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Actas Dermo-sifiliograficas Jun 2023Pruritus is the most common symptom of dermatologic and systemic diseases. The diagnosis of pruritus is clinical, although additional tests may be necessary to identify... (Review)
Review
Pruritus is the most common symptom of dermatologic and systemic diseases. The diagnosis of pruritus is clinical, although additional tests may be necessary to identify or confirm the cause. Translational medicine has led to the discovery of new mediators of itch, or pruritogens, as well as new receptors. Knowing how to properly recognize the main pathway that mediates itch in each patient is the key to successful treatment. Although the histaminergic pathway predominates in conditions like urticaria or drug-induced pruritus, it is the nonhistaminergic pathway that predominates in nearly all other skin diseases covered in this review. Part 1 of this 2-part review discusses the classification of pruritus, additional testing, the pathophysiology of itch and the pruritogens implicated (including cytokines and other molecules), and central sensitization to itch.
Topics: Humans; Dermatology; Pruritus; Skin Diseases; Cytokines
PubMed: 36965771
DOI: 10.1016/j.ad.2023.03.003 -
Clinics in Dermatology 2011Pruritus is an unpleasant sensation leading to the desire to scratch. It is the most common symptom in dermatology, and various skin and systemic diseases can be... (Review)
Review
Pruritus is an unpleasant sensation leading to the desire to scratch. It is the most common symptom in dermatology, and various skin and systemic diseases can be associated with the presence of itching. Pruritus may also be provoked by numerous drugs. Although the exact epidemiologic data are still absent, it is generally accepted that elderly people frequently suffer from pruritus, and the problem of itching in this population remains a challenge for clinicians. The elderly often complain of numerous comorbidities that complicate the determination of the cause of pruritus, as well as its treatment. Physical and mental deprivation may complicate proper assessment of pruritus severity and negatively impair compliance with complex antipruritic therapies. Taking also into account heterogeneity of possible causes of pruritus, every patient with pruritus must be handled individually, regarding the diagnostic procedures and antipruritic therapy.
Topics: Aged; Aged, 80 and over; Humans; Pruritus; Skin Aging
PubMed: 21146727
DOI: 10.1016/j.clindermatol.2010.07.002 -
Giornale Italiano Di Dermatologia E... Apr 2012Chronic pruritus is one of the most frequent complaints of the skin associated with a high disease burden and markedly impaired quality of life. Chronic pruritus (>6... (Review)
Review
Chronic pruritus is one of the most frequent complaints of the skin associated with a high disease burden and markedly impaired quality of life. Chronic pruritus (>6 weeks of duration) may occur in a broad variety of diseases including dermatological, systemic, neurological, psychosomatic/psychiatric and gynaecological ones and in every age group (children, adults, pregnant women, elderly patients). The medical care of patients with chronic pruritus has improved significantly in the past few years (14). Though research into the neurobiology of chronic pruritus has failed to resolve the mechanisms underlying this disease, it has led to the awareness that management of patients with chronic pruritus needs a separate strategy that is different from therapy of the underlying disease. The antipruritic therapy is still based on symptomatic regimens and target-specific therapies urgently needed.
Topics: Age Distribution; Anti-Inflammatory Agents; Anticonvulsants; Antidepressive Agents; Chronic Disease; Endocrine System Diseases; Forecasting; Histamine Antagonists; Humans; Immunosuppressive Agents; Mental Disorders; Narcotic Antagonists; Neoplasms; Nervous System Diseases; Pruritus; Sex Distribution; Skin Diseases; Ultraviolet Therapy
PubMed: 22481579
DOI: No ID Found -
Current Gastroenterology Reports Jul 2019Pruritus is a common extrahepatic symptom in various liver disorders, in particularly those with cholestatic features. This review summarizes epidemiology,... (Review)
Review
PURPOSE OF REVIEW
Pruritus is a common extrahepatic symptom in various liver disorders, in particularly those with cholestatic features. This review summarizes epidemiology, pathophysiology, evidence-based therapeutic recommendations and currently investigated drugs for pruritus in hepatobiliary disorders.
RECENT FINDINGS
Recent epidemiological data suggest pruritus as a common and relevant symptom in immune-mediated liver diseases, i.e., primary biliary cholangitis (PBC) with over 70% affected patients, up to 56% suffering from chronic pruritus. The better pathophysiological understanding of hepatic pruritus has led to the identification of novel therapeutic targets, addressed in drug trials using KOR agonists, PPAR agonists, and ileal bile acid transporter inhibitors. Hepatic itch remains among the most agonizing symptoms for affected patients and a clinical challenge for physicians. Therapeutic recommendations include a guideline-based stepwise approach starting with cholestyramine, followed by rifampicin, naltrexone, and sertraline. Bezafibrate and ileal bile acid transporter inhibitors represent promising future anti-pruritic treatment options.
Topics: Humans; Liver Diseases; Pruritus
PubMed: 31367993
DOI: 10.1007/s11894-019-0713-6 -
Acta Dermato-venereologica. Supplementum May 2003The history, neurophysiology, clinical aspects and treatment of pruritus are reviewed in this article. The different forms of pruritus in dermatological and systemic... (Review)
Review
The history, neurophysiology, clinical aspects and treatment of pruritus are reviewed in this article. The different forms of pruritus in dermatological and systemic diseases are described, and the various aetiologies and pathophysiology of pruritus in systemic diseases are discussed. Lack of understanding of the neurophysiology and pathophysiology of pruritus has hampered the development of adequate therapies. Nevertheless, the discovery of primary afferent neurons and, presumably, second-order neurons with typical histamine responses mediating pruritic sensations can be regarded as a breakthrough in our understanding of the mechanisms behind pruritus. The number of experimental and therapeutic studies has greatly increased during the past few years, reflecting an increased interest in this topic. However, further effort is needed to develop new therapeutic concepts and clarify some confusion arising from promising case reports and uncontrolled clinical studies. A precise work-up for evaluating patients with pruritus is proposed, which may help the physician to identify the underlying causes and thus to treat the patient appropriately.
Topics: Female; Humans; Pregnancy; Pregnancy Complications; Pruritus
PubMed: 12822193
DOI: No ID Found -
BioMed Research International 2019Scalp pruritus is a frequent problem encountered in dermatological practice. This disorder is caused by various underlying diseases and is a diagnostic and therapeutic... (Review)
Review
Scalp pruritus is a frequent problem encountered in dermatological practice. This disorder is caused by various underlying diseases and is a diagnostic and therapeutic challenge. Scalp pruritus may be localized to the scalp or extended to other body areas. It is sometimes not only associated with skin diseases or specific skin changes, but also associated with lesions secondary to rubbing or scratching. Moreover, scalp pruritus may be difficult to diagnose and manage and may have a great impact on the quality of life of patients. It can be classified as dermatologic, neuropathic, systemic, and psychogenic scalp pruritus based on the potential underlying disease. A thorough evaluation of patients presenting with scalp pruritus is important. Taking history and performing physical examination and further investigations are essential for diagnosis. Therapeutic strategy comprises removal of the aggravating factors and appropriate treatment of the underlying condition. All treatments should be performed considering an individual approach. This review article focuses on the understanding of the pathophysiology and the diagnostic and therapeutic management of scalp pruritus.
Topics: Animals; Humans; Pruritus; Quality of Life; Scalp; Skin
PubMed: 30766878
DOI: 10.1155/2019/1268430 -
Anais Brasileiros de Dermatologia 2012Pruritus is a symptom that may be associated with a wide array of diseases - skin diseases, systemic diseases or even those without a defined cause. According to its... (Review)
Review
Pruritus is a symptom that may be associated with a wide array of diseases - skin diseases, systemic diseases or even those without a defined cause. According to its severity and evolution, it may compromise the patients' quality of life in a significant way. New therapeutic approaches, in which histamine release is not the main event, are being described for pruritus control. Therefore, taking into account the origin of the mediators of pruritus, we conducted a review of the available resources emphasizing that, although very important, anti-histamines are not the answer for every kind of pruritus.
Topics: Antipruritics; Humans; Pruritus
PubMed: 23044567
DOI: 10.1590/s0365-05962012000500011 -
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 -
American Journal of Health-system... Sep 1996Uremic pruritus and its treatment are reviewed. Pruritus affects 50-90% of patients undergoing peritoneal dialysis or hemodialysis; symptoms usually begin about six... (Review)
Review
Uremic pruritus and its treatment are reviewed. Pruritus affects 50-90% of patients undergoing peritoneal dialysis or hemodialysis; symptoms usually begin about six months after the start of dialysis and range from localized and mild to generalized and severe. The mechanism underlying uremic pruritus is poorly understood; possibilities include secondary hyperparathyroidism and divalent-ion abnormalities; histamine, allergic sensitization, and proliferation of skin mast cells; hypervitaminosis A; iron-deficiency anemia; neuropathy and neurologic changes; or some combination of these. The cornerstone of therapy for uremic pruritus is regular, intensive, efficient dialysis. Other nonpharmacologic measures consist of the use of non-complement-activating dialysis membranes, compliance with dietary restrictions, electric-needle (acupuncture) therapy, and ultraviolet light therapy. Pharmacologic treatments that have been used include activated charcoal, antihistamines, capsaicin, cholestyramine, emollients and topical corticosteroids, epoetin, pizotyline, ketotifen, and nicergoline. Treatment results have been highly variable, and many of the clinical trials have been flawed. Phosphate-binding agents appear to be the most effective. Although enough is known to determine a reasonable set of steps in approaching a patient's uremic pruritus, more research is needed to understand the pathophysiology of this condition and to establish more reliable treatments. Pruritus is a common and sometimes severe complication of chronic renal failure. Efficient dialysis, dietary restrictions, phosphate-binding therapy, and phototherapy are the most effective treatments currently available.
Topics: Humans; Pruritus; Uremia
PubMed: 8879322
DOI: 10.1093/ajhp/53.18.2159 -
European Journal of Pain (London,... Jan 2016Psoriasis is one of the most common chronic inflammatory skin diseases, found in about 1-3% of the general population. Pruritus affects about 60-90% of patients with... (Review)
Review
BACKGROUND AND OBJECTIVE
Psoriasis is one of the most common chronic inflammatory skin diseases, found in about 1-3% of the general population. Pruritus affects about 60-90% of patients with psoriasis. The aim of this review was to summarize current knowledge about the pathogenesis and treatment of this symptom in psoriasis patients.
RESULTS
Majority of psoriatic patients consider pruritus as the most bothersome symptom. The pathogenesis of pruritus is still unknown but the major concept of its origin is focused on neurogenic inflammation. Possible itch mediators include neuropeptides released from dermal nerve endings upon various stimuli, which were found to be abnormally expressed in itchy psoriatic plaques. Another important phenomenon supporting the idea of neurogenic inflammation as a key player in pruritus accompanying psoriasis is abnormal innervations of psoriatic skin. Possibly increased innervation density in psoriasis may decrease the threshold for pruritic stimuli. It is also suggested that pruritus in psoriasis might be related to abnormal functioning of the peripheral opioid system. Despite the high frequency of pruritus in psoriasis, to date there is no single antipruritic therapy dedicated specifically to treat itch in this disease.
CONCLUSIONS
Neurogenic inflammation seems to be important for itchiness in psoriasis. Treatment of pruritus in patients with psoriasis should be directed towards the resolution of skin lesions, as disease remission usually is linked with pruritus relief.
Topics: Humans; Pruritus; Psoriasis
PubMed: 26415584
DOI: 10.1002/ejp.768