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Dermatologie (Heidelberg, Germany) Jun 2024Chronic itch is a frequent and debilitating condition that greatly affects the quality of life of those affected. In a subset of patients, damage to the peripheral or... (Review)
Review
Chronic itch is a frequent and debilitating condition that greatly affects the quality of life of those affected. In a subset of patients, damage to the peripheral or central nervous system constitutes the cause of the itch. Small-fiber neuropathy, nerve compression syndromes, post-herpetic neuralgia, scars and burns are possible conditions affecting the peripheral nervous system potentially causing itch, whereas space-occupying lesions affecting the spinal cord and stroke are examples of conditions that may induce central itch. Neuropathic itch starts on normal appearing skin, is often accompanied by pain sensations and other dysesthesias, and usually relieved by local cold application. Its distribution depends on the affected site of the somatosensory system. A comprehensive medical history is paramount to reach the diagnosis, while complementary diagnostics with skin biopsies for the investigation of cutaneous neuromorphological alterations or medical imaging to rule out nerve impingement may be advised in selected cases. Topical agents such as capsaicin or local anesthetics as well as systemic drugs such as gabapentinoids, antidepressants and opioid receptor modulators are used in the treatment of neuropathic itch. This review article provides an overview of the clinical features, underlying causes, diagnostic workup and therapeutic approach in neuropathic itch.
PubMed: 38869846
DOI: 10.1007/s00105-024-05374-z -
JAAD International Sep 2024Chronic pruritus (CP) is a poorly characterized condition associated with intense pruritus without a primary skin eruption. This condition tends to emerge more commonly...
BACKGROUND
Chronic pruritus (CP) is a poorly characterized condition associated with intense pruritus without a primary skin eruption. This condition tends to emerge more commonly in older adults, and there is limited research on triggering factors.
OBJECTIVE
To explore the clinical characteristics and pathophysiology of CP following exposure to an immune stimulus.
METHODS
Clinical characteristics and plasma samples were collected from 15 patients who developed CP following an immune stimulus such as checkpoint inhibitors or vaccination. A multiplex panel was used to analyze plasma cytokine concentrations within these patients.
RESULTS
Most immunotherapy-treated patients experienced CP during treatment or after 21 to 60 days of receiving treatment, while vaccine-stimulated patients developed pruritus within a week of vaccination. Plasma cytokine analysis revealed elevated levels of 12 cytokines in patients with immune-stimulated CP compared to healthy controls. Notably, T helper 2 (Th2) related cytokines interleukin (IL)-5 (fold change 2.65; q < 0.25) and thymic stromal lymphopoietin (fold change 1.61 q < 0.25) were upregulated.
LIMITATIONS
Limitations of this study include limited sample size, particularly in the plasma cytokine assay.
CONCLUSIONS AND RELEVANCE
This study reveals triggers of CP development and describes alterations in blood Th2 markers in patients with CP, including IgE, increased blood eosinophils, and cytokines IL-5 and thymic stromal lymphopoietin.
PubMed: 38868400
DOI: 10.1016/j.jdin.2024.03.022 -
Cureus May 2024The diagnosis of skin lesions involving the eyes can be challenging, especially when uncommon etiologies are considered. We present a case of a 52-year-old female...
The diagnosis of skin lesions involving the eyes can be challenging, especially when uncommon etiologies are considered. We present a case of a 52-year-old female initially diagnosed with blepharoconjunctivitis but later found to have a subcutaneous heartworm infection. The patient experienced recurrent episodes of unilateral palpebral edema, pain, pruritus, and a sensation of a foreign body in her eye. Upon examination, a vermiform structure with peristaltic movements was observed, raising suspicion of subcutaneous dirofilariasis and prompting further investigations. Serological tests confirmed the presence of anti- spp. antibodies. Surgical removal of the worm led to the resolution of symptoms. This case highlights the importance of considering uncommon etiologies, such as subcutaneous heartworm infection, in patients presenting with atypical migratory skin lesions or ocular manifestations when there is no definite diagnosis and the condition does not respond to usual medical treatment.
PubMed: 38868288
DOI: 10.7759/cureus.60208 -
Journal of Perioperative Practice Jun 2024Assess safety and efficacy of an Enhanced Recovery After Caesarean protocol.
OBJECTIVE
Assess safety and efficacy of an Enhanced Recovery After Caesarean protocol.
BACKGROUND
Caesarean sections are among the most commonly performed surgeries worldwide, but have been associated with postoperative chronic pain and opioid abuse.
METHODS
ASA 2 females, over 18 years, non-primiparous, repeat elective LSCS. Primary outcomes were length of stay and opioid consumption. Secondary outcomes were pain scores, functional assessment scores, pruritus, nausea and vomiting.
RESULTS
A total of 579 women divided into standard care (389 patients) and enhanced recovery after caesarean groups (190 patients). Enhanced recovery after caesarean associated with reduced length of stay, 50.8 hours (interquartile range 48.6, 53.6) versus 72.2 hours (interquartile range 53.2, 75.7) in standard care. Enhanced recovery after caesarean associated with reduced opioid consumption, median 10 (interquartile range 0, 27.5mg) versus 120mg (interquartile range 90, 145mg) in standard care at 24 hours and 30 (interquartile range 7.7, 67.5mg) versus 177.5mg (interquartile range 132.5, 222.5 mg) at 48 hours. Pain scores reduced from moderate to mild in the enhanced recovery after caesarean. functional assessment scores trend towards improved function in the enhanced recovery after caesarean group (Functional assessment scores B 8.9% in enhanced recovery after caesarean versus 147% in standard care). Increased pruritus in the enhanced recovery after caesarean with 41.6% compared with 9.3% in standard care. Nausea and vomiting increased in enhanced recovery after caesarean group 48.9% versus 11.6% in standard care.
CONCLUSION
Enhanced recovery after caesarean associated with a reduction in length of stay, opioid consumption and improved pain scores with an increase in side effects.
PubMed: 38867421
DOI: 10.1177/17504589241256458 -
Hematology/oncology Clinics of North... Jun 2024Pruritus, rash, and various other forms of dermatotoxicity are the most frequent adverse events among patients with cancer receiving targeted molecular therapy and... (Review)
Review
Pruritus, rash, and various other forms of dermatotoxicity are the most frequent adverse events among patients with cancer receiving targeted molecular therapy and immunotherapy. Immune checkpoint inhibitors, macrophage-targeting agents, and epidermal growth factor receptor/MEK inhibitors not only exert antitumor effects but also interfere with molecular pathways essential for skin immune homeostasis. Studying cancer therapy-induced dermatotoxicity helps us identify molecular mechanisms governing skin immunity and deepen our understanding of human biology. This review summarizes new mechanistic insights emerging from the analysis of cutaneous adverse events and discusses knowledge gaps that remain to be closed by future research.
PubMed: 38866636
DOI: 10.1016/j.hoc.2024.05.002 -
JAMA Dermatology Jun 2024Prurigo nodularis (PN) is a debilitating skin disease characterized by the hallmark symptom of chronic itch; the intensity of itch in PN was assessed using the Worst...
IMPORTANCE
Prurigo nodularis (PN) is a debilitating skin disease characterized by the hallmark symptom of chronic itch; the intensity of itch in PN was assessed using the Worst Itch Numeric Rating Scale (WI-NRS) to evaluate the primary efficacy end point of 2 recent phase 3 studies of dupilumab treatment for PN.
OBJECTIVE
To validate the psychometric properties and to determine the clinically meaningful improvement threshold for WI-NRS in patients with moderate to severe PN.
DESIGN, SETTING, AND PARTICIPANTS
In this secondary analysis of the PRIME and PRIME2 trials, content validity of WI-NRS was assessed through in-depth patient interviews. Psychometric assessments used pooled data from masked, intention-to-treat (ITT) patients with PN from randomized, double-masked, and placebo-controlled studies. Psychometric assessments included test-retest reliability, construct validity, known-groups validity, and sensitivity to change in adult patients with moderate-to-severe PN. Thresholds for meaningful within-patient improvement in the WI-NRS score were determined using anchor and distribution-based approaches. Data were analyzed after completion of each study, December 2019 to November 2021 for PRIME and January 2020 to August 2021 for PRIME2.
EXPOSURES
Dupilumab (300 mg) or placebo subcutaneously every 2 weeks for 24 weeks.
MAIN OUTCOMES AND MEASURES
WI-NRS score at specified time points up to 24 weeks after randomization.
RESULTS
A total of 20 patients were included across the 2 studies (mean [SD] age, 49.3 [17.2] years; 11 female [55%]); 311 patients were included in the pooled intention-to-treat analysis (mean [SD] age, 49.5 [16.1] years; 203 female [65.3%]). The WI-NRS questions (20 of 20 patients), recall period (19 of 20 patients), and response scale (20 of 20 patients) were easy to understand and relevant for patients with PN. Adequate test-retest reliability was observed between screening and baseline (intraclass correlation coefficient = 0.72, using Patient Global Impression of Severity [PGIS] to define stable patients). Convergent and discriminant validity was supported by moderate to strong correlations (absolute r range = 0.34-0.73) with other conceptually related measures and weaker correlations (absolute r range = 0.06-0.32) with less-related measures, respectively. WI-NRS was sensitive to change, as demonstrated by differences in change from baseline among groups (per PGIS change and PGI of Change [PGIC]). Using anchor-based approach with PGIS and PGIC, the clinically meaningful improvement threshold was 4 points (range, 3.0-4.5), which was also supported by distribution-based methods.
CONCLUSION AND RELEVANCE
This study found that WI-NRS may be a fit-for-purpose instrument to support efficacy end points measuring the intensity of itching in adults with PN.
TRIAL REGISTRATION
NCT04183335 (PRIME) and NCT04202679 (PRIME2).
PubMed: 38865146
DOI: 10.1001/jamadermatol.2024.1634 -
Veterinary Medicine and Science Jul 2024Sarcoptic mange is rare in cats. The main symptoms reported in cases of feline sarcoptic mange include crusty lesions and pruritus, although these may vary in severity...
BACKGROUND
Sarcoptic mange is rare in cats. The main symptoms reported in cases of feline sarcoptic mange include crusty lesions and pruritus, although these may vary in severity among individuals.
OBJECTIVES
This report describes three cats infested with Sarcoptes scabiei, all presenting with pruritus and excoriation.
METHODS
The diagnosis was confirmed by microscopic observation of skin scrape samples.
RESULTS
All three cats were treated successfully using moxidectin and imidacloprid, selamectin and ivermectin, respectively.
CONCLUSIONS
The clinical presentation of feline scabies appears to be more variable in cats than in dogs. Infestation with S. scabiei should be considered a differential diagnosis for cats presenting with pruritic inflammatory skin disease.
Topics: Animals; Scabies; Cat Diseases; Cats; Male; Female; Poland; Sarcoptes scabiei; Ivermectin; Nitro Compounds; Neonicotinoids; Insecticides; Macrolides
PubMed: 38864312
DOI: 10.1002/vms3.1500 -
SAGE Open Medical Case Reports 2024Chronic kidney disease-associated pruritus leads to decreased quality of life and is an independent risk factor for mortality. There is limited evidence for treatment of...
Chronic kidney disease-associated pruritus leads to decreased quality of life and is an independent risk factor for mortality. There is limited evidence for treatment of chronic kidney disease-associated pruritus, with only one on-label treatment approved by the FDA and Health Canada. We present a case of a 69-year-old female with a history of chronic kidney disease, who presented to clinic with a several-year history of diffuse, intense pruritus. There were no primary lesions. She was started on dupilumab 600 mg loading dose, then 300 mg subcutaneously every 2 weeks. At her follow-up appointment 5 months after initiation of dupilumab, she reported her pruritus as 1/10, with no interruptions in her sleep. Her creatinine remained elevated and was stable throughout the follow-up period. This case demonstrates sustained improvement in chronic kidney disease-associated pruritus with dupilumab. Further research is required to quantify the efficacy of dupilumab for treatment of chronic kidney disease-associated pruritus.
PubMed: 38864030
DOI: 10.1177/2050313X241260491 -
International Journal of Dermatology Jun 2024
PubMed: 38863322
DOI: 10.1111/ijd.17300 -
Journal of Patient-reported Outcomes Jun 2024Cholestatic pruritus and fatigue are debilitating conditions associated with primary biliary cholangitis (PBC) and can significantly impact patients' quality of life.... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Cholestatic pruritus and fatigue are debilitating conditions associated with primary biliary cholangitis (PBC) and can significantly impact patients' quality of life. Pruritus in PBC often worsens at night and patients frequently report sleep disturbance, which contributes to cognitive symptoms and fatigue. Linerixibat is an ileal bile acid transporter inhibitor in clinical development for the treatment of pruritus associated with PBC and was recently assessed versus placebo in the Phase 2b GLIMMER trial. This post-hoc analysis assesses the relationship between pruritus severity and sleep disturbance in participants of GLIMMER regardless of treatment group.
METHODS
GLIMMER (NCT02966834), a multicenter, double-blind, randomized, placebo-controlled trial, recruited 147 patients with PBC and moderate-to-severe pruritus. Following 4 weeks single-blind placebo, patients (randomized 3:1) received linerixibat or placebo for 12 weeks (to Week 16). Participants graded their itch (twice daily) and its interference with sleep (once daily) in an electronic diary using a 0-10 numerical rating scale (NRS). Weekly and monthly itch scores were calculated as the mean of the worst daily itch score over the respective time period. At study visits, participants completed the 5-D itch scale and the PBC-40 quality of life questionnaire, both of which contain an item specific to itch-related sleep disturbance. The impact of pruritus on sleep was assessed post hoc through correlations between the changes in NRS, 5-D itch, and PBC-40.
RESULTS
Strong correlations were found between change from baseline in weekly itch and sleep NRS scores (r = 0.88 [95% confidence interval (CI): 0.83; 0.91]) at the end of treatment (Week 16), as well as in monthly itch and sleep NRS scores (r = 0.84 [95% CI: 0.80; 0.87]). Patients with improved weekly pruritus score severity category demonstrated reduced perceived sleep interference on average. Itch responders (≥2-point improvement in weekly itch score from baseline) displayed larger improvements in weekly sleep NRS score, 5-D itch, and PBC-40 sleep items, than itch non-responders (<2-point improvement).
CONCLUSIONS
A strong correlation exists between changes in pruritus severity and sleep interference in patients with PBC; pruritus reduction could generate concomitant improvement in sleep.
Topics: Humans; Pruritus; Female; Male; Double-Blind Method; Middle Aged; Liver Cirrhosis, Biliary; Sleep Wake Disorders; Quality of Life; Aged; Severity of Illness Index; Adult; Treatment Outcome
PubMed: 38862718
DOI: 10.1186/s41687-024-00722-y