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Clinics in Geriatric Medicine Feb 2024Pruritus is the most common dermatologic complaint in the geriatric population. Its growing prevalence coincides with the rapid growth of the elderly population... (Review)
Review
Pruritus is the most common dermatologic complaint in the geriatric population. Its growing prevalence coincides with the rapid growth of the elderly population (>65 years of age) in the United States. According to the US Census Bureau, 16.9% of the population, or more than 56 million adults 65 years and older, lived in the United States in 2022. Pruritus is a condition that accompanies a diverse array of underlying etiologic factors. The mechanism of normal itch impulse transmission has been recently elucidated. The itch sensation originates from epidermal/dermal receptors connected to unmyelinated, afferent C-fibers that transmit the impulse from the periphery.
Topics: Aged; Humans; Scabies; Pruritus
PubMed: 38000864
DOI: 10.1016/j.cger.2023.09.010 -
Acta Dermato-venereologica Jan 2020Beginning from embryological development, skin and psyche are closely related to physiological state regardless of age. Altering the homeostasis of one of these... (Review)
Review
Beginning from embryological development, skin and psyche are closely related to physiological state regardless of age. Altering the homeostasis of one of these components impacts on the other, thereby substantiating that the relationship between itch and psyche is bilateral. Itch has a complex pathogenesis, which involves the peripheral and central nervous systems, as well as various inflammatory mediators. This paper reviews key aspects of itch pathogenesis, relevant associations with stress, the contagiousness of itch, psychological and psychiatric considerations related to itch, and the burden of itch with respect to impairment of health-related quality of life (HRQoL) and stigmatization. Despite the fact that itch-psyche associations still pose many questions, current knowledge supports the role of a holistic, interdisciplinary approach to these patients in order to improve their well-being.
Topics: Adaptation, Psychological; Cost of Illness; Humans; Prejudice; Pruritus; Quality of Life; Risk Factors; Stereotyping; Stress, Psychological
PubMed: 31940046
DOI: 10.2340/00015555-3346 -
Annales de Dermatologie Et de... Mar 2018
Review
Topics: Drug Eruptions; Female; Histamine Release; Humans; Hypersensitivity, Immediate; Male; Parasitic Diseases; Pregnancy; Pregnancy Complications; Pruritus; Skin Neoplasms
PubMed: 29455944
DOI: 10.1016/j.annder.2018.01.016 -
Digestive Diseases (Basel, Switzerland) 2015Pruritus is a preeminent symptom in patients with chronic cholestatic liver disorders such as primary biliary cirrhosis and primary sclerosing cholangitis. More than... (Review)
Review
Pruritus is a preeminent symptom in patients with chronic cholestatic liver disorders such as primary biliary cirrhosis and primary sclerosing cholangitis. More than two-thirds of these patients experience itching during the course of their disease. This symptom is also frequently observed in patients with other causes of cholestasis such as cholangiocarcinoma, inherited forms of cholestasis and intrahepatic cholestasis of pregnancy, but may accompany almost any other liver disease. The pathogenesis of pruritus of cholestasis remains largely elusive. Increased concentrations of bile salts, histamine, serotonin, progesterone metabolites and endogenous opioids have been controversially discussed as potential pruritogens. However, for these molecules, neither a correlation with itch intensity nor a causative link could be established. The G protein-coupled receptor for bile salts, TGR5, has been shown to be expressed in dorsal root ganglia and give rise to itch in rodents, albeit upon stimuli with suprapathological concentrations of bile salts. The potent neuronal activator lysophosphatidic acid (LPA) and its forming enzyme, autotaxin (ATX), could be identified in the serum of patients with cholestatic pruritus. ATX activity correlated with itch severity and effectiveness of several anti-pruritic therapeutic interventions in cholestatic patients. Thus, the ATX-LPA-axis may represent a key element in the pathogenesis of this agonizing symptom. Treatment options for pruritus of cholestasis remain limited to a few evidence-based and several experimental medical and interventional therapies. The current guideline-based recommendations include the anion exchange resins colestyramine, the pregnane X receptor-agonist and enzyme inducer rifampicin, the μ-opioid antagonist naltrexone, and the selective serotonin reuptake inhibitors sertraline. Still, a considerable part of patients is unresponsive to these drugs and requires experimental approaches including phototherapy, plasmapheresis, albumin dialysis or nasobiliary drainage. This review outlines the current knowledge on pathogenesis of cholestatic pruritus and summarizes evidence-based and experimental therapeutic interventions for cholestatic patients with itch.
Topics: Cholangitis, Sclerosing; Cholestasis; Humans; Liver Cirrhosis, Biliary; Pruritus; Signal Transduction
PubMed: 26641452
DOI: 10.1159/000440829 -
Neuroscience Letters Jan 2022The transient receptor potential (TRP) channel superfamily responds to various physical, chemical, and environmental stimuli including the detection of sensations both... (Review)
Review
The transient receptor potential (TRP) channel superfamily responds to various physical, chemical, and environmental stimuli including the detection of sensations both harmful and non-harmful. Among these sensations is pruritus, or itch. There are at least 27 different TRP channels and about six of them are involved in pruriception. The function of these six receptors is primarily seen in the skin and the dorsal root ganglia. Identification and biological insights provided by these receptors in pruriception is important for human health as mutations and activations of many of these channels cause discomfort and disease. This review will focus on involvement of TRP channels in pruriception that may render these channels as the targets of many antagonistic topical medications, which may help patients' better cope with the pruritus that results from various cutaneous and systemic diseases.
Topics: Animals; Humans; Pruritus; Sensory Receptor Cells; Transient Receptor Potential Channels
PubMed: 34861341
DOI: 10.1016/j.neulet.2021.136379 -
The American Journal of Managed Care May 2023Prurigo nodularis (PN) is a chronic neural- and immune-mediated disease that is characterized by intense itch, history of skin scratching, and development of... (Review)
Review
Prurigo nodularis (PN) is a chronic neural- and immune-mediated disease that is characterized by intense itch, history of skin scratching, and development of papulonodular lesions. These lesions can develop consequent to a cycle of itching and scratching associated with inflammation and changes in skin cells and nerve fibers (eg, pathogenic skin fibrosis, tissue remodeling, and chronic neuronal sensitization). Diagnosis of PN involves individual evaluation of clinical characteristics to identify disease and symptom severity. In the United States, adult patients with PN (estimated, < 90,000) are more likely to be older (age, 50-60 years); in addition, this disease is detected at higher rates in women and Black individuals relative to other demographic subgroups. Still, the small population of patients with PN exhibits considerably high use of health care resources and experiences considerable symptom burden and negatively impacted quality of life. Further, PN is associated with increased rates of a range of comorbid diseases compared with other inflammatory dermatoses (eg, atopic dermatitis, psoriasis). Adequate treatment must address both the neural and immunological component of the disease; there remains a great unmet need for safe and effective therapies that can reduce the burden of disease.
Topics: Adult; Humans; Female; United States; Middle Aged; Prurigo; Quality of Life; Pruritus; Skin; Dermatitis, Atopic
PubMed: 37146288
DOI: 10.37765/ajmc.2023.89366 -
Obstetrics and Gynecology Oct 2022Pregnancy dermatoses are inflammatory skin disorders that occur during pregnancy or immediately postpartum. This heterogenous group of disorders includes pemphigoid... (Review)
Review
Pregnancy dermatoses are inflammatory skin disorders that occur during pregnancy or immediately postpartum. This heterogenous group of disorders includes pemphigoid gestationis, polymorphic eruption of pregnancy, intrahepatic cholestasis of pregnancy, atopic eruption of pregnancy, and pustular psoriasis of pregnancy. In this article, we provide a comprehensive literature review of each condition focusing on nomenclature, epidemiology, pathogenesis, clinical presentation, diagnosis, differential diagnosis, maternal risk, fetal risk, and treatment. We aim to increase awareness and help clinicians recognize, diagnose, and manage these unique conditions.
Topics: Female; Pregnancy; Humans; Pregnancy Complications; Pemphigoid Gestationis; Cholestasis, Intrahepatic; Skin Diseases; Diagnosis, Differential; Pruritus
PubMed: 36075066
DOI: 10.1097/AOG.0000000000004938 -
The Journal of Family Practice Sep 2022Quick thinking and fast reflexes during the physical exam led to an identification that confirmed the diagnosis.
Quick thinking and fast reflexes during the physical exam led to an identification that confirmed the diagnosis.
Topics: Diagnosis, Differential; Exanthema; Humans; Pruritus
PubMed: 36179139
DOI: 10.12788/jfp.0473 -
Cutis Jul 2022
Topics: Exanthema; Humans; Prurigo; Pruritus
PubMed: 36179235
DOI: 10.12788/cutis.0549 -
JAMA Dermatology Dec 2023
Topics: Humans; Pruritus
PubMed: 37728895
DOI: 10.1001/jamadermatol.2023.3384