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Acta Medica Croatica : Casopis... 2008Uremic pruritus is a common and sometimes severe complication of chronic renal failure. Itch affects 50-90% of patients undergoing peritoneal dialysis or hemodialysis... (Review)
Review
Uremic pruritus is a common and sometimes severe complication of chronic renal failure. Itch affects 50-90% of patients undergoing peritoneal dialysis or hemodialysis and 25% of patients with preterminal chronic renal failure. The mechanism underlying uremic pruritus is poorly understood; possibilities include histamin, proteases, interleukin-2 and TNF- produced by skin mast-cells, substance P, neuropathy and neurological changes, high level of Ca, P, PTH, Al, Mg, divalent ion abnormalities, hypervitaminosis A, inflammation, or some combination of these. Therapeutic measures include regular efficient dialysis, transplantation, topical measures as an emollients, topical steroids, systemic measures as diet, opioids and physical treatment with phototherapy, acupuncture etc. Treatment results are highly variable and more research is needed to understand the patophysiology of this condition and to establish more reliable treatments. Most effective treatments in this moment are efficient dialysis, dietary restrictions, phosphate-binding therapy and phototherapy.
Topics: Humans; Pruritus; Uremia
PubMed: 18578330
DOI: No ID Found -
MMW Fortschritte Der Medizin May 2022
Topics: Chronic Disease; Humans; Pruritus
PubMed: 35585411
DOI: 10.1007/s15006-022-1025-6 -
Experimental Dermatology Feb 2002Pruritus is an essential feature of atopic dermatitis (AD) and the diagnosis of active AD cannot be made without the history of itching. Because of the high impact on... (Review)
Review
Pruritus is an essential feature of atopic dermatitis (AD) and the diagnosis of active AD cannot be made without the history of itching. Because of the high impact on life quality, most of the patients measure the severity of eczema by the intensity of pruritus rather than appearance of skin lesions. However, although pruritus is a cardinal symptom of AD, its mechanism and association with the cutaneous nervous system is not completely understood. Recently, a considerable progress has been achieved in clarifying the complex pathophysiology of pruritus in AD. As a cutaneous sensory perception, itch requires excitation of neuropeptide-containing free nerve endings of unmyelinated nociceptor fibers. It is well known that histamine and acetylcholine provoke itch by direct binding to 'itch receptors' and several mediators such as neuropeptides, proteases or cytokines indirectly via histamine release. Interestingly, some variations of these complex mechanisms could be demonstrated in patients with AD. This review highlights the recent knowledge of different mechanisms which may be involved in regulating pruritus in patients with AD potentially leading to new therapeutic applications for the treatment of itch in AD.
Topics: Dermatitis, Atopic; Humans; Nociceptors; Pruritus
PubMed: 11952824
DOI: 10.1034/j.1600-0625.2002.110102.x -
The Journal of Allergy and Clinical... Nov 2018Itch is a common sensory experience that is prevalent in patients with inflammatory skin diseases, as well as in those with systemic and neuropathic conditions. In... (Review)
Review
Itch is a common sensory experience that is prevalent in patients with inflammatory skin diseases, as well as in those with systemic and neuropathic conditions. In patients with these conditions, itch is often severe and significantly affects quality of life. Itch is encoded by 2 major neuronal pathways: histaminergic (in acute itch) and nonhistaminergic (in chronic itch). In the majority of cases, crosstalk existing between keratinocytes, the immune system, and nonhistaminergic sensory nerves is responsible for the pathophysiology of chronic itch. This review provides an overview of the current understanding of the molecular, neural, and immune mechanisms of itch: beginning in the skin, proceeding to the spinal cord, and eventually ascending to the brain, where itch is processed. A growing understanding of the mechanisms of chronic itch is expanding, as is our pipeline of more targeted topical and systemic therapies. Our therapeutic armamentarium for treating chronic itch has expanded in the last 5 years, with developments of topical and systemic treatments targeting the neural and immune systems.
Topics: Animals; Brain; Chronic Disease; Humans; Neurons; Pruritus; Spinal Cord
PubMed: 30409247
DOI: 10.1016/j.jaci.2018.09.005 -
Acta Dermato-venereologica Oct 2022Lichen simplex chronicus is a form of chronic localized pruritus with a secondary dermatitis, and one of the most common types of chronic itch conditions, estimated to...
Lichen simplex chronicus is a form of chronic localized pruritus with a secondary dermatitis, and one of the most common types of chronic itch conditions, estimated to affect more than 10% of the general population. However, despite its prevalence and burden, there has been limited research into the pathogenesis and aetiology of lichen simplex chronicus, which, historically, made it a challenging condition to treat. In recent years, our understanding of this condition, along with that of pruritus and the itch-scratch cycle, has increased greatly, enabling a substantial increase in treatment options. In addition, there are several new promising treatments currently in development and trials. This article discusses the definition, epidemiology, clinical characteristics, pathophysiology, and current therapeutic options for lichen simplex chronicus, in order to highlight recent advancements in this field.
Topics: Humans; Neurodermatitis; Pruritus
PubMed: 36250769
DOI: 10.2340/actadv.v102.4367 -
American Journal of Kidney Diseases :... Jul 2007The prevalence of chronic kidney disease (CKD) and end-stage renal disease is increasing worldwide. Despite improvements in dialysis methods, including the development... (Review)
Review
The prevalence of chronic kidney disease (CKD) and end-stage renal disease is increasing worldwide. Despite improvements in dialysis methods, including the development of novel biocompatible membranes and ultrapure dialysate, CKD-associated pruritus remains a common and significant public health issue. Not only does this distressing symptom profoundly impact on quality of life and sleep, recent evidence showed that pruritus also was associated with poor patient outcome. Nonetheless, nephrologists and other health care professionals often fail to recognize and adequately address the pruritus associated with CKD. The pathophysiological mechanism of CKD-associated pruritus is poorly defined, and, as a result, the development of specific therapies has proved to be a challenge. The purpose of this review is to highlight the importance of this neglected topic by providing an overview of recent epidemiological studies, outcomes data, proposed pathophysiological mechanisms, and emerging treatment options.
Topics: Humans; Kidney Failure, Chronic; Pruritus
PubMed: 17591521
DOI: 10.1053/j.ajkd.2007.03.010 -
Seminars in Cutaneous Medicine and... Jun 2011
Topics: Humans; Pruritus
PubMed: 21767765
DOI: 10.1016/j.sder.2011.04.007 -
Revue Medicale Suisse Apr 2006Diagnosis and treatment of pruritus is still a great problem. The pathophysiologic principles are mostly unknown, however the progress in neurosciences also added... (Review)
Review
Diagnosis and treatment of pruritus is still a great problem. The pathophysiologic principles are mostly unknown, however the progress in neurosciences also added several new neurophysiologic explanations for pruritus. There exist several different types of pruritus and also the treatment of the different forms varies. The treatment of chronic pruritus is not the same as the treatment of acute pruritus. Usually more than one pathological disorder leads to severe pruritus and therefore the diagnostic of the different forms of pruritus and the treatment needs an interdisciplinary approach. One of the major causes of itch is dry skin, this is true for elderly persons and also for patients with atopic dermatitis. Therefore, the treatment of the dry skin is one of the most important measures against pruritus.
Topics: Humans; Pruritus
PubMed: 16711453
DOI: No ID Found -
Indian Journal of Dermatology,... 2014Pruritus is the most common symptom secondary to skin diseases. Advances in the fields of neurobiology, immunology and physiology have made it possible for us to... (Review)
Review
Pruritus is the most common symptom secondary to skin diseases. Advances in the fields of neurobiology, immunology and physiology have made it possible for us to understand and unravel the deeper pathophysiological basis of pruritus. This review aims to update our current understanding of the mechanisms and mediators of pruritus. Special attention is paid to endogenous itch mediators particularly newly identified ones like endovanilloids, opioids, neurotrophins, cannabinoids, proteases and cytokines. Various theories explaining the peripheral encoding of itch are reviewed. Multiple neural pathways including the central itch pathways as well as supraspinal processing of itch and brain areas involved in pruritus are highlighted. Apart from peripheral itch mediators, spinal neural receptors are also involved in control of itch and should form part of the development of a novel antipruritic strategy. Further studies are required to fill the lacunae in our current understanding of the pathophysiology of pruritus.
Topics: Humans; Nerve Fibers, Unmyelinated; Pruritus; Skin; Skin Diseases
PubMed: 24685845
DOI: 10.4103/0378-6323.129377 -
Dermatologic Therapy 2005Itch and pruritus are two terms for the same thing. In this essay I will argue that casting about for a distinction between them creates only confusion. Once that matter... (Review)
Review
Itch and pruritus are two terms for the same thing. In this essay I will argue that casting about for a distinction between them creates only confusion. Once that matter is settled, it is still necessary to come up with a clinical classification for itches of different types. No system yet proposed, including the one that will be suggested here, is perfect.
Topics: Humans; Pruritus; Terminology as Topic
PubMed: 16296999
DOI: 10.1111/j.1529-8019.2005.00040.x