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Wounds : a Compendium of Clinical... Jan 2018Chronic itch continues to be a problem that plagues millions of humans and animals. Pruritus has a negative impact on patient quality of life and many patients... (Review)
Review
Chronic itch continues to be a problem that plagues millions of humans and animals. Pruritus has a negative impact on patient quality of life and many patients experience sleep deprivation, anxiety, and depression, similar to patients with chronic pain. This review provides an overview of clinical pruritus research with special emphasis on itch that wound care providers may see. In addition, the need for using multifactorial questionnaires for better research in pruritus is summarized. Similarities and differences in itch characteristics, triggers, and relievers in various patient populations are discussed. A brief overview of itch receptors and pathways is provided to help the reader better understand the complexity of the resultant itch sensation. Also, some nonpharmacological and pharmacological antipruritic therapies and their mechanisms of action are included.
Topics: Animals; Antipruritics; Chronic Disease; Cicatrix; Humans; Nociceptors; Peripheral Nervous System; Pruritus; Quality of Life; Wound Healing; Wounds and Injuries
PubMed: 29406293
DOI: No ID Found -
Acta Dermato-venereologica Jan 2020Chronic pruritus is a frequent global condition. The pathophysiology, underlying aetiology, clinical manifestation, associated burden and response to therapy of chronic... (Review)
Review
Chronic pruritus is a frequent global condition. The pathophysiology, underlying aetiology, clinical manifestation, associated burden and response to therapy of chronic pruritus varies from patient to patient, making clinical research and management of this condition challenging. There are still several unmet needs, such as the need to standardize translational research protocols, diagnostic and therapeutic procedures and to enhance the knowledge of the humanistic and economic burden associated with chronic pruritus. Basic and clinical research is of the utmost importance to target these matters. Clinical research has the potential to identify new relevant mechanisms in affected patients, which may lead to identification of novel therapy targets. This article discusses in depth current shortcomings in the daily care of patients with chronic pruritus and the challenges clinical researchers and physicians treating chronic pruritus face in addressing these matters.
Topics: Animals; Antipruritics; Biomedical Research; Chronic Disease; Humans; Pruritus; Research Design; Risk Factors; Treatment Outcome
PubMed: 31940048
DOI: 10.2340/00015555-3348 -
Seminars in Cutaneous Medicine and... Jun 2011Chronic itch can be caused by dysfunctions of itch-sensing neurons that produce sensory hallucinations of pruritogenic stimuli. The cellular and molecular mechanisms are... (Review)
Review
Chronic itch can be caused by dysfunctions of itch-sensing neurons that produce sensory hallucinations of pruritogenic stimuli. The cellular and molecular mechanisms are still unknown. All neurological disease categories have been implicated, and neurological causes should be considered for patients with otherwise-unexplained itch. The same neurological illnesses that cause neuropathic pain can also or instead cause itch. These include shingles (particularly of the head or neck), small-fiber polyneuropathies, radiculopathies (eg, notalgia paresthetica and brachioradial pruritis), and diverse lesions of the trigeminal nerve, root, and central tracts. Central nervous system lesions affecting sensory pathways, including strokes, multiple sclerosis, and cavernous hemangiomas, can cause central itch. Neuropathic itch is a potent trigger of reflex and volitional scratching although this provides only fleeting relief. Rare patients whose lesion causes sensory loss as well as neuropathic itch can scratch deeply enough to cause painless self-injury. The most common location is on the face (trigeminal trophic syndrome). Treating neuropathic itch is difficult; antihistamines, corticosteroids, and most pain medications are largely ineffective. Current treatment recommendations include local or systemic administration of inhibitors of neuronal excitability (especially local anesthetics) and barriers to reduce scratching.
Topics: Central Nervous System Diseases; Herpes Zoster; Humans; Peripheral Nervous System Diseases; Pruritus
PubMed: 21767768
DOI: 10.1016/j.sder.2011.04.006 -
Acta Dermato-venereologica Jan 2020Beginning from embryological development, skin and psyche are closely related to physiological state regardless of age. Altering the homeostasis of one of these... (Review)
Review
Beginning from embryological development, skin and psyche are closely related to physiological state regardless of age. Altering the homeostasis of one of these components impacts on the other, thereby substantiating that the relationship between itch and psyche is bilateral. Itch has a complex pathogenesis, which involves the peripheral and central nervous systems, as well as various inflammatory mediators. This paper reviews key aspects of itch pathogenesis, relevant associations with stress, the contagiousness of itch, psychological and psychiatric considerations related to itch, and the burden of itch with respect to impairment of health-related quality of life (HRQoL) and stigmatization. Despite the fact that itch-psyche associations still pose many questions, current knowledge supports the role of a holistic, interdisciplinary approach to these patients in order to improve their well-being.
Topics: Adaptation, Psychological; Cost of Illness; Humans; Prejudice; Pruritus; Quality of Life; Risk Factors; Stereotyping; Stress, Psychological
PubMed: 31940046
DOI: 10.2340/00015555-3346 -
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 -
Neuroscience Letters Jan 2022The transient receptor potential (TRP) channel superfamily responds to various physical, chemical, and environmental stimuli including the detection of sensations both... (Review)
Review
The transient receptor potential (TRP) channel superfamily responds to various physical, chemical, and environmental stimuli including the detection of sensations both harmful and non-harmful. Among these sensations is pruritus, or itch. There are at least 27 different TRP channels and about six of them are involved in pruriception. The function of these six receptors is primarily seen in the skin and the dorsal root ganglia. Identification and biological insights provided by these receptors in pruriception is important for human health as mutations and activations of many of these channels cause discomfort and disease. This review will focus on involvement of TRP channels in pruriception that may render these channels as the targets of many antagonistic topical medications, which may help patients' better cope with the pruritus that results from various cutaneous and systemic diseases.
Topics: Animals; Humans; Pruritus; Sensory Receptor Cells; Transient Receptor Potential Channels
PubMed: 34861341
DOI: 10.1016/j.neulet.2021.136379 -
The American Journal of Managed Care May 2023Prurigo nodularis (PN) is a chronic neural- and immune-mediated disease that is characterized by intense itch, history of skin scratching, and development of... (Review)
Review
Prurigo nodularis (PN) is a chronic neural- and immune-mediated disease that is characterized by intense itch, history of skin scratching, and development of papulonodular lesions. These lesions can develop consequent to a cycle of itching and scratching associated with inflammation and changes in skin cells and nerve fibers (eg, pathogenic skin fibrosis, tissue remodeling, and chronic neuronal sensitization). Diagnosis of PN involves individual evaluation of clinical characteristics to identify disease and symptom severity. In the United States, adult patients with PN (estimated, < 90,000) are more likely to be older (age, 50-60 years); in addition, this disease is detected at higher rates in women and Black individuals relative to other demographic subgroups. Still, the small population of patients with PN exhibits considerably high use of health care resources and experiences considerable symptom burden and negatively impacted quality of life. Further, PN is associated with increased rates of a range of comorbid diseases compared with other inflammatory dermatoses (eg, atopic dermatitis, psoriasis). Adequate treatment must address both the neural and immunological component of the disease; there remains a great unmet need for safe and effective therapies that can reduce the burden of disease.
Topics: Adult; Humans; Female; United States; Middle Aged; Prurigo; Quality of Life; Pruritus; Skin; Dermatitis, Atopic
PubMed: 37146288
DOI: 10.37765/ajmc.2023.89366 -
Neuron Jul 2022The ability to sense the environment is essential to survival and is the primary purpose of the somatosensory nervous system. However, despite its highly conserved... (Review)
Review
The ability to sense the environment is essential to survival and is the primary purpose of the somatosensory nervous system. However, despite its highly conserved nature, the sensation of itch has been historically overlooked, and its importance in medicine underappreciated. Herein, we highlight how fundamental discoveries, coupled to rapid successes of new therapeutics, have placed itch biology at the forefront of a translational revolution in the field of somatosensation and beyond.
Topics: Humans; Pruritus
PubMed: 35447089
DOI: 10.1016/j.neuron.2022.03.031 -
Acta Gastro-enterologica Belgica 2019Pruritus is a common, troublesome symptom in patients with cholestatic liver diseases, especially frequent in intrahepatic cholestasis of pregnancy (ICP) and in primary... (Review)
Review
Pruritus is a common, troublesome symptom in patients with cholestatic liver diseases, especially frequent in intrahepatic cholestasis of pregnancy (ICP) and in primary biliary cholangitis (PBC). Cholestatic associated pruritus can have profound effects on the quality of life. The underlying mechanism is still poorly understood. Severe potential pruritogens have been discussed, such as bile salts, opioids, steroid and lysophosphatidic acid (LPA), but none of these are considered as key mediators. Because of this unraveling pathophysiology the treatment of hepatogenic pruritus often represents a clinical challenge. The EASL guidelines have suggested a step-wise approach, starting with elimination of pruritogens by bile acid sequestrants (cholestyramine), in second line managing the metabolism of pruritogens (rifampicin) and in third-line and fourth- line by modifying the itch perception with μ-opioid antagonist or selective serotonin reuptake inhibitors (SSRI). In treatment-refractory pruritus interruption of the enterohepatic cycle by molecular absorbent recirculating system (MARS), nasobiliairy drainage or experimental therapy such as Ultraviolet B light therapy can be considered. Liver transplantation may be reserved for intractable pruritus. Clinical trials with novel agents are ongoing, potentially providing efficacious options in the future.
Topics: Cholestasis; Cholestasis, Intrahepatic; Cholestyramine Resin; Female; Humans; Pregnancy; Pruritus; Quality of Life
PubMed: 30888758
DOI: No ID Found -
Drugs Apr 2021Pruritus, commonly known as itch, is a very common symptom in numerous dermatological disorders and systemic diseases. It can manifest as acute, or when lasting longer... (Review)
Review
Pruritus, commonly known as itch, is a very common symptom in numerous dermatological disorders and systemic diseases. It can manifest as acute, or when lasting longer than 6 weeks, it is considered chronic and can lead to significant distress and reduced quality-of-life of those suffering. Current therapeutics are limited and are lacking in efficacy, and the development of more effective treatments is needed. The neurokinin 1 receptor (NK1R) antagonists are a novel class of drugs that possess several properties such as antidepressant, anxiolytic and antiemetic activities. Recently, several studies have described the antipruritic activity of NK1R antagonists for treating chronic pruritus. In this review we outline the pathogenesis of chronic pruritus, the mechanism by which the neuropeptide substance P (SP) and its receptor NK1R may be targeted to inhibit pruritic activity, and the efficacy and tolerability of NK1R antagonists, which have been, or are currently being investigated for treating conditions where chronic pruritus is a major symptom. Increasing evidence from ongoing and completed studies demonstrates the importance of SP and NK1R signalling in mediating pruritic activity. Several NK1R antagonists have shown significant antipruritic activity and thus targeting the SP-NK1R pathway may provide a therapeutic option for treating chronic pruritus of certain origin/s in the foreseeable future.
Topics: Humans; Neurokinin-1 Receptor Antagonists; Pruritus; Receptors, Neurokinin-1
PubMed: 33675531
DOI: 10.1007/s40265-021-01478-1