1
|
Raison-Peyron N, El Gana M, Amelot F, Bessis D. Post-vaccine nodules with prurigo in a child successfully treated by dupilumab. Pediatr Dermatol 2024. [PMID: 38697666 DOI: 10.1111/pde.15615] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/24/2024] [Indexed: 05/05/2024]
Abstract
We report the case of a 7-year-old girl with severe generalized prurigo associated with diffuse persistent pruritic nodules due to sensitization to aluminum-adsorbed vaccines. Treatment with dupilumab resulted in an excellent therapeutic response.
Collapse
Affiliation(s)
- Nadia Raison-Peyron
- Department of Dermatology, University Hospital of Montpellier and University of Montpellier, Montpellier, France
| | - Marwa El Gana
- Department of Dermatology, University Hospital of Montpellier and University of Montpellier, Montpellier, France
| | | | - Didier Bessis
- Department of Dermatology, University Hospital of Montpellier and University of Montpellier, Montpellier, France
| |
Collapse
|
2
|
Skrzypczak T, Skrzypczak A, Szepietowski JC. Deciphering the enigma of itch sensation: insights and impact from a readability study. Int J Dermatol 2024. [PMID: 38581104 DOI: 10.1111/ijd.17144] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/03/2024] [Accepted: 03/04/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Itch terminology is ambiguous. How itch was described in online materials and how terminology influenced the readability of these materials was previously unknown. MATERIALS AND METHODS Two groups of search terms, itch and prurigo, were translated into five of the most prevalent European Union (EU) languages. The itch group consisted of "itch" and "pruritus." The prurigo group consisted of "prurigo," "prurigo nodularis," and "chronic prurigo". Then, a search of the terms in each language was queried in the Google search engine in the private mode of the Internet browser. The first 50 results generated were assessed for suitability. Patient education was the primary objective of the materials provided, with no barriers or advertisements included. In cases where the terms yielded identical outcomes, any duplicated materials were omitted from the analysis. When translating search terms within a group led to just one shared transcription, the results were attributed to the search term with the most similar syntax. The Lix score was utilized to assess readability. RESULTS 314 articles in English, German, Italian, French, and Spanish were evaluated. The term "pruritus" was the most commonly used description for the sensation of itching, with 142 (45%) articles included. Overall, the mean Lix score was 54 ± 9, classifying all articles as hard to comprehend. Articles in the itch group had significantly (P < 0.001) lower mean Lix score (52 ± 9) than materials in the prurigo group (56 ± 10). CONCLUSIONS Despite being more accessible to conceptualize, skin conditions such as prurigo had lower readability compared to information about the itch itself. The distinction between "itch" and "pruritus" was unclear.
Collapse
Affiliation(s)
| | - Anna Skrzypczak
- Faculty of Dentistry, Wroclaw Medical University, Wroclaw, Poland
| | - Jacek C Szepietowski
- Department of Dermatology, Venerology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| |
Collapse
|
3
|
Kumar S, Batra A, Budania A, Sharma D, Elhence PA. 'Generalised Pruritus with Prurigo-Like Lesions and Generalised Lymphadenopathy: Could be an Early Diagnostic Clue for Angioimmunoblastic T-Cell Lymphoma (AITL) and/or Histoplasmosis'. Indian J Dermatol 2023; 68:726. [PMID: 38371550 PMCID: PMC10868997 DOI: 10.4103/ijd.ijd_974_22] [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] [Indexed: 02/20/2024] Open
Abstract
Angioimmunoblastic T-cell lymphoma (AITL) is an uncommon systemic lymphoproliferative disorder that comprises approximately one-fifth of all mature peripheral T-cell lymphomas. A broad range of cutaneous manifestations include maculopapular, papulovesicular, erythrodermic, urticarial, plaque-like and nodular, and they are mentioned in 50% of patients and may precede systemic symptoms, which include lymphadenopathy, hepatosplenomegaly and constitutional symptoms. Histoplasmosis is a common granulomatous infection worldwide caused by Histoplasma capsulatum, a dimorphic fungus. Cutaneous manifestations are reported to occur in 10% to 25% of immunosuppressed patients with disseminated histoplasmosis. Generalised pruritus as a presenting feature is rarely described in both of these entities. We report a unique case of AITL with histoplasmosis discovered during paraclinical assessment of generalised pruritus (? neurodermatitis) with prurigo-like lesions and lymphadenopathy.
Collapse
Affiliation(s)
- Shubham Kumar
- From the Department of Dermatology, Venereology, and Leprology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Anmol Batra
- From the Department of Dermatology, Venereology, and Leprology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Anil Budania
- From the Department of Dermatology, Venereology, and Leprology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Deepak Sharma
- Department of General Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Poonam A Elhence
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| |
Collapse
|
4
|
Parthasarathy V, Cravero K, Deng J, Sun Z, Engle SM, Auxier AN, Hahn N, Sims JT, Okragly AJ, Alphonse MP, Kwatra SG. Circulating plasma IL-13 and periostin are dysregulated type 2 inflammatory biomarkers in prurigo nodularis: A cluster analysis. Front Med (Lausanne) 2022; 9:1011142. [PMID: 36561717 PMCID: PMC9763609 DOI: 10.3389/fmed.2022.1011142] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 08/03/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022] Open
Abstract
Importance Prurigo nodularis (PN) is a chronic heterogeneous inflammatory skin disease. Objective To elucidate which components of type 2 inflammation are dysregulated systemically in PN. Design Whole blood was obtained from PN patients with uncontrolled disease and control patients without pruritus. Plasma was assayed for IL-4, IL-5, IL-13, IgE, and periostin. ANOVA was utilized to compare PN and control patients and multiple-hypothesis adjusted p-value was calculated with the significance threshold at 0.05. Clustering was performed using K-means clustering. Participants PN patients (n = 29) and controls (n = 18) from Johns Hopkins Dermatology had similar age sex, and race distributions. Results Single-plex assays of the biomarkers demonstrated elevated circulating plasma IL-13 (0.13 vs. 0.006 pg/mL, p = 0.0008) and periostin (80.3 vs. 60.2 ng/mL, p = 0.012) in PN compared to controls. IL-4 (0.11 vs. 0.02 pg/mL, p = 0.30) and IL-5 (0.75 vs. 0.40 pg/mL, p = 0.10) were not significantly elevated, while IgE approached significance (1202.0 vs. 432.7 ng/mL, p = 0.08). Clustering of PN and control patients together revealed two clusters. Cluster 1 (n = 36) consisted of 18 PN patients and 18 controls. Cluster 2 (n = 11) consisted entirely of PN patients (p < 0.01). Cluster 2 had higher levels of IL-13 (0.33 vs. 0.008 pg/mL, p = 0.0001) and IL-5 (1.22 vs. 0.43 pg/mL, p = 0.03) compared to cluster 1. Conclusion and relevance This study demonstrates elevation of IL-13 and periostin in the blood of PN patients, with distinct clusters with varying degrees of type 2 inflammation. Given this heterogeneity, future precision medicine approaches should be explored in the management of PN.
Collapse
Affiliation(s)
- Varsha Parthasarathy
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Karen Cravero
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Junwen Deng
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Zhe Sun
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, United States
| | - Sarah M. Engle
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, United States
| | - Autum N. Auxier
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, United States
| | - Nathan Hahn
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, United States
| | - Jonathan T. Sims
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, United States
| | - Angela J. Okragly
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, United States
| | - Martin P. Alphonse
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Shawn G. Kwatra
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States,*Correspondence: Shawn G. Kwatra,
| |
Collapse
|
5
|
Kabbani M, Mboyo Mpita G, Benhadou F. Ustekinumab plus dupilumab in the treatment of concomitant psoriasis and prurigo nodularis. J Eur Acad Dermatol Venereol 2022; 36:e1050-e1051. [PMID: 35857380 DOI: 10.1111/jdv.18445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Mariam Kabbani
- Department of Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Greta Mboyo Mpita
- Department of Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Farida Benhadou
- Department of Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
6
|
Han J, Palomino A, Estupinan B, Wozniak A, Swan J. Psychiatric Comorbidity in Prurigo Nodularis and the Impact of Socioeconomic Status. J Clin Aesthet Dermatol 2022; 15:53-58. [PMID: 35783571 PMCID: PMC9239124] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE We sought to investigate the relationship between psychiatric comorbidity, socioeconomic status (SES), and mental health utilization among patients with prurigo nodularis (PN). METHODS We conducted a retrospective cohort study of patients with PN from 2007 to 2019. SES was approximated using zip codes; per capita income data was compared to the Livable Income Threshold. RESULTS 288 patients were included. Patients were predominantly female (57%) and significantly more likely to have a psychiatric disorder than men (p=0.001). 44.1 percent of patients had at least one psychiatric comorbidity, with mood (74.8%) and anxiety (63.0%) disorders being most common. Patients with PN in lower SES groups had a higher incidence of psychiatric disorder (p=0.566) and utilization of mental health services (p=0.617). 40.9 percent of patients with a diagnosed psychiatric disorder had no record of seeing a psychiatrist or psychologist. LIMITATIONS Patient records were retrospectively reviewed for encounters with a psychiatrist or psychologist, but did not account for other forms of mental health services. Per capita income used to determine SES may not be an accurate representation of an individual's income, nor did it account for the number of people within a household. CONCLUSION Psychiatric comorbidity was common among patients with PN and many went without receiving mental health services. Further studies with larger sample sizes are needed to better understand the impact of SES on these factors.
Collapse
Affiliation(s)
- Jane Han
- Drs. Han, Palomino and Swan are with the Stritch School of Medicine at Loyola University in Maywood, Illinois
| | - Angelina Palomino
- Drs. Han, Palomino and Swan are with the Stritch School of Medicine at Loyola University in Maywood, Illinois
| | - Blanca Estupinan
- Drs. Estupinan and Swan are with the Division of Dermatology at Loyola University Medical Center in Maywood, Illinois
| | - Amy Wozniak
- Dr. Wozniak is with the Department of Biostatistics at Loyola University in Maywood, Illinois
| | - James Swan
- Drs. Han, Palomino and Swan are with the Stritch School of Medicine at Loyola University in Maywood, Illinois
- Drs. Estupinan and Swan are with the Division of Dermatology at Loyola University Medical Center in Maywood, Illinois
| |
Collapse
|
7
|
Ständer S, Sun YG, Schmelz M. Editorial: Pruritus Medicine. Front Med (Lausanne) 2021; 8:763667. [PMID: 34651005 PMCID: PMC8505712 DOI: 10.3389/fmed.2021.763667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 09/06/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Sonja Ständer
- Department of Dermatology, Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Yan-Gang Sun
- State Key Laboratory of Neuroscience, Center for Excellence in Brain Science & Intelligence Technology, Institute of Neuroscience, Chinese Academy of Sciences, Beijing, China
| | - Martin Schmelz
- Department Experimental Pain Research, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Affiliation(s)
- Elke Weisshaar
- Occupational Dermatology, Department of Dermatology, Ruprecht-Karls University Heidelberg, Heidelberg, Germany
| |
Collapse
|
10
|
Garcovich S, Maurelli M, Gisondi P, Peris K, Yosipovitch G, Girolomoni G. Pruritus as a Distinctive Feature of Type 2 Inflammation. Vaccines (Basel) 2021; 9:vaccines9030303. [PMID: 33807098 PMCID: PMC8005108 DOI: 10.3390/vaccines9030303] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 12/13/2022] Open
Abstract
Pruritus is a common symptom of several skin diseases, both inflammatory and neoplastic. Pruritus might have a tremendous impact on patients’ quality of life and strongly interfere with sleep, social, and work activities. We review the role of type-2 inflammation and immunity in the pathogenesis of chronic pruritic conditions of the skin. Type 2 cytokines, including IL-4, IL-13, thymic stromal lymphopoietin, periostin, IL-31, IL-25, and IL-33 are released by mast cells, innate lymphoid cells 2, keratinocytes, and type 2 T lymphocytes, and are master regulators of chronic itch. These cytokines might act as direct pruritogen on primary sensory neurons (pruriceptors) or alter the sensitivity to other itch mediators Type 2 inflammation- and immunity-dominated skin diseases, including atopic dermatitis, prurigo nodularis, bullous pemphigoid, scabies, parasitic diseases, urticaria, and Sézary syndrome are indeed conditions associated with most severe pruritus. In contrast, in other skin diseases, such as scleroderma, lupus erythematosus, hidradenitis suppurativa, and acne, type 2 inflammation is less represented, and pruritus is milder or variable. Th2 inflammation and immunity evolved to protect against parasites, and thus, the scratching response evoked by pruritus might have developed to alert about the presence and to remove parasites from the skin surface.
Collapse
Affiliation(s)
- Simone Garcovich
- Dermatology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
- Dermatology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Correspondence:
| | - Martina Maurelli
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, 37126 Verona, Italy; (M.M.); (P.G.); (G.G.)
| | - Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, 37126 Verona, Italy; (M.M.); (P.G.); (G.G.)
| | - Ketty Peris
- Dermatology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
- Dermatology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Gil Yosipovitch
- Miami Itch Center, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL 33136, USA;
| | - Giampiero Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, 37126 Verona, Italy; (M.M.); (P.G.); (G.G.)
| |
Collapse
|
11
|
Takeuchi S, Inoue K, Kuretake K, Kiyomatsu-Oda M, Furue M. Dupilumab shows slow, steady effectiveness for intractable prurigo in patients with atopic dermatitis. J Dermatol 2021; 48:638-644. [PMID: 33742710 DOI: 10.1111/1346-8138.15843] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/17/2021] [Accepted: 02/21/2021] [Indexed: 11/27/2022]
Abstract
Prurigo lesions in atopic dermatitis are intractable. This single-center, retrospective study examined dupilumab's clinical effects on intractable prurigo. Twenty adult atopic dermatitis patients (12 with prurigo, eight without) were administrated dupilumab. Its effects on itching and disease severity were examined with Numerical Rating Scale-Itch (NRS-I), Eczema Area and Severity Index (EASI), and Investigator Global Assessment (IGA) scores; body surface areas (BSA); and thymus- and activation-regulated chemokine (TARC), total immunoglobulin (Ig)E, and eosinophil levels. NRS-I scores, EASI scores, TARC levels, and total IgE levels before dupilumab treatment were not statistically different between the prurigo and non-prurigo groups. With dupilumab treatment, NRS-I scores, EASI scores, IGA scores, BSA, TARC levels, and total IgE levels were significantly reduced from baseline in both groups at 1-2 months and onward, but skin symptom improvement in the prurigo group was slower than in the non-prurigo group, as evidenced by significantly higher EASI scores, BSA, and TARC levels at several time points during the 12 months of dupilumab treatment. Prurigo patients were slower in EASI-50 achievement and significantly lower in EASI-90 achievement at 12 months than non-prurigo patients. Adherence to dupilumab was not different, but total equivalent amounts of concomitant therapeutic agents (corticosteroids and tacrolimus) used during dupilumab treatment were significantly higher in the prurigo group (median, 56.2 g/week) than in the non-prurigo group (median, 33.7 g/week). There were 2.2 adverse events per patient on average; ocular complaints were most frequent. Dupilumab was effective in treating intractable prurigo, but despite significantly greater concomitant therapeutic agent use, skin symptom improvement was slower in prurigo patients than in non-prurigo patients.
Collapse
Affiliation(s)
- Satoshi Takeuchi
- Department of Dermatology, Federation of National Public Service Personnel Mutual Aid Associations, Hamanomachi Hospital, Fukuoka, Japan.,Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keiichi Inoue
- Department of Dermatology, Federation of National Public Service Personnel Mutual Aid Associations, Hamanomachi Hospital, Fukuoka, Japan
| | - Keisuke Kuretake
- Department of Dermatology, Federation of National Public Service Personnel Mutual Aid Associations, Hamanomachi Hospital, Fukuoka, Japan
| | - Mari Kiyomatsu-Oda
- Department of Dermatology, Federation of National Public Service Personnel Mutual Aid Associations, Hamanomachi Hospital, Fukuoka, Japan
| | - Masutaka Furue
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| |
Collapse
|
12
|
Chung BY, Um JY, Kang SY, Jung MJ, Kim JC, Kwak IS, Park CW, Kim HO. Oral Alitretinoin for Patients with Refractory Prurigo. Medicina (Kaunas) 2020; 56:E599. [PMID: 33182351 PMCID: PMC7695266 DOI: 10.3390/medicina56110599] [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] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/03/2020] [Accepted: 11/06/2020] [Indexed: 11/17/2022]
Abstract
Background: prurigo is a chronic skin disorder associated with a history of chronic pruritus. The pathogenesis of prurigo is largely unknown and the treatment of prurigo is unsatisfactory and challenging. Conventional systemic treatments may be beneficial; however, their possible side effects and possible transient efficacy is still a problem. We aimed to present the clinical course and effect of treatment with alitretinoin on patients with prurigo nodularis initially treated with conventional treatments like oral antihistamine, cyclosporine, and phototherapy. Methods: all the patients had prurigo nodularis refractory to conventional treatment. Their medical records included demographic features, past medical history, duration of disease, and treatment modalities; and the clinical courses of the patients were reviewed for this retrospective study. We evaluated patient pruritus and skin lesions for the duration. Results: we present reports involving 10 patients with refractory prurigo. All the patients in our cases were treated with oral alitretinoin after previous treatments and reported the improvement of skin lesions and pruritus within 2 weeks to 3 months. Conclusions: we suggest that oral alitretinoin may be an effective and well tolerated treatment option for patients with intractable prurigo. Further clinical studies are warranted to confirm the long-lasting efficacy and safety of alitretinoin for treating patients with prurigo.
Collapse
Affiliation(s)
- Bo Young Chung
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University college of Medicine, 1, Singil-ro, Yeoungdeungpo-gu, Seoul 07441, Korea; (B.Y.C.); (J.Y.U.); (S.Y.K.); (M.J.J.); (J.C.K.)
| | - Ji Young Um
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University college of Medicine, 1, Singil-ro, Yeoungdeungpo-gu, Seoul 07441, Korea; (B.Y.C.); (J.Y.U.); (S.Y.K.); (M.J.J.); (J.C.K.)
| | - Seok Young Kang
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University college of Medicine, 1, Singil-ro, Yeoungdeungpo-gu, Seoul 07441, Korea; (B.Y.C.); (J.Y.U.); (S.Y.K.); (M.J.J.); (J.C.K.)
| | - Min Je Jung
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University college of Medicine, 1, Singil-ro, Yeoungdeungpo-gu, Seoul 07441, Korea; (B.Y.C.); (J.Y.U.); (S.Y.K.); (M.J.J.); (J.C.K.)
| | - Jin Cheol Kim
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University college of Medicine, 1, Singil-ro, Yeoungdeungpo-gu, Seoul 07441, Korea; (B.Y.C.); (J.Y.U.); (S.Y.K.); (M.J.J.); (J.C.K.)
| | - In-Suk Kwak
- Department of Anesthesiology and Pain Medicine, Burn Center, Hangang Sacred Heart Hospital, Hallym University College of Medicine, 94-200 Yeoungdeungpo-dong, Yeoungdeungpo-gu, Seoul 07247, Korea;
| | - Chun Wook Park
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University college of Medicine, 1, Singil-ro, Yeoungdeungpo-gu, Seoul 07441, Korea; (B.Y.C.); (J.Y.U.); (S.Y.K.); (M.J.J.); (J.C.K.)
| | - Hye One Kim
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University college of Medicine, 1, Singil-ro, Yeoungdeungpo-gu, Seoul 07441, Korea; (B.Y.C.); (J.Y.U.); (S.Y.K.); (M.J.J.); (J.C.K.)
| |
Collapse
|
13
|
Jedlowski PM, Fazel M, Foshee JP, Curiel-Lewandrowski C. A patient with concurrent prurigo nodularis and squamous cell carcinomas of keratoacanthoma type: The role of aprepitant in diagnostic clarity. JAAD Case Rep 2020; 6:3-5. [PMID: 31956685 DOI: 10.1016/j.jdcr.2019.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
14
|
|
15
|
Whang KA, Khanna R, Thomas J, Aguh C, Kwatra SG. Racial and Gender Differences in the Presentation of Pruritus. Medicines (Basel) 2019; 6:E98. [PMID: 31569651 DOI: 10.3390/medicines6040098] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/27/2019] [Accepted: 09/25/2019] [Indexed: 11/17/2022]
Abstract
Background: Pruritus is a common disease symptom with a variety of etiologies known to reduce patient quality of life. We aimed to characterize the racial and gender differences in the presentation of pruritus for itch-related patient visits both within a single institution and nationally. Methods: Cross sectional study of patients ≥ 18 years old seen at Johns Hopkins Health System between 1/1/12 and 1/1/18. Results were compared to data from 2005–2011 from the National Ambulatory Medical Care Survey (NAMCS) and the National Health Ambulatory Medical Care Survey (NHAMCS). Results: Our findings indicate that itch patients at JHHS (n = 18,753) were more likely to be black compared to white patients (37% vs. 19%, p < 0.01) when compared to patients without itch—a trend also noted nationally based on data from NAMCS/NHAMCS (26% vs. 21%, p = 0.05). Black itch patients are also more likely to be diagnosed with prurigo nodularis (OR 2.37, p < 0.0001), lichen planus (OR 1.22, p < 0.0001), and atopic dermatitis OR 1.51, p < 0.0001). Female itch patients are more likely to be diagnosed with autoimmune (OR 1.66, p < 0.0001) and psychiatric comorbidities (OR 1.2–1.8, p < 0.0001) than male itch patients. When compared to black itch patients nationally, white itch patients were more likely to visit a dermatologist (29% vs. 18%, p = 0.028). Our data can identify associated conditions and demographic differences but are unable to support a causal relationship. Conclusions: Black and female patients are more likely to present with pruritus, a symptom associated with comorbidities such as prurigo nodularis, lichen planus, atopic dermatitis, and psychiatric conditions.
Collapse
|
16
|
Abstract
Background Despite being one of the most common presenting dermatological symptoms, itching continues to perplex health care professionals because it is notoriously difficult to control. Objective This review gathers evidence to answer the 2-part question, "Why do we itch and scratch?" by exploring the history of itchy disease, the neurobiology of itch, and the 4 different clinical origins of itch: pruritogenic, neurological, neuropathic, and psychological. Results The automated scratching reflex and its biological and psychological reasons for existence are complicated and poorly understood. Currently, there are a myriad of treatments available for individuals suffering from this condition; however, many remain symptomatic. Conclusions The itch-scratch cycle is a complex pain-like sensation with a reflex-like response. In the future, continued exploration into the mechanisms behind itch and scratch may open the doors for new therapeutic interventions.
Collapse
|
17
|
Steinke S, Zeidler C, Riepe C, Bruland P, Soto-Rey I, Storck M, Augustin M, Bobko S, Garcovich S, Legat FJ, Lvov A, Misery L, Osada N, Reich A, Şavk E, Serra-Baldrich E, Streit M, Szepietowski JC, Weger W, Dugas M, Ständer S. Humanistic burden of chronic pruritus in patients with inflammatory dermatoses: Results of the European Academy of Dermatology and Venereology Network on Assessment of Severity and Burden of Pruritus (PruNet) cross-sectional trial. J Am Acad Dermatol 2019; 79:457-463.e5. [PMID: 30119869 DOI: 10.1016/j.jaad.2018.04.044] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [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: 01/08/2018] [Revised: 04/17/2018] [Accepted: 04/20/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Chronic pruritus is a multifactorial, challenging symptom of global relevance. OBJECTIVE The European Academy of Dermatology and Venereology Network on Assessment of Severity and Burden of Pruritus (PruNet) investigation aimed to analyze the severity and humanistic burden of chronic pruritus in patients suffering from inflammatory dermatoses across Europe. METHODS Prospectively collected routine data on 552 patients (with atopic dermatitis, contact dermatitis, prurigo nodularis, psoriasis vulgaris, lichen planus, or mycosis fungoides [pruritus numeric rating scale score ≥3]) from 9 European centers (in Austria, France, Germany, Italy, Poland, Russia, Spain, Switzerland, and Turkey) were analyzed by univariate and multivariate variance analyses of various itch characteristics and quality of life (as measured by the Dermatology Life Quality Index and the ItchyQoL). RESULTS Duration, frequency, and intensity of pruritus (according to a numeric rating scale and visual analog scale) and related impairment of quality of life differed between European centers and dermatologic diagnoses (P < .05). The country in which the center was located had a greater impact on how patients evaluated pruritus intensity and quality of life than diagnosis did (P < .001). LIMITATIONS One center per country was included. CONCLUSION The humanistic burden of chronic pruritus in patients with inflammatory dermatoses is high. European cross-cultural factors may have a stronger influence than a specific dermatologic diagnosis on how patients rate intensity of pruritus and quality of life.
Collapse
Affiliation(s)
- Sabine Steinke
- Center for Chronic Pruritus, Department of Dermatology, University Hospital of Münster, Münster, Germany; Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Claudia Zeidler
- Center for Chronic Pruritus, Department of Dermatology, University Hospital of Münster, Münster, Germany
| | - Claudia Riepe
- Center for Chronic Pruritus, Department of Dermatology, University Hospital of Münster, Münster, Germany
| | - Philipp Bruland
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Iñaki Soto-Rey
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Michael Storck
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Svetlana Bobko
- Department of Dermatology, University Hospital Moscow, Moscow, Russia
| | - Simone Garcovich
- Department of Dermatology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Franz J Legat
- Department of Dermatology, Medical University of Graz, Graz, Austria; Das Kurhaus-Bad Gleichenberg, Bad Gleichenberg, Austria
| | - Andrey Lvov
- Department of Dermatology, University Hospital Moscow, Moscow, Russia
| | - Laurent Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - Nani Osada
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Adam Reich
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland; Department of Dermatology, University of Rzeszow, Rzeszow, Poland
| | - Ekin Şavk
- Department of Dermatology, Adnan Menderes University, Aydın, Turkey
| | - Esther Serra-Baldrich
- Cutaneous Allergy Unit, Department of Dermatology, Hospital Sant Pau, Universitat Autònoma Barcelona, Barcelona, Spain
| | - Markus Streit
- Department of Dermatology, Kantonsspital Aarau, Aarau, Switzerland
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Wolfgang Weger
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Martin Dugas
- Institute of Medical Informatics, University of Münster, Münster, Germany
| | - Sonja Ständer
- Center for Chronic Pruritus, Department of Dermatology, University Hospital of Münster, Münster, Germany
| |
Collapse
|
18
|
Abstract
Human, dog, and cat fleas, as well as bedbugs, feed by biting their victims, causing acute prurigo, which is aggravated in sensitized victims (papular urticaria). The lesions appear in the classic "breakfast, lunch, and dinner" pattern. There are two main explanations: the parasites "map" the skin area in search of the best places to bite, and their removal when victim scratches, and then reattach to the skin. Treatments aim to control pruritus, as well as hypersensitivity reactions when necessary. Prevention is based on environmental control measures. The "breakfast, lunch, and dinner" sign is a definitive marker for diagnosis and the parasite´s identification and control.
Collapse
Affiliation(s)
- Gabriel Peres
- Department of Dermatology and Radiotherapy, Faculdade de Medicina de
Botucatu, Universidade Estadual Paulista, Botucatu (SP), Brazil
| | | | - Vidal Haddad Junior
- Department of Dermatology and Radiotherapy, Faculdade de Medicina de
Botucatu, Universidade Estadual Paulista, Botucatu (SP), Brazil
| |
Collapse
|
19
|
Akarsu S, Ozbagcivan O, Ilknur T, Semiz F, Inci BB, Fetil E. Xerosis cutis and associated co-factors in women with prurigo nodularis. An Bras Dermatol 2018; 93:671-679. [PMID: 30156616 PMCID: PMC6106662 DOI: 10.1590/abd1806-4841.20187127] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [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] [Received: 03/22/2017] [Accepted: 08/20/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Current data regarding the associated factors of prurigo nodularis are still uncertain, except for atopic predisposition. OBJECTIVES The purposes of this study were to (1) determine the frequencies of xerosis and other accompanying diseases of female patients with prurigo nodularis; (2) compare the demographic, clinical and accompanying disease characteristics by grouping these patients according to whether they have associated xerosis (who were subsequently subgrouped as atopic or non-atopic) or not. METHODS In this retrospective descriptive study, 80 females with PN were categorized according to the accompanying diseases (dermatological, systemic, neurological, psychogenic, mixed, or undetermined origin). RESULTS A total of 45 associated co-factors including dermatological in 63 (78.8%), systemic in 57 (71.3%), psychological in 33 (41.3%) and neurological co-factors in 14 (17.5%) of all patients with prurigo nodularis were detected. Xerosis was observed in 48 (60%) patients (non-atopic co-factors in 66.7% of them). The ratio of patients with mixed co-factors, dermatological+systemic co-factors and dermatological+systemic+psychological co-factors were found to be significantly higher in patients with xerosis compared to those without xerosis. STUDY LIMITATIONS Our study has certain limitations such as the absence of an age-matched control group, absence of follow-up data and the fact that the diagnosis of xerosis has not been based on objective methods. CONCLUSIONS Xerosis has been identified in more than half of the patients with PN and it has been determined that in most patients xerosis is associated especially with diabetes mellitus and other conditions related to prurigo nodularis.
Collapse
Affiliation(s)
- Sevgi Akarsu
- Department of Dermatology, Faculty of Medicine, Dokuz Eylul
University, Izmir, Turkey
| | - Ozlem Ozbagcivan
- Department of Dermatology, Faculty of Medicine, Dokuz Eylul
University, Izmir, Turkey
| | - Turna Ilknur
- Department of Dermatology, Faculty of Medicine, Dokuz Eylul
University, Izmir, Turkey
| | - Fatma Semiz
- Department of Dermatology, Faculty of Medicine, Dokuz Eylul
University, Izmir, Turkey
| | - Burcu Bahar Inci
- Department of Dermatology, Faculty of Medicine, Dokuz Eylul
University, Izmir, Turkey
| | - Emel Fetil
- Department of Dermatology, Faculty of Medicine, Dokuz Eylul
University, Izmir, Turkey
| |
Collapse
|
20
|
Naciri I, Hassam B. [Adenocarcinoma of the ampulla of Vater revealed by prurigo]. Pan Afr Med J 2018; 28:154. [PMID: 29564035 PMCID: PMC5851668 DOI: 10.11604/pamj.2017.28.154.13846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 10/06/2017] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ilhame Naciri
- Service de Dermatologie et Vénérologie, Centre Hospitalier Universitaire IBN Sina, Faculté de Médecine et de Pharmacie, Université Mohammed V, Rabat, Maroc
| | - Baderddine Hassam
- Service de Dermatologie et Vénérologie, Centre Hospitalier Universitaire IBN Sina, Faculté de Médecine et de Pharmacie, Université Mohammed V, Rabat, Maroc
| |
Collapse
|
21
|
Abstract
Pigeon lice are insects that feed on feathers of these birds; their life cycle includes egg, nymph and adult and they may cause dermatoses in humans. Four persons of the same family, living in an urban area, presented with widespread intensely pruritic erythematous papules. A great number of lice were seen in their house, which moved from a nest of pigeons located on the condenser of the air-conditioning to the dormitory of one of the patients. Even in urban environments, dermatitis caused by parasites of birds is a possibility in cases of acute prurigo simplex. Pigeon lice are possible etiological agents of this kind of skin eruption, although they are often neglected, even by dermatologists.
Collapse
Affiliation(s)
- Hamilton Ometto Stolf
- Discipline of Dermatology, Faculdade de Ciências
Médicas, Universidade de Campinas (FCM-Unicamp) - Campinas (SP),
Brazil
| | | | - Ana Cláudia Cavalcante Espósito
- Department of Dermatology and Radiotherapy, Faculdade de Medicina
de Botucatu, Universidade Estadual Paulista "Júlio de Mesquita Filho"
(FMB-Unesp) - Botucatu (SP), Brazil
| | - Vidal Haddad Júnior
- Department of Dermatology and Radiotherapy, Faculdade de Medicina
de Botucatu, Universidade Estadual Paulista "Júlio de Mesquita Filho"
(FMB-Unesp) - Botucatu (SP), Brazil
| |
Collapse
|
22
|
Weisshaar E, Molin S, Darsow U, Geier J. Contact sensitization in prurigo patients. Contact Dermatitis 2016; 75:173-9. [PMID: 27061085 DOI: 10.1111/cod.12564] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 10/27/2015] [Revised: 01/27/2016] [Accepted: 02/06/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND There are no studies on contact allergy in patients with prurigo. With itch being important in the pathophysiology of prurigo diseases and being a symptom of allergic contact dermatitis, we aimed to investigate contact allergy in patients suffering from prurigo. OBJECTIVES Exploratory analysis of patch test results in prurigo patients. MATERIALS AND METHODS A retrospective analysis of data of the Information Network of Departments of Dermatology, 2005-2014, was performed. RESULTS Of 116 744 patch tested patients, 639 (0.55%) were diagnosed with prurigo. The median age was 61 years, 286 (45%) were pensioners, and 252 (39.5%) had generalized prurigo. The indication for patch testing was exclusion of contact allergy in 412 patients (64.5%), and 223 patients (35%) had at least one positive patch test reaction. There was no distinctive pattern of sensitization. Prurigo patients had significantly more (and stronger) reactions to the irritant control patch test with sodium lauryl sulfate than a control group (27.6% versus 21.0%). CONCLUSIONS Although prurigo is not a typical clinical manifestation of contact sensitization, our results indicate that patch testing in these patients may be helpful.
Collapse
Affiliation(s)
- Elke Weisshaar
- Department of Clinical Social Medicine, Occupational and Environmental Dermatology, Ruprecht Karls University, 69115, Heidelberg, Germany
| | - Sonja Molin
- Department of Dermatology and Allergy, Ludwig Maximilian University, 80337, Munich, Germany
| | - Ulf Darsow
- Department of Dermatology and Allergy, Biederstein Technical University, 80802, Munich, Germany.,ZAUM Centre of Allergy and Environment, 80802, Munich, Germany
| | - Johannes Geier
- Information Network of Departments of Dermatology (IVDK), University of Göttingen, 37075, Göttingen, Germany
| |
Collapse
|
23
|
Takamura S, Suyama T, Teraki Y. Immunoglobulin G4-related disease presenting with prurigo: Circulating T-helper 2 cells may be involved in the pathogenesis. J Dermatol 2016; 43:1067-70. [PMID: 27027509 DOI: 10.1111/1346-8138.13372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 02/10/2016] [Indexed: 11/30/2022]
Abstract
We report a case of immunoglobulin G4-related disease (IgG4-RD) which presented with prurigo on the trunk and extremities. A 66-year-old man had a 2-month history of itchy erythematous papules on his trunk and extremities. Bilateral eyelid swelling and enlargement of the submandibular and parotid glands were also observed. Computed tomography revealed pleural thickening and diffuse pancreatic enlargement. Serum levels of IgG4 were markedly increased. A biopsy specimen obtained from an erythematous papule showed a perivascular inflammatory infiltrate of lymphocytes with eosinophils in the dermis, whereas a parotid gland biopsy revealed an infiltrate of abundant IgG4-positive plasma cells. Treatment with prednisolone resulted in improvement of the skin and other lesions along with a decrease in IgG4 serum levels. A flow cytometric assay revealed that percentages of interleukin (IL)-4- and IL-13-producing CD4(+) T cells were markedly higher in the circulation of the IgG4-RD patient than in that of healthy subjects. Moreover, those populations dramatically decreased after treatment. Thus, prurigo may be a skin manifestation of IgG4-RD and T-helper 2 cells may contribute to the pathogenesis.
Collapse
Affiliation(s)
- Saori Takamura
- Department of Dermatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Takayuki Suyama
- Department of Dermatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Yuichi Teraki
- Department of Dermatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| |
Collapse
|
24
|
Kenyon AP, Tribe RM, Nelson-Piercy C, Girling JC, Williamson C, Seed PT, Vaughan-Jones S, Shennan AH. Pruritus in pregnancy: a study of anatomical distribution and prevalence in relation to the development of obstetric cholestasis. Obstet Med 2010; 3:25-9. [PMID: 27582836 DOI: 10.1258/om.2010.090055] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2010] [Indexed: 12/27/2022] Open
Abstract
The main objective of this study was to determine the prevalence and anatomical distribution of pruritus in 6532 pregnant women from a UK antenatal population. Pregnant women attending and completing antenatal care at two general hospitals over a 12-month period were recruited and contacted on three occasions by post. Medical advice and a questionnaire detailing the nature and severity of their pruritus were included. Pruritus in pregnancy, as reported by questionnaire, affected approximately 23% of pregnancies (n = 1521/6532 women) and 1.6% (n = 25) of these women developed obstetric cholestasis (OC). Overall, 0.66% of the antenatal population (43/6532) had a clinical diagnosis of OC (95% CI: 0.48-0.89%). Itching unrelated to OC was most commonly reported to be worst on the abdomen (31%, 616/2014). Women with OC reported pruritus to be most severe on the palms and soles in 16% (4/25) and 'all over' in 24% (6/25) compared with 5% (54/1120) (P < 0.05) and 4% (42/1120, P < 0.0001) of those without OC. In conclusion, pruritus affected approximately one in four women and OC one in 135 women during the study period. Women whose pruritus is 'all over' or most severe on the 'palms or soles' may be at greater risk of the disease.
Collapse
Affiliation(s)
- A P Kenyon
- Maternal and Fetal Research Unit, Division of Reproduction and Endocrinology, King's College
| | - R M Tribe
- Maternal and Fetal Research Unit, Division of Reproduction and Endocrinology, King's College
| | - C Nelson-Piercy
- Maternal and Fetal Research Unit, Division of Reproduction and Endocrinology, King's College
| | | | | | - P T Seed
- Maternal and Fetal Research Unit, Division of Reproduction and Endocrinology, King's College
| | - S Vaughan-Jones
- Department of Dermatology, St Peter's Hospital Chertsey , Surrey , UK
| | - A H Shennan
- Maternal and Fetal Research Unit, Division of Reproduction and Endocrinology, King's College
| |
Collapse
|