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Seminars in Cutaneous Medicine and... Jun 2011Pruritus (itch) is a major symptom in many dermatologic as well as systemic diseases and has a dramatic impact on the quality of life in these patients. The symptom of... (Review)
Review
Pruritus (itch) is a major symptom in many dermatologic as well as systemic diseases and has a dramatic impact on the quality of life in these patients. The symptom of itch has to be treated on the basis of its pathophysiology and its underlying disease. In daily practice, a "quick" diagnosis of the underlying disease is often difficult, although a rapid relief of the itch is desired. We often treat patients on the basis of the symptomatology. A rational therapeutic ladder for a symptomatic therapy is useful until the final diagnosis has been confirmed. There are probably many subtypes of pruritus, just as there are many diseases that cause itch. The pathophysiology in many subtypes of pruritus is still poorly understood, hindering a rapid and targeted treatment strategy. An extensive diagnostic workup is often required to determine the final cause(s) of the itch. Thus, in daily life, physicians often start with a more or less rational therapeutic strategy to combat the debilitating itch. We present possible therapeutic ladders that form the basis for effective therapeutic itch strategies in various diseases. On the basis of our current knowledge about the different pathophysiologies of itch, on clinical trials or case reports, and our own clinical experience, we aim to present therapeutic ladders for the rapid as well as long-term management of itch. Finally, we summarize current exciting developments of experimental strategies in itch research and in clinical development for itch therapy.
Topics: Algorithms; Anticonvulsants; Antidepressive Agents; Chronic Disease; Glucocorticoids; Histamine Antagonists; Humans; Immunosuppressive Agents; Narcotic Antagonists; Phototherapy; Pruritus; Receptors, Opioid
PubMed: 21767775
DOI: 10.1016/j.sder.2011.05.001 -
Seminars in Cutaneous Medicine and... Jun 2011Patients with renal failure, usually end-stage renal disease (ESRD), commonly are afflicted by severe pruritus. The pathogenesis of ESRD pruritus is unknown, but... (Review)
Review
Patients with renal failure, usually end-stage renal disease (ESRD), commonly are afflicted by severe pruritus. The pathogenesis of ESRD pruritus is unknown, but improving the quality of dialysis can reduce the prevalence and severity of ESRD pruritus. Topical and systemic agents as well as broadband ultraviolet phototherapy can be extremely beneficial. Gabapentin has been recently discovered as an effective agent for the patient with ESRD pruritus. Kappa opiate agonists are promising new therapeutic options.
Topics: Humans; Kidney Failure, Chronic; Phototherapy; Pruritus; Renal Dialysis; Severity of Illness Index
PubMed: 21767770
DOI: 10.1016/j.sder.2011.04.005 -
Drug News & Perspectives Dec 2008Pruritus (itch) is an unpleasant sensation inducing the desire to scratch. Chronic pruritus (>6 weeks' duration) is a major and distressing symptom of many diseases of... (Review)
Review
Pruritus (itch) is an unpleasant sensation inducing the desire to scratch. Chronic pruritus (>6 weeks' duration) is a major and distressing symptom of many diseases of dermatological, systemic, neurological or psychogenic origin. Frequently, the underlying cause of pruritus cannot be identified and causal therapy is not possible. Furthermore, chronic pruritus is frequently refractory to conventional symptomatic therapies. Recent research has revealed new neuronal mechanisms in the skin and brain, suggesting novel therapeutic targets. The efficacy of the corresponding innovative therapies has been proven in recent studies and case series. For example, topical or systemic application of specific agonists such as cannabinoids or calcineurin inhibitors can influence neuroreceptors on sensory nerve fibers of the skin and suppress pruritus. Itch-selective neurons in the dorsal horn of the spinal cord can be targeted to inhibit the transmission of pruritus to the somatosensory cortex. Anticonvulsants, antidepressants and micro-opioid receptor antagonists interfere with the sensation of pruritus in the central nervous system. Chronic pruritus of any origin leads to considerable psychosocial burden and impairs quality of life. Psychoeducational interventions, stress training, training in social competence and relaxation techniques are therefore important elements in the treatment of chronic pruritus. Increasing knowledge of the neurobiology of chronic pruritus offers new therapeutic strategies. Currently, several clinical trials are investigating the efficacy of new substances addressing neuroreceptors and cytokines in the skin and central nervous system. The present review aims to provide an overview of current neurophysiological and neurochemical therapeutic models in chronic pruritus.
Topics: Animals; Antipruritics; Brain; Calcineurin Inhibitors; Cannabinoids; Central Nervous System Agents; Chronic Disease; Dermatologic Agents; Humans; Pruritus; Skin; Stress, Psychological
PubMed: 19221635
DOI: 10.1358/dnp.2008.21.10.1314057 -
Acta Gastro-enterologica Belgica Dec 2012Pruritus can be the dominant symptom of cholestatic liver disease but is difficult to treat since unraveling its pathophysiology is a great challenge. Serum autotaxin... (Review)
Review
Pruritus can be the dominant symptom of cholestatic liver disease but is difficult to treat since unraveling its pathophysiology is a great challenge. Serum autotaxin activity correlates with pruritus intensity, but its causal relationship, expression pattern and exact mode of action during cholestasis remain to be established. The anion exchange resin cholestyramine, the PXR agonist rifampicin, the opioid antagonist naltrexone and the serotonine reuptake inhibitor sertraline are recommended by evidence-based guidelines as stepwise therapeutic approaches to treat itch in cholestasis. Rifampicin, the most effective antipruritic agent in cholestatic itch, has been shown to reduce autotaxin transcription in vitro. Experimental approaches include UVB phototherapy, extracorporeal albumin dialysis, nasobiliary drainage and in desperate cases even liver transplantation. Relevant clinical observations along with the different metabolic, neurologic and endocrine targets of available therapies in cholestatic pruritus are reviewed here.
Topics: Anion Exchange Resins; Antipruritics; Cholestasis; Cholestyramine Resin; Combined Modality Therapy; Dialysis; Disease Management; Enzyme Inhibitors; Humans; Narcotic Antagonists; Phosphoric Diester Hydrolases; Phototherapy; Prognosis; Pruritus; Rifampin; Selective Serotonin Reuptake Inhibitors; Severity of Illness Index; Treatment Outcome
PubMed: 23402082
DOI: No ID Found -
The Journal of Investigative Dermatology May 2021Diverse sensory neurons exhibit distinct neuronal morphologies with a variety of axon terminal arborizations subserving their functions. Because of its clinical...
Diverse sensory neurons exhibit distinct neuronal morphologies with a variety of axon terminal arborizations subserving their functions. Because of its clinical significance, the molecular and cellular mechanisms of itch are being intensely studied. However, a complete analysis of itch-sensing terminal arborization is missing. Using an MrgprC11 transgenic mouse line, we labeled a small subset of itch-sensing neurons that express multiple itch-related molecules including MrgprA3, MrgprC11, histamine receptor H1, IL-31 receptor, 5-hydroxytryptamine receptor 1F, natriuretic precursor peptide B, and neuromedin B. By combining sparse genetic labeling and whole-mount placental alkaline phosphatase histochemistry, we found that itch-sensing skin arbors exhibit free endings with extensive axonal branching in the superficial epidermis and large receptive fields. These results revealed the unique morphological characteristics of itch-sensing neurons and provide intriguing insights into the basic mechanisms of itch transmission.
Topics: Animals; Mice; Mice, Inbred C57BL; Nociceptors; Pruritus; Receptors, G-Protein-Coupled; Sensory Receptor Cells; Skin
PubMed: 33091423
DOI: 10.1016/j.jid.2020.08.030 -
Nephrology, Dialysis, Transplantation :... Jan 2024Chronic kidney disease-associated pruritus (CKD-aP) is an underrated symptom in patients with impaired kidney function. The present study assessed the prevalence, impact...
BACKGROUND
Chronic kidney disease-associated pruritus (CKD-aP) is an underrated symptom in patients with impaired kidney function. The present study assessed the prevalence, impact on quality of life (QoL) and risk factors for CKD-aP in a contemporary national cohort of patients on haemodialysis. In addition, we evaluated attending physicians' awareness and approach to therapy.
METHODS
Validated patient's and physician's questionnaires on pruritus severity and QoL were used in combination with information obtained by the Austrian Dialysis and Transplant Registry.
RESULTS
The prevalence of mild, moderate and severe pruritus in 962 observed patients was 34.4%, 11.4% and 4.3%. Physicians' estimated prevalence values were 25.0 (95% CI 16.8-33.2), 14.4 (11.3-17.6) and 6.3% (4.9-8.3), respectively. The estimated national prevalence estimate extrapolated from the observed patients was 45.0% (95% CI 39.5-51.2) for any, 13.9% (95% CI 10.6-17.2) for moderate and 4.2% (95% CI 2.1-6.2) for severe CKD-aP. CKD-aP severity was significantly associated with impaired QoL. Risk factors for moderate-severe pruritus were higher C-reactive protein [odds ratio (OR) 1.61 (95% CI 1.07-2.43)] and parathyroid hormone (PTH) values [OR 1.50 (95% CI 1.00-2.27)]. Therapy for CKD-aP included changes in the dialysis regimen, topical treatments, antihistamines, gabapentin and pregabalin and phototherapy in a majority of centres.
CONCLUSIONS
While the overall prevalence of CKD-aP in our study is similar to that in previously published literature, the prevalence of moderate-severe pruritus is lower. CKD-aP was associated with reduced QoL and elevated markers of inflammation and PTH. The high awareness of CKD-aP in Austrian nephrologists may explain the lower prevalence of more severe pruritus.
Topics: Humans; Renal Dialysis; Quality of Life; Prevalence; Renal Insufficiency, Chronic; Parathyroid Hormone; Pruritus; Physicians; Perception
PubMed: 37429597
DOI: 10.1093/ndt/gfad152 -
European Journal of Pain (London,... Jan 2016
Topics: Biomedical Research; Humans; Pain; Pruritus
PubMed: 26415674
DOI: 10.1002/ejp.778 -
Journal of the American Academy of... Oct 2012Pruritus can be a distressing and even debilitating symptom for patients with cutaneous T-cell lymphoma (CTCL). To date, few studies have evaluated the pathophysiology... (Review)
Review
BACKGROUND
Pruritus can be a distressing and even debilitating symptom for patients with cutaneous T-cell lymphoma (CTCL). To date, few studies have evaluated the pathophysiology of this symptom. Because of this, therapy for pruritus in CTCL has mainly relied on those therapies that target and treat the lymphoma. For patients living with CTCL that relapses or becomes refractory to treatment, and who continue to experience severe itch, this lymphoma-targeted treatment may not be enough to combat their pruritus. Therefore, other itch-targeted therapies are needed for use in this disease.
OBJECTIVE
We sought to evaluate the current evidence regarding the mechanism of action and treatments for pruritus associated with CTCL.
METHODS
An explicit and thorough search was restricted to all peer-reviewed literature available through MEDLINE (1950 to September 2011) and PubMed. Search terms used were "pruritus," "cutaneous T-cell lymphoma," "CTCL," "mycosis fungoides," "MF," and "Sézary syndrome." All studies that involved pruritus in CTCL, mycosis fungoides, or Sézary syndrome were evaluated by all 3 authors.
RESULTS
The current literature helps to identify therapies and possible mechanisms for treating patients with CTCL-associated pruritus.
LIMITATION
Most studies were preclinical. Only studies involving mechanisms of action or treatment were included.
CONCLUSION
A guideline is necessary to assist in the treatment of pruritus in CTCL and additional studies are necessary to uncover the exact mechanism or mechanisms of action.
Topics: Humans; Lymphoma, T-Cell, Cutaneous; Pruritus; Skin Neoplasms
PubMed: 22285672
DOI: 10.1016/j.jaad.2011.12.021 -
Renal Failure Dec 2023Chronic kidney disease-associated pruritus (CKD-aP) is very common and sometimes refractory to treatment in hemodialysis patients. In a trial conducted in Japan,... (Randomized Controlled Trial)
Randomized Controlled Trial
Chronic kidney disease-associated pruritus (CKD-aP) is very common and sometimes refractory to treatment in hemodialysis patients. In a trial conducted in Japan, nalfurafine, effectively reduced itching of treatment-resistant CKD-aP. Our present bridging study aimed to evaluate the efficacy and safety of nalfurafine in Chinese cohort with refractory CKD-aP. In this phase III, multicenter bridging study conducted at 22 sites in China, 141 Chinese cases with refractory CKD-aP were randomly (2:2:1) assigned to receive 5 μg, 2.5 μg of nalfurafine or a placebo orally for 14 days in a double-blind manner. The primary end point was the mean decrease in the mean visual analogue scale (VAS) from baseline. A total of 141 patients were included. The primary endpoint analysis based on full analysis set (FAS), the difference of mean VAS decrease between 5 μg nalfurafine and placebo group was 11.37 mm ( = .041); the difference of mean VAS decrease between 2.5 μg and placebo group was 8.81 mm, but not statistically significantly different. Both differences were greater than 4.13 mm, which met its predefined success criterion of at least 50% efficacy of the key Japanese clinical trial. The per protocol set (PPS) analysis got similar results. The incidence of adverse drug reactions (ADRs) was 49.1% in 5μg, 38.6% in 2.5 μg and 33.3% in placebo group. The most common ADR was insomnia, seen in 21 of the 114 nalfurafine patients. Oral nalfurafine effectively reduced itching with few significant ADRs in Chinese hemodialysis patients with refractory pruritus.
Topics: Humans; Renal Dialysis; Kidney; Renal Insufficiency, Chronic; Drug-Related Side Effects and Adverse Reactions; Pruritus
PubMed: 36856148
DOI: 10.1080/0886022X.2023.2175590 -
British Medical Journal (Clinical... Jun 1981Three patients were studied in whom brief contact of the skin with water at any temperature evoked intense itching without visible changes in the skin. The patients were...
Three patients were studied in whom brief contact of the skin with water at any temperature evoked intense itching without visible changes in the skin. The patients were otherwise apparently healthy, and this chronic and disabling disorder tended to attract a "psychogenic" label. Pharmacological studies showed that the condition was associated with local release of acetyl choline in the skin, mast-cell degranulation, and raised blood histamine concentrations. It responded well to antihistamines in two of the three patients. Aquagenic pruritus is probably common, but it is generally unrecognised and may be misdiagnosed. Antihistamines may induce a good therapeutic response.
Topics: Acetylcholine; Adult; Cytoplasmic Granules; Female; Histamine; Histamine Antagonists; Humans; Male; Mast Cells; Pruritus; Skin; Time Factors; Water
PubMed: 6788168
DOI: 10.1136/bmj.282.6281.2008