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The Journal of Investigative Dermatology Jan 2022
Topics: Animals; Humans; Interdisciplinary Communication; Molecular Targeted Therapy; Neurogenic Inflammation; Pruritus; Quality of Life; Signal Transduction
PubMed: 34924149
DOI: 10.1016/j.jid.2021.11.003 -
Dermatologic Clinics Jul 2018Pruritus in pregnancy can be a source of significant discomfort in the pregnant patient. Some cases are associated with pregnancy-specific dermatoses, although some... (Review)
Review
Pruritus in pregnancy can be a source of significant discomfort in the pregnant patient. Some cases are associated with pregnancy-specific dermatoses, although some patients experience a flare of a preexisting dermatosis. Severe pruritus may be a manifestation of a pregnancy-specific dermatosis associated with increased fetal risks and complications. Early accurate diagnosis and appropriate management are important. Examination often reveals important clinical findings, aiding accurate diagnosis. Pemphigoid gestationis often presents with periumbilical involvement, whereas polymorphic eruption of pregnancy spares the umbilicus and presents in the striae distensae. Intrahepatic cholestasis of pregnancy is associated with intense pruritus of the palms.
Topics: Cholestasis, Intrahepatic; Female; Humans; Pemphigoid Gestationis; Pregnancy; Pregnancy Complications; Pruritus
PubMed: 29929597
DOI: 10.1016/j.det.2018.02.012 -
Canadian Family Physician Medecin de... Dec 2017To describe an approach that allows for a streamlined assessment and accurate differentiation of most patients with itch in primary care and to provide an update on the... (Review)
Review
OBJECTIVE
To describe an approach that allows for a streamlined assessment and accurate differentiation of most patients with itch in primary care and to provide an update on the available nonpharmacologic, topical, and systemic therapies.
SOURCES OF INFORMATION
MEDLINE (Ovid) and PubMed were searched for the key words or Searches were refined for each cause and treatment by adding appropriate key words, and subsequent hand searches of the references of retrieved literature were performed.
MAIN MESSAGE
A good body of evidence from high-quality trials does not exist for treatment of pruritus, and the treatments that do exist are inconsistent in their success. The dominant causes of generalized itch are xerosis and eczema. Most patients will improve with nonpharmacologic therapy including frequent moisturization. If this avenue fails, further investigations are warranted to help guide subsequent treatment with any of the many cause-specific topical and systemic approaches available.
CONCLUSION
Chronic itch can be debilitating for patients. The approach described allows for a streamlined assessment and accurate differentiation of most patients with itch in primary care.
Topics: Diagnosis, Differential; Humans; Patient Care Management; Primary Health Care; Pruritus
PubMed: 29237630
DOI: No ID Found -
Frontiers in Immunology 2023Pruritus is the most common symptom of dermatological disorders, and prurigo nodularis (PN) is notorious for intractable and severe itching. Conventional treatments... (Review)
Review
Pruritus is the most common symptom of dermatological disorders, and prurigo nodularis (PN) is notorious for intractable and severe itching. Conventional treatments often yield disappointing outcomes, significantly affecting patients' quality of life and psychological well-being. The pathogenesis of PN is associated with a self-sustained "itch-scratch" vicious cycle. Recent investigations of PN-related itch have partially revealed the intricate interactions within the cutaneous neuroimmune network; however, the underlying mechanism remains undetermined. Itch mediators play a key role in pruritus amplification in PN and understanding their action mechanism will undoubtedly lead to the development of novel targeted antipruritic agents. In this review, we describe a series of pruritogens and receptors involved in mediating itching in PN, including cytokines, neuropeptides, extracellular matrix proteins, vasculogenic substances, ion channels, and intracellular signaling pathways. Moreover, we provide a prospective outlook on potential therapies based on existing findings.
Topics: Humans; Prurigo; Quality of Life; Pruritus; Neuropeptides; Administration, Cutaneous
PubMed: 38077377
DOI: 10.3389/fimmu.2023.1301817 -
Dermatologic Clinics Jul 2018Chronic itching can be frustrating for patients and providers, and patients are not always willing to accept that their psychiatric health has an impact on their skin.... (Review)
Review
Chronic itching can be frustrating for patients and providers, and patients are not always willing to accept that their psychiatric health has an impact on their skin. Psychogenic pruritus is defined as itch not related to dermatologic or systemic causes. When a patient presents with pruritus, regardless of the presumed cause, the standard work-up should include a thorough history, dermatologic examination, and laboratory examinations or biopsies as needed. If no medical source is found, the provider must work in partnership with the patient to explore other causes and that may include acknowledging and treating underlying psychiatric conditions.
Topics: Humans; Mental Disorders; Pruritus; Psychophysiologic Disorders; Referral and Consultation; Skin Diseases
PubMed: 29929602
DOI: 10.1016/j.det.2018.02.015 -
Dermatologic Clinics Jul 2018Itch is the cardinal symptom of scabies, present in more than 90% of the cases, generalized and intense, worsening at night, and often sparing the head. The primary... (Review)
Review
Itch is the cardinal symptom of scabies, present in more than 90% of the cases, generalized and intense, worsening at night, and often sparing the head. The primary complications of the itch in scabies are secondary bacterial infections and psychosocial issues leading to impairment on life quality. Currently, there are no specific data analyzing mechanisms of the itch in scabies, but the latest progress made in the understanding of host-mite interactions may help to improve understanding. Management of itch in scabies consists primarily of the treatment of the mite infestation, but sometimes the itching sensation may persist after adequate therapy.
Topics: Humans; Impetigo; Pruritus; Scabies
PubMed: 29929601
DOI: 10.1016/j.det.2018.02.009 -
Current Opinion in Nephrology and... Sep 2022Among the many difficult symptoms that patients with kidney disease experience, pruritus is one of the most frequent and troubling. Because a substantial amount of new... (Review)
Review
PURPOSE OF REVIEW
Among the many difficult symptoms that patients with kidney disease experience, pruritus is one of the most frequent and troubling. Because a substantial amount of new information has accumulated, we seek here to review the subject.
RECENT FINDINGS
Pruritus is not only a common problematic symptom among patients with kidney disease, but its considerably more frequent than nephrologists recognize. The result for patients is not just uncomfortable itch but degraded quality of life as well. The pathogenesis is increasingly understood, but many aspects remain to be fully resolved. Importantly, research is progressing on treatment, leading to the first approved medication in the United States, difelikefalin, in August, 2021.
SUMMARY
As nephrology is progressing to a greater focus on patient symptoms, recognition of the importance of pruritus has led to increased interest and improved diagnosis and treatment options.
Topics: Chronic Disease; Humans; Nephrology; Pruritus; Quality of Life; Renal Insufficiency, Chronic
PubMed: 35894277
DOI: 10.1097/MNH.0000000000000824 -
International Journal of Dermatology Feb 2020Pruritus is one of the most common dermatologic complaints and, as the most common dermatologic symptom, is a major contributor to frequent dermatology visits. Chronic... (Review)
Review
Pruritus is one of the most common dermatologic complaints and, as the most common dermatologic symptom, is a major contributor to frequent dermatology visits. Chronic pruritus mirrors another major medical condition faced by millions of Americans each year - chronic pain. In older literature, pain and pruritus were thought to have been conveyed by the same C fiber, and the proportion contributing to pruritus was just a small subset of this general fiber. Overall, pain and pruritus share many integral similarities. Although these sensations both initiate the body's awareness to injury, pain and itch may have evolved for sensing different damages such as a burrowing parasite or a noxious stimulus, respectively. This seems to have been validated through analyses of their pathophysiology, acute and chronic conditions, and treatment modalities. However, their symptoms and intrinsic mechanisms vary considerably. It is important to view pruritus in more of an overall, whole body experience, rather than just the sensory aspect. Future studies should investigate the psychological treatment of chronic pruritus, considering the immense similarities with its chronic pain counterpart.
Topics: Acute Disease; Chronic Disease; Humans; Nerve Fibers, Unmyelinated; Nociceptive Pain; Pain; Pruritus
PubMed: 31605395
DOI: 10.1111/ijd.14678 -
Anais Brasileiros de Dermatologia 2022This review is focused on updating knowledge about cholestatic pruritus. It summarizes clinical-epidemiological characteristics, pathophysiology, diagnostic approach,... (Review)
Review
This review is focused on updating knowledge about cholestatic pruritus. It summarizes clinical-epidemiological characteristics, pathophysiology, diagnostic approach, and evidence-based therapeutic recommendations regarding this form of pruritus. Pruritus is a frequent symptom that accompanies several liver diseases, particularly cholestatic ones. The symptom may be mild and tolerable, but it can also dramatically reduce the quality of life. Although the exact pathophysiology of this form of pruritus remains unclear, current evidence supports a mixed origin. It is extremely important for dermatologists to have knowledge about cholestatic pruritus since they are usually the first physicians to be sought by the patient when they experience the symptom. In the absence of specific dermatological alterations, cholestasis must always be considered as a possible cause of pruritus. In addition to allowing an adequate diagnosis, a better pathophysiological understanding of hepatic pruritus provides the identification of new therapeutic targets and, consequently, optimization of the approach in patients with this condition.
Topics: Cholestasis; Humans; Pruritus; Quality of Life
PubMed: 35279351
DOI: 10.1016/j.abd.2021.06.007 -
Seminars in Nephrology Jul 2015Pruritus is a common and distressing symptom in patients with chronic kidney disease. The most recent epidemiologic data have suggested that approximately 40% of... (Review)
Review
Pruritus is a common and distressing symptom in patients with chronic kidney disease. The most recent epidemiologic data have suggested that approximately 40% of patients with end-stage renal disease experience moderate to severe pruritus and that uremic pruritus (UP) has a major clinical impact, being associated strongly with poor quality of life, impaired sleep, depression, and increased mortality. The pathogenesis of UP remains largely unclear, although several theories on etiologic or contributing factors have been proposed including increased systemic inflammation; abnormal serum parathyroid hormone, calcium, and phosphorus levels; an imbalance in opiate receptors; and a neuropathic process. UP can present somewhat variably, although it tends to affect large, discontinuous, but symmetric, areas of skin and to be most symptomatic at night. A variety of alternative systemic or dermatologic conditions should be considered, especially in patients with asymmetric pruritus or other atypical features. Treatment initially should focus on aggressive skin hydration, patient education on minimizing scratching, and optimization of the aspects of chronic kidney disease care that are most relevant to pruritus, including dialysis adequacy and serum parathyroid hormone, calcium, and phosphorus management. Data for therapy specifically for UP remain limited, although topical therapies, gabapentin, type B ultraviolet light phototherapy, acupuncture, and opioid-receptor modulators all may play a role.
Topics: Humans; Incidence; Kidney Failure, Chronic; Prevalence; Pruritus; Quality of Life; Risk Factors
PubMed: 26355256
DOI: 10.1016/j.semnephrol.2015.06.009