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Expert Opinion on Emerging Drugs Sep 2015Chronic pruritus occurs in 13% of the general population without age limitation. There is a high unmet need here as effective treatment options are still missing. (Review)
Review
INTRODUCTION
Chronic pruritus occurs in 13% of the general population without age limitation. There is a high unmet need here as effective treatment options are still missing.
AREAS COVERED
Clinical and experimental research during the past decade identified new mechanisms in chronic pruritus allowing the definition of a broad range of specific treatment targets for the first time. This refers specifically to inflammatory pruritic dermatoses, uremic and cholestatic pruritus. Targets identified are, for example, receptors for substance P, IL-31 and nerve growth factor. Search was made for current studies addressing these diseases and targets in the available clinical registration databases.
EXPERT OPINION
The current pharmacological development is very promising especially for patients suffering from chronic pruritus in inflammatory dermatoses, chronic kidney diseases and hepatobiliary diseases. However, there are still several pruritic diseases in which neither mediators nor specific target populations (e.g., children) nor stages of diseases, have been identified; however, it can be assumed that within the next 10 years, major changes in the possibilities of antipruritic treatment will take place.
Topics: Animals; Antipruritics; Chronic Disease; Drug Design; Humans; Molecular Targeted Therapy; Pruritus
PubMed: 26027744
DOI: 10.1517/14728214.2015.1051964 -
Cells Oct 2021In infants, pruritus is frequently considered as absent because they do not scratch themselves. Because pruritus could induce severe adverse effects in this vulnerable... (Review)
Review
In infants, pruritus is frequently considered as absent because they do not scratch themselves. Because pruritus could induce severe adverse effects in this vulnerable population, we aimed to review existing evidence on the ability of young infants to experience itch and on how to assess itch-related discomfort in this population. A literature review was performed (Pubmed, Google Scholar). Neurological itch pathways are well described. Skin development starts early during gestation. At 34 weeks of gestation, skin is almost complete while skin adaptations occur after birth. Newborn skin is neurologically functional, including the ability for young infants to feel pain. Similarities and interactions between pain and pruritus support the hypothesis that infants could feel pruritus. However, the existence of pruritus in infants has never been evidenced. Many itchy conditions can affect them, suggesting non-negligible prevalence of infant pruritus among which atopic dermatitis (AD) is the most studied disease. Studies reported a negative impact of AD on children and their families. There is no existing validated method to assess pruritus in infants, although they may feel pruritus and chronic pruritus can lead to serious adverse effects. To appropriately diagnose pruritus appears of great interest among young infants. Development of a method is required to this aim.
Topics: Biomedical Research; Humans; Infant; Pain; Pruritus; Skin
PubMed: 34685768
DOI: 10.3390/cells10102788 -
Handbook of Experimental Pharmacology 2015Protease-activated receptors (PARs) have been implicated in a variety of physiological functions, as well as somatosensation and particularly itch and pain. Considerable... (Review)
Review
Protease-activated receptors (PARs) have been implicated in a variety of physiological functions, as well as somatosensation and particularly itch and pain. Considerable attention has focused on PARs following the finding they are upregulated in the skin of atopic dermatitis patients. The present review focuses on recent studies showing that PARs are critically involved in itch and sensitization of itch. PARs are expressed by diverse cell types including primary sensory neurons, keratinocytes, and immune cells and are activated by proteases that expose a tethered ligand. Endogenous proteases are also released from diverse cell types including keratinocytes and immune cells. Exogenous proteases released from certain plants and insects contacting the skin can also induce itch. Increased levels of proteases in the skin contribute to inflammation that is often accompanied by chronic itch which is not predominantly mediated by histamine. The neural pathway signaling itch induced by activation of PARs is distinct from that mediating histamine-induced itch. In addition, there is evidence that PARs play an important role in sensitization of itch signaling under conditions of chronic itch. These recent findings suggest that PARs and other molecules involved in the itch-signaling pathway are good targets to develop novel treatments for most types of chronic itch that are poorly treated with antihistamines.
Topics: Animals; Humans; Pruritus; Receptors, Proteinase-Activated
PubMed: 25861783
DOI: 10.1007/978-3-662-44605-8_13 -
International Journal of Dermatology Jan 2019Itch, also referred to as pruritus, is an unpleasant cutaneous sensation provoking the desire to scratch. It is often an uncomfortable, subjective sensation responsible... (Review)
Review
Itch, also referred to as pruritus, is an unpleasant cutaneous sensation provoking the desire to scratch. It is often an uncomfortable, subjective sensation responsible for decreased quality of life in a variety of psychodermatological conditions. Comorbid psychiatric conditions, including depression and anxiety, are frequently associated with itch and scratch cycle. The reciprocal and intricate relationship between the psyche and itch has been widely studied. The neurobiology of itch involves the complexity of specific mediators, itch-related neuronal pathways, and central processing of itch. The connection between itch and the psyche can be grouped under three headings: pruritic diseases with psychosocial sequelae, pruritic diseases aggravated by psychosocial factors, and psychiatric disorders causing pruritus. Itch and pain modulation go together in most circumstances and involve various substances including histamine, interleukins, protease-activated receptors, transient receptor potential receptors, opioids, and cannabinoids. The close interaction between keratinocytes and nerve endings modulating pain and itch also play a major role. Management of itch associated with its psychosomatic components is directed at an underlying cause and adopting a holistic approach to address not only dermatologic and somatosensory aspects, but also the cognitive, emotional, and psychosocial components. An integrated multidisciplinary team consisting of a dermatologist, psychiatrist, psychologist, and social worker is vital in addressing the multifaceted aspects of pruritus.
Topics: Anxiety; Comorbidity; Depression; Humans; Models, Psychological; Pain; Perception; Pruritus; Psychophysiologic Disorders; Skin Diseases
PubMed: 29917231
DOI: 10.1111/ijd.14081 -
Clinics in Dermatology 2016Polymorphic eruption of pregnancy (PEP), a specific dermatosis of pregnancy also known as pruritic urticarial papules and plaques of pregnancy (PUPPP), is a benign,... (Review)
Review
Polymorphic eruption of pregnancy (PEP), a specific dermatosis of pregnancy also known as pruritic urticarial papules and plaques of pregnancy (PUPPP), is a benign, self-limited skin disorder. Key features include an increased prevalence in primigravidas, onset in the third trimester, remission near the time of delivery, and association with multiple gestation pregnancy. The clinical features are crucial to diagnosis. Histopathology is nonspecific, and immunofluorescence studies help differentiate PEP from pemphigoid gestationis. The pathogenesis of PEP remains elusive, and relevant theories are reviewed. There are no associated maternal or fetal risks, and treatment is largely symptomatic.
Topics: Female; Gravidity; Humans; Pregnancy; Pregnancy Complications; Pregnancy, Multiple; Prognosis; Pruritus; Sex Factors
PubMed: 27265077
DOI: 10.1016/j.clindermatol.2016.02.011 -
Der Hautarzt; Zeitschrift Fur... Aug 2016
Topics: Dermatology; Forecasting; Humans; Immunotherapy; Molecular Targeted Therapy; Pruritus
PubMed: 27306977
DOI: 10.1007/s00105-016-3824-0 -
Rehabilitation Nursing : the Official... 2018Postburn pruritus is a syndrome of stressful symptoms that is pervasive and occurs in over 90% of burn patients and continues for years after the burn has healed.... (Review)
Review
BACKGROUND
Postburn pruritus is a syndrome of stressful symptoms that is pervasive and occurs in over 90% of burn patients and continues for years after the burn has healed. Postburn pruritus is experienced by burn survivors that may require medical management and effective interventions.
PURPOSE
This article shows how to effectively relieve postburn pruritus by developing a postburn pruritus relief protocol.
DESIGN
A descriptive literature review was conducted, and relevant empirical articles written during the years 2000-2014 were appraised to create a postburn pruritus relief protocol. Twenty-six of 79 articles were selected using preestablished inclusion criteria: any age group experiencing burn-related pruritus after second- or third-degree burns. Databases were Cochrane Central Register of Controlled Trials, CINAHL, EBSCO, PubMed, the National Guideline Clearinghouse, Google Scholar, and the American Burn Association website.
CONCLUSIONS
This protocol included both nonpharmacological and pharmacological interventions that have been delineated for use and was developed to apply based on the healing stage: prehealing, healing, and posthealing.
Topics: Burns; Guidelines as Topic; Humans; Pruritus; Wound Healing
PubMed: 30395557
DOI: 10.1097/rnj.0000000000000095 -
Acta Dermato-venereologica Apr 2017Pruritus occurs frequently in the elderly population, but it has not been fully defined and its precise prevalence is unknown. Putative causes of pruritus are numerous... (Review)
Review
Pruritus occurs frequently in the elderly population, but it has not been fully defined and its precise prevalence is unknown. Putative causes of pruritus are numerous and patients' quality of life can be greatly reduced. In the absence of any specific cause, a diagnosis of senile pruritus is proposed, suggesting that itch is secondary to ageing. However, the relationship of pruritus with skin ageing and/or neuronal ageing and/or immune ageing is poorly understood. Many treatments have been reported, but are poorly effective. This paper reviews the literature on senile pruritus, in order to improve understanding of this condition and to enable improved diagnosis and treatment.
Topics: Age of Onset; Aged; Aging; Geriatric Assessment; Humans; Predictive Value of Tests; Prevalence; Pruritus; Quality of Life; Risk Factors; Treatment Outcome
PubMed: 27840888
DOI: 10.2340/00015555-2574 -
International Journal of Molecular... Sep 2022Chronic itch is one of the most prominent clinical characteristics of diverse systematic diseases. It is a devastating sensation in pathological diseases. Despite its... (Review)
Review
Chronic itch is one of the most prominent clinical characteristics of diverse systematic diseases. It is a devastating sensation in pathological diseases. Despite its importance, there are no FDA-labelled drugs specifically geared toward chronic itch. The associated complex pathogenesis and diverse causes escalate chronic itch to being one of the top challenges in healthcare. Humanized antibodies against IL-13, IL-4, and IL-31 proved effective in treatment of itch-associated atopic dermatitis but remain to be validated in chronic itch. There are still no satisfactory anti-itch therapeutics available toward itch-related neuropeptides including GRP, BNP, SST, CGRP, and SP. The newly identified potential itch targets including OSM, NMB, glutamate, periostin, and Serpin E1 have opened new avenues for therapeutic development. Proof-of-principle studies have been successfully performed on antagonists against these proteins and their receptors in itch treatment in animal models. Their translational interventions in humans need to be evaluated. It is of great importance to summarize and compare the newly emerging knowledge on chronic itch and its pathways to promote the development of novel anti-itch therapeutics. The goal of this review is to analyze the different physiologies and pathophysiologies of itch mediators, whilst assessing their suitability as new targets and discussing future therapeutic development.
Topics: Animals; Dermatitis, Atopic; Humans; Neuropeptides; Pruritus
PubMed: 36077340
DOI: 10.3390/ijms23179935 -
Deutsche Medizinische Wochenschrift... Nov 2016Pruritus (itch) is the most frequent skin symptom. It can be attributed to a skin disease in many cases. Furthermore pruritus may also be a precursing symptom or... (Review)
Review
Pruritus (itch) is the most frequent skin symptom. It can be attributed to a skin disease in many cases. Furthermore pruritus may also be a precursing symptom or principal complaint of an internal, neurological or psychiatric disease. It has been observed that elderly patients are increasingly affected. In many cases pruritus has multifactorial causes. This requires careful diagnostics, including a detailed medical history and medical examination of the patient. Previous diseases and comorbidities need to be considered as possible causes, as well as current and previous drug intake. By this important information can be obtained at an early time, which may lead to further investigation. Aim of rational diagnostics is to evaluate especially internal diseases which need to be assessed by laboratory testing and more specific diagnostics. Due to the multitude of possible causing diseases, diagnosis and therapy of chronic itch need an interdisciplinary approach.
Topics: Humans; Medical History Taking; Physical Examination; Pruritus
PubMed: 27855461
DOI: 10.1055/s-0042-114092