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Acta Dermato-venereologica Mar 2016The literature on chronic pruritus, paresthesia and delusional infestation indicates that a wide variety of conditions ranging from AIDS to vitamin deficiencies may... (Review)
Review
The literature on chronic pruritus, paresthesia and delusional infestation indicates that a wide variety of conditions ranging from AIDS to vitamin deficiencies may cause these symptoms. In many, or perhaps most of these cases, activation of itch pathways seems to be the underlying cause of the skin sensations and perhaps even the visual hallucinations characteristic of delusional infestation. The principle difference between diagnoses of chronic pruritus and delusional infestation appears to lie in the patient's interpretation of the cause of the symptoms, rather than underlying physiological differences. Delusional infestation, paresthesia and chronic pruritus must be considered symptoms of underlying conditions.
Topics: Chronic Disease; Delusional Parasitosis; Diagnosis, Differential; Humans; Predictive Value of Tests; Pruritus; Sensation; Skin
PubMed: 26337109
DOI: 10.2340/00015555-2236 -
Journal of the American Academy of... Dec 2019Patients suffering from cholestasis often report experiencing a debilitating, unrelenting itch. In contrast to conditions, such as urticaria, in which histamine...
Patients suffering from cholestasis often report experiencing a debilitating, unrelenting itch. In contrast to conditions, such as urticaria, in which histamine primarily drives itch (pruritus), cholestatic pruritus is multifactorial and more difficult to treat. Existing therapies are not always effective and have undesirable adverse effect profiles. Here, we conducted a systematic literature review to evaluate conventional treatment strategy, current pathophysiologic understanding, and the role of new therapies in the context of cholestatic pruritus. We discuss novel findings implicating bile acids, lysophosphatidic acid, and bilirubin as potential important mediators of cholestatic itch. New therapies that aim to remove or modulate pruritogens have been supported in observational cohort studies and randomized controlled trials. Although these new therapies show promise, further research is needed to confirm the pathophysiology of cholestatic pruritus so that targeted therapy can be developed.
Topics: Cholestasis; Humans; Pruritus
PubMed: 31009666
DOI: 10.1016/j.jaad.2019.04.035 -
Clinics and Research in Hepatology and... Apr 2018Pruritus is a disabling symptom accompanying chronic cholestasis. In extreme cases, the refractory nature of pruritus can result in a need for invasive therapies... (Review)
Review
Pruritus is a disabling symptom accompanying chronic cholestasis. In extreme cases, the refractory nature of pruritus can result in a need for invasive therapies including liver transplantation. The pathogenesis of pruritus in cholestatic disease is poorly understood. It may involve a specific neural pathway (similar to that associated with pain) regulated by several pruritogenic substances such as bile acids, opioids, serotonin, and the more recently identified lysophosphatidic acid. While the therapeutic management of cholestatic pruritus is well established in adults, there is no consensus in children, in light of the difficulty of conducting controlled clinical studies. The currently recommended strategy to manage cholestatic pruritus in children is based on several lines of specific therapies that should be associated with skin hydration and with non-specific treatment of cholestasis including ursodeoxycholic acid. Pruritus should be assessed as objectively as possible between each line of therapy. Rifampicin, a potent CYP3A4 inducer, is the first-line treatment of cholestatic pruritus. Second-line therapies require evaluation of the child in an expert center and are discussed on a case-by-case basis depending on the underlying disease and the experience of the center. These include inhibitors of serotonin reuptake (sertraline), opioid antagonists (naloxone), or ASBT inhibitors. Invasive therapies such as biliary diversion or liver transplantation can also be proposed in the most severe cases. The aim of the current update is to review the physiopathologic mechanisms implicated in cholestatic pruritus and to propose potential therapeutic strategies in children.
Topics: Child; Cholestasis; Humans; Practice Guidelines as Topic; Pruritus
PubMed: 29031874
DOI: 10.1016/j.clinre.2017.08.007 -
Der Hautarzt; Zeitschrift Fur... Jul 2020Chronic pruritus is a symptom of many systemic diseases. In contrast to dermatological pruritus, there are no primary changes in skin appearance. Establishing the... (Review)
Review
Chronic pruritus is a symptom of many systemic diseases. In contrast to dermatological pruritus, there are no primary changes in skin appearance. Establishing the correct diagnosis in these cases can be quite challenging. In some instances, laboratory tests can be helpful. This report highlights the importance of specific and target-orientated laboratory tests in four patients with chronic pruritus due to systemic diseases.
Topics: Clinical Laboratory Techniques; Humans; Pruritus
PubMed: 32468294
DOI: 10.1007/s00105-020-04615-1 -
Pediatric Dermatology Sep 2021Chronic pruritus associated with systemic diseases in the pediatric population has been infrequently addressed in the literature. This review focuses on chronic pruritus... (Review)
Review
Chronic pruritus associated with systemic diseases in the pediatric population has been infrequently addressed in the literature. This review focuses on chronic pruritus presenting without cutaneous manifestations. Common systemic etiologies include diseases with hepatic, renal, and hematologic origins. This encompasses several congenital liver disorders, end-stage renal disease (ESRD), and lymphoproliferative disorders such as Hodgkin's lymphoma. In this paper, an expert panel describes the clinical characteristics, pathophysiology, and therapeutic treatment ladders for chronic pruritus associated with the aforementioned systemic etiologies. Novel therapies are also reviewed. Our aim is to shed light on this unexplored area of pediatric dermatology and instigate further research.
Topics: Child; Dermatology; Humans; Lymphoproliferative Disorders; Pruritus
PubMed: 34515372
DOI: 10.1111/pde.14596 -
British Medical Journal Oct 1980
Topics: Humans; Pruritus; Uremia
PubMed: 7427559
DOI: No ID Found -
Dermatitis : Contact, Atopic,... 2023Itch occurs in various dermatologic and systemic conditions. Many patients report that certain foods instigate itch, although there is limited published information in... (Review)
Review
Itch occurs in various dermatologic and systemic conditions. Many patients report that certain foods instigate itch, although there is limited published information in dermatology on food-induced pruritus. In addition, itch severity is rarely mentioned. Food can induce pruritus through either ingestion or direct contact with skin or mucosal membranes. The most common type of itch provoked by food is acute urticaria, often through the classical immunoglobulin E (IgE)-mediated pathway. Other mechanisms include non-IgE-mediated, mixed (IgE-mediated and non-IgE-mediated), T-cell-mediated, and nonimmune reactions. For patients presenting with urticaria, generalized pruritus, oral pruritus, or dermatitis, a thorough history is warranted, and possible food associations should be considered and assessed. Although any food seems to have the potential to elicit an immune response, certain foods are especially immunogenic. Treatment includes avoidance of the trigger and symptom management. Careful consideration should be used as to avoid unnecessarily restrictive elimination diets.
Topics: Humans; Dermatitis, Atopic; Pruritus; Skin; Urticaria; Allergens; Immunoglobulin E
PubMed: 36705658
DOI: 10.1089/DERM.0000000000000916 -
Acta Dermato-venereologica Sep 2021Chronic pruritus of unknown origin is established when no underlying origin for pruritus can be determined. This retrospective cohort study aimed to determine the...
Chronic pruritus of unknown origin is established when no underlying origin for pruritus can be determined. This retrospective cohort study aimed to determine the clinical profile and disease-related burden of chronic pruritus of unknown origin. A total of 263 patients (female/male: 154/109, median age 55 years) were included. Moderate to severe itch intensities were recorded (median average itch: 5.5/10, n = 200; median worst itch: 7.5/10, n = 199). In most cases pruritus lasted longer than 1 year (77.6%), occurred daily (68.2%), occurred in attacks (72.8%), and was often accompanied by dysaesthesias, such as burning, tingling and stinging. Quality of life was moderately impaired, while 22.2% and 12.4% of patients showed pathological anxiety and depression scores. Scratch lesions were associated with higher intensities of itch and greater impairment of quality of life, while women were more burdened by the disease than men. Chronic pruritus of unknown origin may occur at any age and the majority of patients endure severe itch with substantial disease-related burden.
Topics: Chronic Disease; Cost of Illness; Female; Humans; Male; Middle Aged; Pruritus; Quality of Life; Retrospective Studies
PubMed: 34405244
DOI: 10.2340/00015555-3892 -
Nursing Older People Sep 2009Pruritus is one of the most common skin conditions in older people. People may develop pruritus for many reasons but often it is not possible to diagnose the cause.... (Review)
Review
Pruritus is one of the most common skin conditions in older people. People may develop pruritus for many reasons but often it is not possible to diagnose the cause. Pruritus can cause physical and psychological suffering, affecting quality of life. The persistent itch leads to scratching which is a threat to skin integrity. It can also disrupt sleep and affect relationships. Pruritus should be treated actively. It is essential that people with pruritus receive a holistic assessment and that treatment plans are negotiated to maximise concordance and thus effective outcomes.
Topics: Aged; Geriatric Nursing; Humans; Pruritus
PubMed: 19785297
DOI: 10.7748/nop2009.09.21.7.35.c7277 -
Acta Dermato-venereologica Jan 2020Chronic itch is a burdensome clinical problem that often accompanies pathological dry skin-based conditions, such as atopic dermatitis, and systemic disorders, such as... (Review)
Review
Chronic itch is a burdensome clinical problem that often accompanies pathological dry skin-based conditions, such as atopic dermatitis, and systemic disorders, such as kidney diseases, with an unclear pathomechanism and treatments. One of the basic mouse models to investigate mechanisms of itch associated with dry skin is a mixture of acetone and ether followed by water. Animal studies using the acetone and ether followed by water model have revealed that many mediators and receptors, e.g. mas-related G protein-coupled receptor family, transient receptor potential, and chemokines, are responsible for itch and its hypersensitivity, supporting the hypothesis that dry skin-induced itch is a histamine-independent pathway. New insights have been acquired into the interplay between neurones and non-neuronal cells in the initiation, modulation, and sensitization of itch. Several thera-peutic options for itching have thus been developed. This review summarizes the updated pathogenesis and therapeutic strategies for itch in dry skin conditions.
Topics: Animals; Antipruritics; Humans; Pruritus; Risk Factors; Signal Transduction; Skin; Treatment Outcome; Water Loss, Insensible
PubMed: 31940044
DOI: 10.2340/00015555-3344