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Anais Brasileiros de Dermatologia 2022This review is focused on updating knowledge about cholestatic pruritus. It summarizes clinical-epidemiological characteristics, pathophysiology, diagnostic approach,... (Review)
Review
This review is focused on updating knowledge about cholestatic pruritus. It summarizes clinical-epidemiological characteristics, pathophysiology, diagnostic approach, and evidence-based therapeutic recommendations regarding this form of pruritus. Pruritus is a frequent symptom that accompanies several liver diseases, particularly cholestatic ones. The symptom may be mild and tolerable, but it can also dramatically reduce the quality of life. Although the exact pathophysiology of this form of pruritus remains unclear, current evidence supports a mixed origin. It is extremely important for dermatologists to have knowledge about cholestatic pruritus since they are usually the first physicians to be sought by the patient when they experience the symptom. In the absence of specific dermatological alterations, cholestasis must always be considered as a possible cause of pruritus. In addition to allowing an adequate diagnosis, a better pathophysiological understanding of hepatic pruritus provides the identification of new therapeutic targets and, consequently, optimization of the approach in patients with this condition.
Topics: Cholestasis; Humans; Pruritus; Quality of Life
PubMed: 35279351
DOI: 10.1016/j.abd.2021.06.007 -
Seminars in Nephrology Jul 2015Pruritus is a common and distressing symptom in patients with chronic kidney disease. The most recent epidemiologic data have suggested that approximately 40% of... (Review)
Review
Pruritus is a common and distressing symptom in patients with chronic kidney disease. The most recent epidemiologic data have suggested that approximately 40% of patients with end-stage renal disease experience moderate to severe pruritus and that uremic pruritus (UP) has a major clinical impact, being associated strongly with poor quality of life, impaired sleep, depression, and increased mortality. The pathogenesis of UP remains largely unclear, although several theories on etiologic or contributing factors have been proposed including increased systemic inflammation; abnormal serum parathyroid hormone, calcium, and phosphorus levels; an imbalance in opiate receptors; and a neuropathic process. UP can present somewhat variably, although it tends to affect large, discontinuous, but symmetric, areas of skin and to be most symptomatic at night. A variety of alternative systemic or dermatologic conditions should be considered, especially in patients with asymmetric pruritus or other atypical features. Treatment initially should focus on aggressive skin hydration, patient education on minimizing scratching, and optimization of the aspects of chronic kidney disease care that are most relevant to pruritus, including dialysis adequacy and serum parathyroid hormone, calcium, and phosphorus management. Data for therapy specifically for UP remain limited, although topical therapies, gabapentin, type B ultraviolet light phototherapy, acupuncture, and opioid-receptor modulators all may play a role.
Topics: Humans; Incidence; Kidney Failure, Chronic; Prevalence; Pruritus; Quality of Life; Risk Factors
PubMed: 26355256
DOI: 10.1016/j.semnephrol.2015.06.009 -
American Family Physician Sep 2003Pruritus is a common manifestation of dermatologic diseases, including xerotic eczema, atopic dermatitis, and allergic contact dermatitis. Effective treatment of...
Pruritus is a common manifestation of dermatologic diseases, including xerotic eczema, atopic dermatitis, and allergic contact dermatitis. Effective treatment of pruritus can prevent scratch-induced complications such as lichen simplex chronicus and impetigo. Patients, particularly elderly adults, with severe pruritus that does not respond to conservative therapy should be evaluated for an underlying systemic disease. Causes of systemic pruritus include uremia, cholestasis, polycythemia vera, Hodgkin's lymphoma, hyperthyroidism, and human immunodeficiency virus (HIV) infection. Skin scraping, biopsy, or culture may be indicated if skin lesions are present. Diagnostic testing is directed by the clinical evaluation and may include a complete blood count and measurement of thyroid-stimulating hormone, serum bilirubin, alkaline phosphatase, serum creatinine, and blood urea nitrogen levels. Chest radiography and testing for HIV infection may be indicated in some patients. Management of nonspecific pruritus is directed mostly at preventing xerosis. Management of disease-specific pruritus has been established for certain systemic conditions, including uremia and cholestasis.
Topics: Cholestasis; Dermatitis; Female; Humans; Pregnancy; Pregnancy Complications; Pruritus
PubMed: 14524401
DOI: No ID Found -
The Veterinary Clinics of North... Sep 1988In spite of the research that has been performed, pruritus remains a poorly understood sensation. It is important to remember that the majority of information presented... (Review)
Review
In spite of the research that has been performed, pruritus remains a poorly understood sensation. It is important to remember that the majority of information presented here is derived from observations of human subjects. One can only speculate as to how much of this information can be extrapolated to pruritus in animals. Pruritus is closely intertwined with pain and touch. Pain and pruritus sensations are carried on A delta and C fibers, ascend on the lateral spinothalamic tract, and terminate in various brain centers, including the thalamus and the cortex. The gate control theory of pain and pruritus describes the substantia gelatinosa cells as "swinging gates" to modify peripheral input and result in stimulation of higher centers. Central factors reduce or amplify the perception of these cutaneous sensations. Histamine is the classic mediator of pruritus, although it is still unknown whether a final common mediator of pruritus exists. Numerous other mediators include proteases, peptides, substance P, opiate peptides, prostaglandins, and leukotrienes. These may have pruritic properties directly, or may act as histamine liberators to cause pruritus.
Topics: Animals; Pruritus
PubMed: 3055650
DOI: 10.1016/s0195-5616(88)50101-8 -
Clinical Gastroenterology and... Jul 2023GLIMMER assessed dose-response, efficacy, and safety of linerixibat, an ileal bile acid transporter inhibitor in development for cholestatic pruritus associated with... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND & AIMS
GLIMMER assessed dose-response, efficacy, and safety of linerixibat, an ileal bile acid transporter inhibitor in development for cholestatic pruritus associated with primary biliary cholangitis (PBC).
METHODS
GLIMMER was a Phase 2b, multicenter, randomized, parallel-group study in adults with PBC and moderate-to-severe pruritus (≥4 on 0-10 numerical rating scale [NRS]). After 4 weeks of single-blind placebo, patients with NRS ≥3 were randomized (3:1) to double-blind linerixibat/placebo for 12 weeks (to week 16), followed by single-blind placebo (to week 20). The primary objective was to investigate dose-related changes in mean worst daily itch (MWDI) score.
RESULTS
One hundred forty-seven patients received placebo (n = 36) or linerixibat (once daily: 20 mg, n = 16; 90 mg, n = 23; 180 mg, n = 27; twice daily: 40 mg, n = 23; 90 mg, n = 22). Linerixibat groups exhibited ≥2-point mean reductions in MWDI from baseline at week 16; however, differences from placebo were not significant. Post hoc analysis of change from baseline in monthly itch score over the treatment period (Phase 3 endpoint) showed significant differences between placebo and linerixibat 180 mg once daily (P = .0424), 40 mg twice daily (P = .0105), and 90 mg twice daily (P = .0370). A significant relationship between total daily dose and response was observed post hoc in the per protocol population (P = .0542). Consistent with mechanism of action, diarrhea was the most frequent adverse event, and incidence increased with dose.
CONCLUSIONS
Linerixibat effect on itch was not significantly different versus placebo in the primary intent-to-treat analysis but was associated with a significant dose-dependent reduction in itch in the per protocol population. A well-tolerated dose was identified for Phase 3 investigation for cholestatic pruritus in PBC.
CLINICALTRIALS
gov ID: NCT02966834.
Topics: Adult; Humans; Liver Cirrhosis, Biliary; Single-Blind Method; Treatment Outcome; Pruritus; Double-Blind Method
PubMed: 36343847
DOI: 10.1016/j.cgh.2022.10.032 -
Der Hautarzt; Zeitschrift Fur... Jul 2020Apps have become part of our daily lives. Apps for pruritus could also play a role in the management of symptoms. (Review)
Review
BACKGROUND
Apps have become part of our daily lives. Apps for pruritus could also play a role in the management of symptoms.
AIM
The aim of this article is to review existing apps for pruritus. In addition, we will discuss whether these apps have been validated and how and which offers might still be lacking.
MATERIALS AND METHODS
The two largest app stores as well as PubMed and Google were searched for apps regarding pruritus. Relevant medical apps were documented and categorized with respect to their functions. PubMed was searched to identify validation studies.
RESULTS
In total 21 apps for pruritus were identified. Of those 12 explicitly focused on pruritus, while 8 included pruritus as a symptom of an underlying disease (especially eczema and urticaria). The following app categories were derived: medical history of chronic pruritus, assessment of pruritus in clinical trials, assessment of nocturnal pruritus, information about pruritus, and diseases with pruritus as a symptom. Three of the apps with explicit focus on pruritus have been scientifically validated.
DISCUSSION
There are different apps for pruritus available. Most apps which explicitly focus on pruritus are aimed at physicians and scientists, while apps for diseases with pruritus as a symptom are more patient-centered. Due to technological advances, apps and wearables could improve management of pruritus in the future.
Topics: Humans; Mobile Applications; Patient Education as Topic; Pruritus; Self Care; Smartphone
PubMed: 32399668
DOI: 10.1007/s00105-020-04603-5 -
Acta Dermato-venereologica Dec 2023Atopic dermatitis is a common inflammatory disease with a chronic and relapsing course. Although considered a childhood disease, it is now evident that atopic dermatitis...
Atopic dermatitis is a common inflammatory disease with a chronic and relapsing course. Although considered a childhood disease, it is now evident that atopic dermatitis is also common in adulthood and in the elderly population. Atopic dermatitis typically manifests with bilateral and symmetrical eczematous lesions on the face, trunk and skin folds. Itch is invariably present and may be very severe, markedly affecting daily life and sleep. In older adults, atopic dermatitis may have a high level of impact on quality of life, frequently burdening an already complex comorbid situation. The full assessment of disease burden (localizations, itch severity, sleep alterations, impact on quality of life, disease history, comorbidities) is crucial to identify the most appropriate treatment. In many cases, moderate-to-severe atopic dermatitis in the elderly population can be successfully and safely treated with biological agents inhibiting the interleukin-4/-13 pathway, whereas the use of Janus kinase inhibitors may pose concerns about the safety profile.
Topics: Humans; Aged; Child; Dermatitis, Atopic; Quality of Life; Pruritus; Cost of Illness; Comorbidity; Severity of Illness Index
PubMed: 38095061
DOI: 10.2340/actadv.v103.13363 -
Der Nervenarzt Feb 2023Neuropathic pruritus is a previously neglected symptom of a wide range of neurological diseases. Peripheral nerve or root compression syndromes, space-occupying... (Review)
Review
Neuropathic pruritus is a previously neglected symptom of a wide range of neurological diseases. Peripheral nerve or root compression syndromes, space-occupying lesions of the central nervous system, chronic inflammatory neurological diseases and polyneuropathy can cause neuropathic pruritus. Even when the identification of the underlying neurological disease is successful, a direct causal treatment is not always possible, hence an effective symptomatic treatment remains the only therapeutic option. The purpose of this review article is to present the current literature on various therapeutic agents and options in the treatment of neuropathic pruritus.
Topics: Humans; Pruritus; Peripheral Nervous System Diseases; Central Nervous System; Polyneuropathies
PubMed: 35951052
DOI: 10.1007/s00115-022-01369-0 -
Dermatologic Clinics Jul 2018Chronic itch is a clinically challenging yet scientifically remarkable and complex process. Increasing understanding of the pathophysiology of chronic itch is leading to... (Review)
Review
Chronic itch is a clinically challenging yet scientifically remarkable and complex process. Increasing understanding of the pathophysiology of chronic itch is leading to targeted therapeutic approaches that are now dramatically improving quality of life. This improvement will accelerate as the tools of basic and clinical research continue to be applied to this previously intractable problem.
Topics: Cell Communication; Central Nervous System Sensitization; Chronic Disease; Humans; Pruritus; Sensory Receptor Cells
PubMed: 29929590
DOI: 10.1016/j.det.2018.02.001 -
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