halvorsen
- Department of Dermatology, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - S Garcovich
- Institute of Dermatology, F. Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - L Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - E Brenaut
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - E Savk
- Department of Dermatology, Aydin Adnan Menderes University, Aydın, Turkey
| | - N Potekaev
- Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology, Moscow, Russia
| | - A Lvov
- Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology, Moscow, Russia
| | - S Bobko
- Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology, Moscow, Russia
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - A Reich
- Department of Dermatology, University of Rzeszów, Rzeszów, Poland
| | - A Bozek
- Department of Dermatology, School of Medicine, University of Information Technology and Management, Rzeszow, Poland
| | - F J Legat
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - M Metz
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Streit
- Department of Dermatology, Kantonsspital Aarau, Aarau, Switzerland
| | | | - M Gonçalo
- Department of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - M Storck
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - I Greiwe
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - T Nau
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - S Steinke
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - M Dugas
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - S Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - C Zeidler
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
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Pereira MP, Derichs L, Meyer Zu Hörste G, Agelopoulos K, Ständer S. Generalized chronic itch induced by small-fibre neuropathy: clinical profile and proposed diagnostic criteria. J Eur Acad Dermatol Venereol 2020; 34:1795-1802. [PMID: 31838774 DOI: 10.1111/jdv.16151] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 11/26/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Small-fibre neuropathy (SFN) is a known cause for pain, however, it may be also associated with chronic itch. The clinical profile of chronic itch due to SFN is poorly defined and accordingly under-diagnosed in clinical care. OBJECTIVES To establish the clinical profile of patients with SFN and to propose diagnostic criteria for this patient population. METHODS Clinical data from patients diagnosed with SFN [chronic generalized itch and reduced intraepidermal nerve fibre density (IENFD)] were analysed retrospectively. RESULTS A total of 142 patients (60 females, median age: 62.5 years) were included. Patients reported daily, moderate to severe itch intensity scores occurring mostly in attacks (62.5%). Only 11 patients experienced exclusively itch, while the remaining patients (92%) reported pruralgia (itch along with painful sensations). Burning (50%), a sensation like needle pricks (46%) and tingling (45%) were the sensory symptoms reported by most patients. Cold or ice application led to an alleviation of the symptoms. The IENFD did not correlate with itch intensity; however, patients with a severely reduced IENFD (<30% of the normative cut-off value) reported more frequently sharp, spiky and drilling sensations compared to the remaining patients. The quality of life was moderately impaired and correlated with itch intensity, whereas anxiety and depression scores were low. CONCLUSIONS Onset of pruralgia on normal appearing skin, occurrence in attacks and symptomatic alleviation with cold/ice application should alert physicians for a possible neuropathic SFN-related origin of itch. A reduced IENFD can confirm the diagnosis of SFN.
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Affiliation(s)
- M P Pereira
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - L Derichs
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - G Meyer Zu Hörste
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - K Agelopoulos
- 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, Zeidler C, Storck M, Agelopoulos K, Philipp-Dormston WG, Zink A, Ständer S. Challenges in Clinical Research and Care in Pruritus. Acta Derm Venereol 2020; 100:adv00028. [PMID: 31940048 PMCID: PMC9128869 DOI: 10.2340/00015555-3348] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Chronic pruritus is a frequent global condition. The pathophysiology, underlying aetiology, clinical manifestation, associated burden and response to therapy of chronic pruritus varies from patient to patient, making clinical research and management of this condition challenging. There are still several unmet needs, such as the need to standardize translational research protocols, diagnostic and therapeutic procedures and to enhance the knowledge of the humanistic and economic burden associated with chronic pruritus. Basic and clinical research is of the utmost importance to target these matters. Clinical research has the potential to identify new relevant mechanisms in affected patients, which may lead to identification of novel therapy targets. This article discusses in depth current shortcomings in the daily care of patients with chronic pruritus and the challenges clinical researchers and physicians treating chronic pruritus face in addressing these matters.
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Pogatzki-Zahn EM, Pereira MP, Cremer A, Zeidler C, Dreyer T, Riepe C, Wempe C, Lotts T, Segelcke D, Ringkamp M, Kremer AE, Agelopoulos K, Ständer S. Peripheral Sensitization and Loss of Descending Inhibition Is a Hallmark of Chronic Pruritus. J Invest Dermatol 2020; 140:203-211.e4. [DOI: 10.1016/j.jid.2019.05.029] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/26/2019] [Accepted: 05/21/2019] [Indexed: 01/25/2023]
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Pereira MP, Agelopoulos K, Köllner J, Neufang G, Schmelz M, Ständer S. Selective Nerve Fibre Activation in Patients with Generalized Chronic Pruritus: Hint for Central Sensitization? Acta Derm Venereol 2019; 99:1009-1015. [PMID: 31289838 DOI: 10.2340/00015555-3261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Indexed: 11/16/2022] Open
Abstract
Central sensitization induces pain augmentation in chronic pain states. An analogous mechanism is speculated for chronic pruritus. This study compared patients with chronic pruritus (n = 79) of different origins (atopic dermatitis, chronic pruritus on non-lesional skin, chronic prurigo) and healthy controls (HC, n = 54) with regard to itch intensity and qualities of sensory symptoms after selective peripheral nerve fibre activation by electrical stimulation at 5 Hz (surrogate for C-fibre function) and 2,000 Hz (surrogate for Aβ-fibre function) using a Neurometer®. Electrically-induced itch was more intense in patients with chronic pruritus than in HC, but patients with chronic pruritus did not report "itch" more often than HC at 5 Hz. Stimulation at 2,000 Hz induced more pricking and tingling, but less throbbing in patients with chronic pruritus compared with HC. Treatment with cooling compound reduced clinical and experimental itch, but did not alter the distribution of sensory symptoms. These data show hyperknesis in chronic pruritus of various origins, arguing for common central sensitization mechanisms.
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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.
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Abstract
Chronic pruritus may arise from different conditions, including dermatological, systemic, neurologic, psychiatric, and psychosomatic diseases, leading to a substantial decrease in the quality of life of affected patients. The neurobiological mechanisms involved in chronic pruritus are not yet fully understood. However, in recent years important achievements have been made in this regard. This article aims to provide an overview of the current understanding of these mechanisms. The complex network of neurons, keratinocytes, inflammatory cells, cytokines, and neurotrophic factors which play a role in the development and maintenance of chronic pruritus are highlighted, as well as the pruritogens involved in pruritic diseases in humans. Additionally, the importance of neuropathy and scratch-induced changes for the pathophysiology of chronic pruritus are discussed. The new findings on the neurobiological mechanisms underlying chronic pruritus have already led to the development of novel therapies, e. g., monoclonal antibodies against specific interleukins, which are important for pruritus transmission. A deeper understanding of the neurobiological mechanisms is necessary in order to develop specifically targeted therapeutic options and thus provide better care for affected patients.
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Affiliation(s)
- M P Pereira
- Kompetenzzentrum Chronischer Pruritus (KCP), Klinik für Hautkrankheiten, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland.
| | - K Agelopoulos
- Kompetenzzentrum Chronischer Pruritus (KCP), Klinik für Hautkrankheiten, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland
| | - A E Kremer
- Medizinische Klinik 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - M Schmelz
- Klinik für Anästhesiologie und Operative Intensivmedizin, Fakultät für Klinische Medizin Mannheim, Ruprecht-Karls-Universität Heidelberg, Mannheim, Deutschland
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Affiliation(s)
- 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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Hidding J, Agelopoulos K, Pereira MP, Conrad H, Hatt H, Lotts T, Osada N, Pogatzki-Zahn E, Schmelz M, Ständer S. Sensory Qualities Point to Different Structural and Functional Skin Patterns in Chronic Pruritus Patients. A Translational Explorative Study. Acta Derm Venereol 2019; 99:668-674. [PMID: 30938826 DOI: 10.2340/00015555-3188] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Indexed: 11/16/2022] Open
Abstract
Chronic pruritus (CP) is often accompanied by paresthetic sensations like warmth, burning and stinging. The aim of this study was to analyze, whether divergent sensations are linked to structural and functional skin alterations in clinically diagnosed CP patients. Clinical responses to capsaicin, histamine, and to thermal and mechanical stimulation, intraepidermal nerve fiber density, and epidermal expression of transient receptor potential (TRP)-channels were investigated in healthy controls, and in CP patients, reporting either warmth (CP-W) or neuropathic sensations (CP-N). In CP-W, pinprick hyperalgesia and increased sensitivity to capsaicin were aligned with increased epidermal TRPV1 expression, while smaller histamine axon reflex erythema matched with significantly reduced intraepidermal nerve fiber density. CP-N showed earlier onset of sensations after capsaicin stimulation, significantly increased warmth detection threshold, and higher epidermal expression of TRPV4 compared to healthy controls. The present study contributes to the neurobiological understanding of the divergence of sensory sensations in CP, indicating new treatment targets.
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Affiliation(s)
- Johanna Hidding
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
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Affiliation(s)
- 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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Pereira MP, Zeidler C, Nau T, Bobko S, Evers AWM, Garcovich S, Gonçalo M, Halvorsen JA, Lambert J, Legat FJ, Leslie T, Metz M, Misery L, Nordlind K, Reich A, Schneider G, Ständer H, Streit M, Szepietowski JC, Wallengren J, Weisshaar E, Ständer S. Position Statement: Linear prurigo is a subtype of chronic prurigo. J Eur Acad Dermatol Venereol 2018; 33:263-266. [PMID: 30288812 DOI: 10.1111/jdv.15275] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 07/26/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Chronic prurigo (CPG) is a distinct disease characterized by chronic pruritus, history and/or signs of prolonged scratching and multiple pruriginous lesions. It may present with various clinical manifestations, including papules, nodules, plaques or umbilicated lesions. Some patients with chronic pruritus show pruriginous linear and scaring scratch lesions (LSSL) and it is unclear whether these lesions belong to the spectrum of CPG. OBJECTIVE To achieve a consensus on the classification of pruriginous LSSL and establish criteria to differentiate them from similar appearing conditions of different nature. METHODS Members of the Task Force Pruritus (TFP) of the European Academy of Dermatology and Venereology participated in the consensus conference, discussing representative clinical cases. Using the Delphi method, consensus was reached when ≥75% of members agreed on a statement. RESULTS Twenty-one members of the TFP with voting rights participated in the meeting. It was consented that LSSL occurs due to chronic pruritus and prolonged scratching, and share common pathophysiological mechanisms with CPG. LSSL were thus considered as belonging to the spectrum of CPG and the term 'linear prurigo' was chosen to describe this manifestation. CONCLUSION Considering linear prurigo as belonging to the spectrum of CPG has important clinical implications, since both the diagnostic and therapeutic approach of these patients should be performed as recommended for CPG. Importantly, linear prurigo should be differentiated from self-inflicted skin lesions as factitious disorders or skin picking syndromes. In the latter, artificial manipulation rather than pruritus itself leads to the development of cutaneous lesions, which can show clinical similarities to linear prurigo.
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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
| | - T Nau
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - S Bobko
- Moscow Scientific and Practical Center of Dermatovenerology and Cosmetology, Moscow, Russia
| | - A W M Evers
- Department of Health, Medical and Neuropsychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - S Garcovich
- Institute of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
| | - M Gonçalo
- Department of Dermatology, University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - J A Halvorsen
- Department of Dermatology, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - J Lambert
- Department of Dermatology, University Hospital of Antwerp, Antwerp, Belgium
| | - F J Legat
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - T Leslie
- Department of Dermatology, Royal Free Hospital, London, UK
| | - M Metz
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - L Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - K Nordlind
- Dermatology and Venereology Unit, Department of Medicine, Karolinska University Hospital, Solna, Sweden
| | - A Reich
- Department of Dermatology, University of Rzeszów, Rzeszów, Poland
| | - G Schneider
- Department of Psychosomatics and Psychotherapy, Münster University Hospital, Münster, Germany
| | - H Ständer
- Dermatological Practice, Bad Bentheim and Department of Dermatology, Klinikum Dortmund GmbH, Dortmund, Germany
| | - M Streit
- Department of Dermatology, Kantonsspital Aarau, Aarau, Switzerland
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - J Wallengren
- Department of Dermatology and Venereology, Skåne University Hospital SUS Lund, Lund University, Lund, Sweden
| | - E Weisshaar
- Department of Social Medicine, Occupational and Environmental Dermatology, University of Heidelberg, Heidelberg, Germany
| | - S Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
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Pereira MP, Basta S, Moore J, Ständer S. Prurigo nodularis: a physician survey to evaluate current perceptions of its classification, clinical experience and unmet need. J Eur Acad Dermatol Venereol 2018; 32:2224-2229. [PMID: 29869425 PMCID: PMC6585684 DOI: 10.1111/jdv.15107] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 05/28/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Prurigo nodularis (PN) is a chronic skin condition characterized by intensely pruritic, hyperkeratotic papulonodular lesions that dramatically impairs patients' quality of life. Management of the condition is challenging, and there is no approved therapy in the United States or in Europe. OBJECTIVE The key aim of this survey was to examine current perceptions of PN diagnosis and management among members of the European Academy of Dermatology and Venereology (EADV). METHODS The survey comprised 29 questions, including multiple choice and open responses, and was sent to clinicians via e-mail during December 2016. The survey results were collected and analysed. RESULTS Responses were received from 30 participants from 14 countries, of whom 22 (73.3%) were members of the EADV Task Force Pruritus. The majority (73.3%) considered PN to be a distinct condition, and the preferred description to explain the most common pathogenesis was 'chronic pruritus leading to chronic scratching' (80.0%). Pruritic nodules (n = 23/30, 76.7%) and scratching (n = 12/30, 40.0%) were the most common descriptors used to characterize PN. Most respondents (60.0%) reported seeing ≤5 unique PN patients per month, the majority of whom (68.8%) visited a physician ~2-4 times per year. PN patients reported to the respondents that they experienced persistent, severe pruritus, with a mean ± SD numeric rating scale score of 7.8 ± 1.2, lasting for >6 months in 82.3% of patients and >2 years in 51.0%. The most frequently prescribed therapies by survey respondents for PN symptoms were antihistamines (90.0%), antidepressants (90.0%), gabapentinoids (86.7%) and immunosuppressants (86.7%). Respondents agreed upon the need for new PN therapies (56.7%), revised PN classification and terminology (23.3%) and better understanding of PN pathophysiology (20.0%). CONCLUSION EADV Task Force Pruritus notes several challenges that must be met to improve symptoms and quality of life for patients with PN.
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Affiliation(s)
- M P Pereira
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - S Basta
- Menlo Therapeutics Inc, Redwood City, CA, USA
| | - J Moore
- Navigant Life Sciences, San Francisco, CA, USA
| | - S Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
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Boozalis E, Tang O, Patel S, Semenov YR, Pereira MP, Stander S, Kang S, Kwatra SG. Ethnic differences and comorbidities of 909 prurigo nodularis patients. J Am Acad Dermatol 2018; 79:714-719.e3. [PMID: 29733939 DOI: 10.1016/j.jaad.2018.04.047] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [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: 02/28/2018] [Revised: 04/17/2018] [Accepted: 04/27/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Prurigo nodularis (PN) is a poorly understood, understudied pruritic dermatosis that reduces quality of life. OBJECTIVE To characterize the demographics and comorbidities associated with PN. METHODS Cross-sectional study of patients 18 years and older who were seen at the Johns Hopkins Health System between December 6, 2012, and December 6, 2017. RESULTS Over the past 5 years, 909 patients with PN were seen at Johns Hopkins Health System. African American patients were 3.4 times more likely to have PN than white patients were (odds ratio [OR], 3.4; 95% confidence interval [CI], 2.9-3.9; P < .001). A comparison of the study patients and race-matched controls revealed that PN was significantly associated with a variety of systemic, cardiovascular, and psychiatric comorbidities, including chronic kidney disease, chronic hepatitis C, chronic obstructive pulmonary disease, congestive heart failure, depression, and atopic dermatitis. Black patients with PN were 10.5 times more likely (OR, 10.5; 95% CI, 7.9-13.9; P < .001) to have HIV than were race-matched controls with atopic dermatitis, and 8 times more likely (OR, 8.0; 95% CI, 5.7-11.1; P < .001) to have HIV than were African American patients with psoriasis. LIMITATIONS Our data describe patients seen by 1 hospital system. Our data identify associated conditions and comorbidities but are unable to support a causal relationship. CONCLUSION PN disproportionately affects African Americans and is associated with several systemic conditions, including HIV, chronic kidney disease, and diabetes.
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Affiliation(s)
- Emily Boozalis
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Olive Tang
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Shivani Patel
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yevgeniy R Semenov
- Division of Dermatology, Washington University School of Medicine, St. Louis, Missouri
| | - Manuel P Pereira
- Center for Chronic Pruritus, Department of Dermatology, University Hospital Münster, Münster, Germany
| | - Sonja Stander
- Center for Chronic Pruritus, Department of Dermatology, University Hospital Münster, Münster, Germany
| | - Sewon Kang
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shawn G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
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Pereira MP, Nau T, Zeidler C, Ständer S. [Chronic prurigo]. Hautarzt 2018; 69:321-330. [PMID: 29568995 DOI: 10.1007/s00105-018-4145-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Chronic prurigo is a disease characterized by the presence of chronic pruritus and singular or multiple usually hyperkeratotic symmetrically distributed itchy papules, nodules, and/or plaques. This condition is difficult to treat and leads to a substantial impairment of the quality of life. It may originate from dermatological, systemic, neurological, psychiatric/psychosomatic, multifactorial or unknown conditions causing itch, which lead to prolonged scratching behavior and sensitization mechanisms and ultimately to the development of pruriginous lesions. Thorough diagnostic efforts, including a detailed clinical history and physical examination, as well as targeted complementary examinations should be initiated as soon as possible. The German guideline recommends topical steroids and phototherapy as first-choice options. Pimecrolimus and capsaicin (topical), as well as antihistamines, anticonvulsants, and immunosuppressive drugs (systemic) should be considered as valid alternatives.
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Affiliation(s)
- M P Pereira
- Kompetenzzentrum Chronischer Pruritus (KCP), Klinik für Hautkrankheiten, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland.
| | - T Nau
- Kompetenzzentrum Chronischer Pruritus (KCP), Klinik für Hautkrankheiten, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland
| | - C Zeidler
- Kompetenzzentrum Chronischer Pruritus (KCP), Klinik für Hautkrankheiten, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland
| | - S Ständer
- Kompetenzzentrum Chronischer Pruritus (KCP), Klinik für Hautkrankheiten, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland
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Affiliation(s)
- 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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Pereira MP, Lüling H, Dieckhöfer A, Steinke S, Zeidler C, Ständer S. Brachioradial Pruritus and Notalgia Paraesthetica: A Comparative Observational Study of Clinical Presentation and Morphological Pathologies. Acta Derm Venereol 2018; 98:82-88. [PMID: 28902951 DOI: 10.2340/00015555-2789] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Brachioradial pruritus (BRP) and notalgia paraesthetica (NP) represent 2 of the most common neuropathic itch syndromes. A total of 58 consecutive patients presenting at the Center for Chronic Pruritus, University Hospital Münster, were analysed with regard to clinical presentation, anatomical and morphological pathologies, impairment in quality of life, and response to treatment with topical capsaicin. Patients with BRP reported stinging and burning more often than those with NP. In the BRP group structural magnetic resonance imaging abnormalities more frequently correlated with localization of the symptoms compared with in patients with NP. In addition, intraepidermal nerve fibre density was decreased in lesional skin in patients with BRP, but not in those with NP, confirming the neuropathic origin in BRP. Topical capsaicin resulted in a significantly higher alleviation of itch and pain intensity and improvement in quality of life in patients with BRP compared with those with NP, which may reflect clinical and aetiological differences between the conditions.
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Affiliation(s)
- Manuel P Pereira
- Center for Chronic Pruritus, Department of Dermatology, University Hospital Münster, Von- Esmarch-Str. 58, DE-48149 Münster, Germany
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Pereira MP, Ständer S. Neurokinin-1 Receptor Antagonists: Promising Agents in the Treatment of Chronic Pruritus. Curr Derm Rep 2017. [DOI: 10.1007/s13671-017-0203-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Oliveira JPV, Pereira MP, Duarte VP, Corrêa FF, Castro EM, Pereira FJ. Cadmium tolerance of Typha domingensis Pers. (Typhaceae) as related to growth and leaf morphophysiology. BRAZ J BIOL 2017; 78:509-516. [PMID: 29995113 DOI: 10.1590/1519-6984.171961] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 02/07/2017] [Indexed: 11/22/2022] Open
Abstract
Typha domingensis (cattail) is a native macrophyte known by its capacity to tolerate several heavy metals effects and the potential use for phytoremediation. However, in despite that cadmium (Cd) is one of the most toxic pollutants; its effects in T. domingensis biology remain uninvestigated. Thus, the objective of this study was to study the tolerance of T. domingensis to cadmium contamination by evaluating its growth, Cd uptake, leaf anatomy and gas exchange. The experiment was designed using three cadmium concentrations (0, 10 and 50 µM) and ten replicates for 90 days. The cadmium uptake, growth, gas exchange, chlorophyll content and leaf anatomy were evaluated. Data was submitted to ANOVA and Scott-Knott test for P<0.05. Typha domingensis accumulates Cd proportionally to its concentration on the solution and the content of this metal was higher in roots as compared to shoots. Plants showed no significant modifications on growth parameters such as the biomass production, number of leaves, number of clones and the biomass allocation to organs. The photosynthesis, transpiration and chlorophyll content were not modified by Cd. Most anatomical traits evaluated were not modified by the metal but the stomatal density and the proportion of vascular tissues were reduced under 50 µM of Cd. In despite, the leaf anatomy showed no toxicity evidences for any Cd level. The absence of growth reduction and the stability of anatomical and physiological traits give insight about the Cd tolerance of this species. Therefore, T. domingensis is able to overcome Cd toxicity and shows potential for phytoremediation.
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Affiliation(s)
- J P V Oliveira
- Programa de Pós-graduação em Botânica Aplicada, Laboratório de Anatomia Vegetal, Departamento de Biologia, Universidade Federal de Lavras - UFLA, Campus Universitário, s/n, CP 3037, CEP 37200-000, Lavras, MG, Brazil
| | - M P Pereira
- Programa de Pós-graduação em Botânica Aplicada, Laboratório de Anatomia Vegetal, Departamento de Biologia, Universidade Federal de Lavras - UFLA, Campus Universitário, s/n, CP 3037, CEP 37200-000, Lavras, MG, Brazil
| | - V P Duarte
- Programa de Pós-graduação em Botânica Aplicada, Laboratório de Anatomia Vegetal, Departamento de Biologia, Universidade Federal de Lavras - UFLA, Campus Universitário, s/n, CP 3037, CEP 37200-000, Lavras, MG, Brazil
| | - F F Corrêa
- Programa de Pós-graduação em Botânica Aplicada, Laboratório de Anatomia Vegetal, Departamento de Biologia, Universidade Federal de Lavras - UFLA, Campus Universitário, s/n, CP 3037, CEP 37200-000, Lavras, MG, Brazil
| | - E M Castro
- Programa de Pós-graduação em Botânica Aplicada, Laboratório de Anatomia Vegetal, Departamento de Biologia, Universidade Federal de Lavras - UFLA, Campus Universitário, s/n, CP 3037, CEP 37200-000, Lavras, MG, Brazil
| | - F J Pereira
- Instituto de Ciências da Natureza, Universidade Federal de Alfenas - UNIFAL-MG, Rua Gabriel Monteiro da Silva, 700, Centro, CEP 37130-001, Alfenas, MG, Brazil
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Pereira MP, Pogatzki-Zahn E, Snels C, Vu TH, Üçeyler N, Loser K, Sommer C, Evers AWM, van Laarhoven AIM, Agelopoulos K, Ständer S. There is no functional small-fibre neuropathy in prurigo nodularis despite neuroanatomical alterations. Exp Dermatol 2017; 26:969-971. [DOI: 10.1111/exd.13343] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Manuel P. Pereira
- Department of Dermatology and Center for Chronic Pruritus; University Hospital Münster; Münster Germany
| | - Esther Pogatzki-Zahn
- Department of Anaesthesiology; Intensive Care and Pain Medicine; University Hospital Münster; Münster Germany
| | - Chantal Snels
- Health, Medical and Neuropsychology Unit; Institute of Psychology; University of Leiden; Leiden The Netherlands
| | - Thai-Ha Vu
- Department of Dermatology and Center for Chronic Pruritus; University Hospital Münster; Münster Germany
| | - Nurcan Üçeyler
- Department of Neurology; University of Würzburg; Würzburg Germany
| | - Karin Loser
- Department of Dermatology and Center for Chronic Pruritus; University Hospital Münster; Münster Germany
| | - Claudia Sommer
- Department of Neurology; University of Würzburg; Würzburg Germany
| | - Andrea Walburga Maria Evers
- Health, Medical and Neuropsychology Unit; Institute of Psychology; University of Leiden; Leiden The Netherlands
| | | | - Konstantin Agelopoulos
- Department of Dermatology and Center for Chronic Pruritus; University Hospital Münster; Münster Germany
| | - Sonja Ständer
- Department of Dermatology and Center for Chronic Pruritus; University Hospital Münster; Münster Germany
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Affiliation(s)
- Manuel P Pereira
- Department of Dermatology, Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
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Abstract
Chronic pruritus arises not only from dermatoses, but also, in up to half of cases, from extracutaneous origins. A multitude of systemic, neurological, psychiatric, and somatoform conditions are associated with pruritus in the absence of skin disease. Moreover, pruritus is a frequently observed side effect of many drugs. It is therefore difficult for physicians to make a correct diagnosis. Chronic pruritus patients frequently present to the dermatologist with skin lesions secondary to a long-lasting scratching behavior, such as lichenification and prurigo nodularis. A structured clinical history and physical examination are essential in order to evaluate the pruritus, along with systematic, medical history-adapted laboratory and radiological tests carried out according to the differential diagnosis. For therapeutic reasons, a symptomatic therapy should be promptly initiated parallel to the diagnostic procedures. Once the underlying factor(s) leading to the pruritus are identified, a targeted therapy should be implemented. Importantly, the treatment of accompanying disorders such as sleep disturbances or mental symptoms should be taken into consideration. Even after successful treatment of the underlying cause, pruritus may persist, likely due to chronicity processes including peripheral and central sensitization or impaired inhibition at spinal level. A vast arsenal of topical and systemic agents targeting these pathophysiological mechanisms has been used to deter further chronicity. The therapeutic options currently available are, however, still insufficient for many patients. Thus, future studies aiming to unveil the complex mechanisms underlying chronic pruritus and develop new therapeutic agents are urgently needed.
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Affiliation(s)
- Manuel P Pereira
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Von-Esmarch-Str. 58, 48149, Münster, Germany
| | - Andreas E Kremer
- Department of Medicine 1, Gastroenterology, Pneumology and Endocrinology, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
| | - Thomas Mettang
- Department of Nephrology, DKD, Helios Klinik, Wiesbaden, Germany
| | - Sonja Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Von-Esmarch-Str. 58, 48149, Münster, Germany.
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Corrêa FF, Pereira MP, Madail RH, Santos BR, Barbosa S, Castro EM, Pereira FJ. Anatomical traits related to stress in high density populations of Typha angustifolia L. (Typhaceae). BRAZ J BIOL 2016; 77:52-59. [PMID: 27382995 DOI: 10.1590/1519-6984.09715] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 11/09/2015] [Indexed: 11/21/2022] Open
Abstract
Some macrophytes species show a high growth potential, colonizing large areas on aquatic environments. Cattail (Typha angustifolia L.) uncontrolled growth causes several problems to human activities and local biodiversity, but this also may lead to competition and further problems for this species itself. Thus, the objective of this study was to investigate anatomical modifications on T. angustifolia plants from different population densities, once it can help to understand its biology. Roots and leaves were collected from natural populations growing under high and low densities. These plant materials were fixed and submitted to usual plant microtechnique procedures. Slides were observed and photographed under light microscopy and images were analyzed in the UTHSCSA-Imagetool software. The experimental design was completely randomized with two treatments and ten replicates, data were submitted to one-way ANOVA and Scott-Knott test at p<0.05. Leaves from low density populations showed higher stomatal density and index. These modifications on stomatal characteristics were more evident on the leaf abaxial surface. Plants from low density populations showed thicker mesophyll and higher proportion of aerenchymal area. Roots from low density populations showed a higher proportion of the vascular cylinder. Whereas, plants from higher density populations showed greater thickness of the endodermis, exodermis, phloem and root cortex. Higher density populations showed a higher proportion of aerenchymal gaps in the root cortex. Therefore, cattail plants from populations growing under high density population show anatomical traits typical of plants under stress, which promotes the development of less functional anatomical modifications to aquatic environments.
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Affiliation(s)
- F F Corrêa
- Departamento de Biologia, Universidade Federal de Lavras, Lavras, MG, Brazil
| | - M P Pereira
- Departamento de Biologia, Universidade Federal de Lavras, Lavras, MG, Brazil
| | - R H Madail
- Instituto Federal de Educação, Ciência e Tecnologia do Sul de Minas Gerais, Poços de Caldas, MG, Brazil
| | - B R Santos
- Instituto de Ciências da Natureza, Universidade Federal de Alfenas, Alfenas, MG, Brazil
| | - S Barbosa
- Instituto de Ciências da Natureza, Universidade Federal de Alfenas, Alfenas, MG, Brazil
| | - E M Castro
- Departamento de Biologia, Universidade Federal de Lavras, Lavras, MG, Brazil
| | - F J Pereira
- Departamento de Biologia, Universidade Federal de Lavras, Lavras, MG, Brazil
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Pereira MP, Werner MU, Dahl JB, Pereira MP, Utke Werner M, Berg Dahl J. Effect of a high-dose target-controlled naloxone infusion on pain and hyperalgesia in patients following groin hernia repair: study protocol for a randomized controlled trial. Trials 2015; 16:511. [PMID: 26554360 PMCID: PMC4640219 DOI: 10.1186/s13063-015-1021-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 10/20/2015] [Indexed: 12/04/2022] Open
Abstract
Background Central sensitization is modulated by the endogenous opioid system and plays a major role in the development and maintenance of pain. Recent animal studies performed following resolution of inflammatory pain showed reinstatement of tactile hypersensitivity induced by administration of a mu-opioid-antagonist, suggesting latent sensitization is mediated by endogenous opioids. In a recent crossover study in healthy volunteers, following resolution of a first-degree burn, 4 out of 12 volunteers developed large secondary areas of hyperalgesia areas after a naloxone infusion, while no volunteer developed significant secondary hyperalgesia after the placebo infusion. In order to consistently demonstrate latent sensitization in humans, a pain model inducing deep tissue inflammation, as used in animal studies, might be necessary. The aim of the present study is to examine whether a high-dose target-controlled naloxone infusion can reinstate pain and hyperalgesia following recovery from open groin hernia repair and thus consistently demonstrate opioid-mediated latent sensitization in humans. Methods/Design Patients submitted to unilateral, primary, open groin hernia repair will be included in this randomized, placebo-controlled, double-blind, crossover study. The experimental days take place 6–8 weeks after surgery, time-points at which patients are expected to be almost pain- free. Prior to administration of naloxone or placebo, the primary outcome (a summated measure of pain: at rest, during transition from supine to standing position, and evoked by pressure algometry) and the secondary outcomes (secondary hyperalgesia/allodynia, pressure pain thresholds, assessed at the surgical site and at the mirror-site in the contralateral groin, and, opioid withdrawal symptoms) will be assessed. These assessments will be repeated at each step of the target-controlled infusion of placebo or naloxone at estimated median (95 % CI) plasma concentrations of 344 ng/ml (130;567), 1059 ng/ml (400;1752) and 3196 ng/ml (1205;5276). Discussion We aim to demonstrate opioid-mediated latent sensitization in a post-surgical setting, using pain as a clinical relevant variable. Impairment of the protective endogenous opioid system may play an important role in the transition from acute to chronic pain. In order to sufficiently block the endogenous opioid system, a high-dose target-controlled naloxone-infusion is used, in accordance with recent findings in animal studies. Trial registration number EUDRACT: 2015-000793-36 (Registration date: 16 February 2015) Clinicaltrials.gov: NCT01992146 (Registration date: 12 December 2014)
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Affiliation(s)
- M P Pereira
- Department of Anaesthesiology, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospitals, Copenhagen, Denmark.
| | - M U Werner
- Multidisciplinary Pain Center, Neuroscience Center, Rigshospitalet, Copenhagen University Hospitals, Copenhagen, Denmark.
| | - J B Dahl
- Department of Anaesthesiology, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospitals, Copenhagen, Denmark.
| | - Manuel Pedro Pereira
- Department of Anaesthesiology, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospitals, Copenhagen, Denmark. .,Multidisciplinary Pain Center, Neuroscience Center, Rigshospitalet, Copenhagen University Hospitals, Copenhagen, Denmark.
| | - Mads Utke Werner
- Multidisciplinary Pain Center, Neuroscience Center, Rigshospitalet, Copenhagen University Hospitals, Copenhagen, Denmark.
| | - Joergen Berg Dahl
- Department of Anaesthesiology, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospitals, Copenhagen, Denmark.
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Pereira MP, Donahue RR, Dahl JB, Werner M, Taylor BK, Werner MU. Endogenous Opioid-Masked Latent Pain Sensitization: Studies from Mouse to Human. PLoS One 2015; 10:e0134441. [PMID: 26305798 PMCID: PMC4549112 DOI: 10.1371/journal.pone.0134441] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 06/08/2015] [Indexed: 01/20/2023] Open
Abstract
Following the resolution of a severe inflammatory injury in rodents, administration of mu-opioid receptor inverse agonists leads to reinstatement of pain hypersensitivity. The mechanisms underlying this form of latent pain sensitization (LS) likely contribute to the development of chronic pain, but LS has not yet been demonstrated in humans. Using a C57BL/6 mouse model of cutaneous mild heat injury (MHI) we demonstrated a dose-dependent reinstatement of pain sensitization, assessed as primary (P < 0.001) and secondary hyperalgesia (P < 0.001) by naloxone (0.3–10 mg/kg), 168 hrs after the induction of MHI. Forward-translating the dose data to a human MHI model (n = 12) we could show that LS does indeed occur after naloxone 2 mg/kg, 168 hrs after a MHI. Our previous unsuccessful efforts to demonstrate unmasking of LS in humans are thus likely explained by an insufficient naloxone dose (0.021 mg/kg). However, while LS was consistently demonstrated in 21/24 mice, LS was only seen in 4/12 subjects. This difference is likely due to selection bias since the C57BL/6 mouse strain exhibits markedly enhanced pain sensitivity in assays of acute thermal nociception. Future exploratory studies in humans should prioritize inclusion of “high-sensitizers” prone to develop LS and use post-surgical models to elucidate markers of vulnerability to chronic postsurgical pain.
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Affiliation(s)
- Manuel P. Pereira
- Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark
| | - Renee R. Donahue
- Department of Physiology, University of Kentucky, Lexington, KY, United States of America
| | - Jørgen B. Dahl
- Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark
| | - Marianne Werner
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Bradley K. Taylor
- Multidisciplinary Pain Center, Neuroscience Center, Rigshospitalet, Copenhagen, Denmark
| | - Mads U. Werner
- Multidisciplinary Pain Center, Neuroscience Center, Rigshospitalet, Copenhagen, Denmark
- * E-mail:
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