Pub Date : 2021-04-01DOI: 10.1097/itx.0000000000000055
G. Farrah, Odette Spruijt, C. McCormack, O. Buelens, S. Lazarakis, M. Prince
Introduction: Cutaneous T-cell lymphomas (CTCLs) represent a rare group of primary cutaneous lymphomas. Pruritus is common in patients with CTCL and is severe and intractable in the subtypes Sézary syndrome (SS) and folliculotropic mycosis fungoides (MF). Materials and methods: We conducted a systematic review on interventions demonstrating efficacy in reducing pruritus in patients with CTCL. The primary aim of our study was to identify disease-directed and itch-directed therapies effective in reducing CTCL-associated pruritus. Our secondary aim was to outline various tools used to quantify itch in clinical studies. Results: Our study identified multiple disease-directed therapies effective in reducing CTCL-associated pruritus. Most evidence supported the use of histone deacetylase inhibitors. For the agents romidepsin, vorinostat, and quisinostat, reduction in pruritus was achieved in both disease responders and nonresponders. Various therapies were effective in managing pruritus associated with SS and folliculotropic MF. Vorinostat is effective in reducing pruritus in patients with SS. Extracorporeal photophoresis, total skin electron beam therapy, and romidepsin are effective in reducing pruritus in patients with folliculotropic MF. The antiemetic aprepitant is an effective targeted treatment of CTCL-associated pruritus. Aprepitant demonstrated efficacy in reducing pruritus in patients with all stages of MF, including patients with SS. Lignocaine administered via continuous subcutaneous infusion is effective in reducing pruritus in patients with advanced-stage MF, including patients with SS. The most frequently used tools to quantify itch were the Visual Analogue Scale and Numerical Rating Scale. Definitions of a significant reduction in pruritus were extremely varied between studies. Discussion: To our knowledge, this is the first systematic review specifically addressing the management of itch in patients with CTCL. Patients with all stages of CTCL were represented across included studies, including patients with folliculotropic MF and SS. A wide range of treatment options were identified, including options appropriate for patients with end-stage disease.
{"title":"A systematic review on the management of pruritus in patients with cutaneous T-cell lymphoma","authors":"G. Farrah, Odette Spruijt, C. McCormack, O. Buelens, S. Lazarakis, M. Prince","doi":"10.1097/itx.0000000000000055","DOIUrl":"https://doi.org/10.1097/itx.0000000000000055","url":null,"abstract":"Introduction: Cutaneous T-cell lymphomas (CTCLs) represent a rare group of primary cutaneous lymphomas. Pruritus is common in patients with CTCL and is severe and intractable in the subtypes Sézary syndrome (SS) and folliculotropic mycosis fungoides (MF). Materials and methods: We conducted a systematic review on interventions demonstrating efficacy in reducing pruritus in patients with CTCL. The primary aim of our study was to identify disease-directed and itch-directed therapies effective in reducing CTCL-associated pruritus. Our secondary aim was to outline various tools used to quantify itch in clinical studies. Results: Our study identified multiple disease-directed therapies effective in reducing CTCL-associated pruritus. Most evidence supported the use of histone deacetylase inhibitors. For the agents romidepsin, vorinostat, and quisinostat, reduction in pruritus was achieved in both disease responders and nonresponders. Various therapies were effective in managing pruritus associated with SS and folliculotropic MF. Vorinostat is effective in reducing pruritus in patients with SS. Extracorporeal photophoresis, total skin electron beam therapy, and romidepsin are effective in reducing pruritus in patients with folliculotropic MF. The antiemetic aprepitant is an effective targeted treatment of CTCL-associated pruritus. Aprepitant demonstrated efficacy in reducing pruritus in patients with all stages of MF, including patients with SS. Lignocaine administered via continuous subcutaneous infusion is effective in reducing pruritus in patients with advanced-stage MF, including patients with SS. The most frequently used tools to quantify itch were the Visual Analogue Scale and Numerical Rating Scale. Definitions of a significant reduction in pruritus were extremely varied between studies. Discussion: To our knowledge, this is the first systematic review specifically addressing the management of itch in patients with CTCL. Patients with all stages of CTCL were represented across included studies, including patients with folliculotropic MF and SS. A wide range of treatment options were identified, including options appropriate for patients with end-stage disease.","PeriodicalId":73523,"journal":{"name":"Itch (Philadelphia, Pa.)","volume":"6 1","pages":"e55 - e55"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42853220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-01DOI: 10.1097/itx.0000000000000054
M. Asai, Y. Koike, Y. Kuwatsuka, K. Kashiyama, Katsumi Tanaka, A. Utani, H. Murota
Keloids are frequently accompanied with pruritus. Because traumatic stimuli such as scratching promotes keloid enlargement, alleviating pruritus is an important aspect of keloid management. To investigate the mechanism of keloid pruritus, we conducted a microarray-based comparison of keloid and nonkeloid skin. Relative expression levels of pruritus-associated ligands and receptors were determined, followed by construction of a heat map focused on serotonergic signaling, and finally pathway analysis. Results demonstrate relative up-regulation of various transcripts within keloid lesions, including those encoding a histamine receptor (H1R), a serotonin receptor (5-HT-2A), and an endothelin receptor (ET-A). Serotonergic signaling may be involved in keloid pruritus.
{"title":"Microarray-based exploration of molecules associated with keloid pruritus","authors":"M. Asai, Y. Koike, Y. Kuwatsuka, K. Kashiyama, Katsumi Tanaka, A. Utani, H. Murota","doi":"10.1097/itx.0000000000000054","DOIUrl":"https://doi.org/10.1097/itx.0000000000000054","url":null,"abstract":"Keloids are frequently accompanied with pruritus. Because traumatic stimuli such as scratching promotes keloid enlargement, alleviating pruritus is an important aspect of keloid management. To investigate the mechanism of keloid pruritus, we conducted a microarray-based comparison of keloid and nonkeloid skin. Relative expression levels of pruritus-associated ligands and receptors were determined, followed by construction of a heat map focused on serotonergic signaling, and finally pathway analysis. Results demonstrate relative up-regulation of various transcripts within keloid lesions, including those encoding a histamine receptor (H1R), a serotonin receptor (5-HT-2A), and an endothelin receptor (ET-A). Serotonergic signaling may be involved in keloid pruritus.","PeriodicalId":73523,"journal":{"name":"Itch (Philadelphia, Pa.)","volume":" ","pages":"e53 - e53"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48504977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-01DOI: 10.1097/itx.0000000000000047
Charmaine Tay, Xiahong Zhao, John C. Allen, Y. Yew, H. Tey
Introduction: Atopic dermatitis (AD) is a common and debilitating condition, with pruritus being the hallmark symptom responsible for negative quality of life in AD patients. Oral antihistamines are commonly used to manage itch in AD, but evidence of its efficacy is lacking and debatable. Methods: A retrospective cohort study on patients with AD treated with antihistamines was conducted at the National Skin Centre from January 2015 to December 2018. Severity of disease was measured using the SCORing Atopic Dermatitis (SCORAD) index. Data was analyzed using a mixed-effects linear model to account for repeated measures on the same individual. Results: There were 161 unique patients with 380 treatment outcomes included in our analysis. Patients who were treated with antihistamines had higher baseline itch and sleep disturbance scores compared with those who were not. We found that the use of antihistamines resulted in significant improvement in itch and sleep disturbance scores with respective mean decreases of 0.67 [95% confidence interval (CI): 0.07, 1.27; P=0.03] and 0.87 (95% CI: 0.22, 1.52; P=0.01) compared with patients not treated with antihistamines. Specifically, second-generation antihistamines improved itch and sleep disturbance scores better than first-generation antihistamines, with a decrease of 0.65 (95% CI: −0.59, 1.88) and 0.61 (95% CI: −0.66, 1.88), respectively, although the difference in effect was not significant. Meanwhile, antihistamine use did not significantly improve total SCORAD and objective SCORAD scores. Conclusion: Treatment with second-generation antihistamines, may be an appropriate treatment modality for managing itch and sleep disturbance in patients with AD.
{"title":"Effectiveness of antihistamines for itch and sleep disturbance in atopic dermatitis: a retrospective cohort study","authors":"Charmaine Tay, Xiahong Zhao, John C. Allen, Y. Yew, H. Tey","doi":"10.1097/itx.0000000000000047","DOIUrl":"https://doi.org/10.1097/itx.0000000000000047","url":null,"abstract":"Introduction: Atopic dermatitis (AD) is a common and debilitating condition, with pruritus being the hallmark symptom responsible for negative quality of life in AD patients. Oral antihistamines are commonly used to manage itch in AD, but evidence of its efficacy is lacking and debatable. Methods: A retrospective cohort study on patients with AD treated with antihistamines was conducted at the National Skin Centre from January 2015 to December 2018. Severity of disease was measured using the SCORing Atopic Dermatitis (SCORAD) index. Data was analyzed using a mixed-effects linear model to account for repeated measures on the same individual. Results: There were 161 unique patients with 380 treatment outcomes included in our analysis. Patients who were treated with antihistamines had higher baseline itch and sleep disturbance scores compared with those who were not. We found that the use of antihistamines resulted in significant improvement in itch and sleep disturbance scores with respective mean decreases of 0.67 [95% confidence interval (CI): 0.07, 1.27; P=0.03] and 0.87 (95% CI: 0.22, 1.52; P=0.01) compared with patients not treated with antihistamines. Specifically, second-generation antihistamines improved itch and sleep disturbance scores better than first-generation antihistamines, with a decrease of 0.65 (95% CI: −0.59, 1.88) and 0.61 (95% CI: −0.66, 1.88), respectively, although the difference in effect was not significant. Meanwhile, antihistamine use did not significantly improve total SCORAD and objective SCORAD scores. Conclusion: Treatment with second-generation antihistamines, may be an appropriate treatment modality for managing itch and sleep disturbance in patients with AD.","PeriodicalId":73523,"journal":{"name":"Itch (Philadelphia, Pa.)","volume":"6 1","pages":"e47 - e47"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42233897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-01DOI: 10.1097/itx.0000000000000049
Maria Agerboe Sondrup, Cecilie Bjergen, Anne N. Gaarskjær, A. Joseph, Rikke S. Lassen, Sh. Y. Mamedov, M. B. Poulsen, T. Radovanović, Cathrine Schacksen, Maja Thaarup, M. S. Andersen, L. Oppel, P. Gazerani
Introduction: Sensory abnormalities (eg, pain) are common in Parkinson disease (PD) with a negative impact on quality of life. As itch is less studied in PD, and pain and itch partially share sensory pathways, we designed this study to identify the occurrence and pattern of spontaneous itch, and responsiveness to a surrogate itch model in PD. Methods: The study protocol was approved (N-20180079) and PD patients and their best matched controls were recruited. A questionnaire was used to collect general information on itch. Sensory alterations were determined by subjective ratings and mechanical sensitivity threshold before and after a standard histamine-dependent itch model on forearms. Itch and pain intensities were rated on visual and numerical rating scales, respectively. Dispersion of itch was drawn on arm charts. Presence and area of alloknesis and hyperknesis were determined. Group comparisons were performed in SPSS with a significant level of 0.05. Descriptive statistic was used for questionnaire’s analysis. Results: Patients (n=20; 68.10±7.91 y, F/M ratio: 8/12) and controls (n=20; 67.35±7.65 y, F/M ratio: 8/12) were examined. PD patients rated less physical and emotional descriptors, except for the stinging (P=0.028). No difference was found between the groups in histamine-provoked itch intensity (P=0.799) or the itchy area. A significantly larger area of hyperknesis was found in PD (P=0.011), but not for the area of alloknesis (P=0.221). Sex-related responses yielded only a tendency toward higher responses in female patients. Discussion: PD does not seem to influence perception of itch, neither spontaneous nor evoked itch, except for hyperknesis area, which was found significantly larger in PD patients following the application of histamine. This finding proposes a potential alteration in central processing of itch that needs further investigation and whether and how it is affected by, for example, PD pathogenesis.
{"title":"Investigation of itch in Parkinson disease","authors":"Maria Agerboe Sondrup, Cecilie Bjergen, Anne N. Gaarskjær, A. Joseph, Rikke S. Lassen, Sh. Y. Mamedov, M. B. Poulsen, T. Radovanović, Cathrine Schacksen, Maja Thaarup, M. S. Andersen, L. Oppel, P. Gazerani","doi":"10.1097/itx.0000000000000049","DOIUrl":"https://doi.org/10.1097/itx.0000000000000049","url":null,"abstract":"Introduction: Sensory abnormalities (eg, pain) are common in Parkinson disease (PD) with a negative impact on quality of life. As itch is less studied in PD, and pain and itch partially share sensory pathways, we designed this study to identify the occurrence and pattern of spontaneous itch, and responsiveness to a surrogate itch model in PD. Methods: The study protocol was approved (N-20180079) and PD patients and their best matched controls were recruited. A questionnaire was used to collect general information on itch. Sensory alterations were determined by subjective ratings and mechanical sensitivity threshold before and after a standard histamine-dependent itch model on forearms. Itch and pain intensities were rated on visual and numerical rating scales, respectively. Dispersion of itch was drawn on arm charts. Presence and area of alloknesis and hyperknesis were determined. Group comparisons were performed in SPSS with a significant level of 0.05. Descriptive statistic was used for questionnaire’s analysis. Results: Patients (n=20; 68.10±7.91 y, F/M ratio: 8/12) and controls (n=20; 67.35±7.65 y, F/M ratio: 8/12) were examined. PD patients rated less physical and emotional descriptors, except for the stinging (P=0.028). No difference was found between the groups in histamine-provoked itch intensity (P=0.799) or the itchy area. A significantly larger area of hyperknesis was found in PD (P=0.011), but not for the area of alloknesis (P=0.221). Sex-related responses yielded only a tendency toward higher responses in female patients. Discussion: PD does not seem to influence perception of itch, neither spontaneous nor evoked itch, except for hyperknesis area, which was found significantly larger in PD patients following the application of histamine. This finding proposes a potential alteration in central processing of itch that needs further investigation and whether and how it is affected by, for example, PD pathogenesis.","PeriodicalId":73523,"journal":{"name":"Itch (Philadelphia, Pa.)","volume":"6 1","pages":"e49 - e49"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45541501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-01DOI: 10.1097/itx.0000000000000048
S. Muddasani, A. Fleischer
Seasonal variation in Google searches for “itch” has been previously observed. There are also a seasonal difference in visits for the symptom of itch. The largest number of these visits occurs in summer and the lowest occurs in winter. We examined the National Ambulatory Medical Care Survey to identify if this trend is consistent for the most common itching diseases. The only diseases that demonstrated seasonal variation in ambulatory visits were vaginitis and vulvovaginitis (P=0.002), rash and other nonspecific skin eruption (P=0.002), and contact dermatitis due to plants (P<0.001). Our results demonstrate that seasonal variation in itch is not universal for all diseases, and it does not occur for many of the most common diseases.
{"title":"Seasonal variation in ambulatory visits for common itching diseases","authors":"S. Muddasani, A. Fleischer","doi":"10.1097/itx.0000000000000048","DOIUrl":"https://doi.org/10.1097/itx.0000000000000048","url":null,"abstract":"Seasonal variation in Google searches for “itch” has been previously observed. There are also a seasonal difference in visits for the symptom of itch. The largest number of these visits occurs in summer and the lowest occurs in winter. We examined the National Ambulatory Medical Care Survey to identify if this trend is consistent for the most common itching diseases. The only diseases that demonstrated seasonal variation in ambulatory visits were vaginitis and vulvovaginitis (P=0.002), rash and other nonspecific skin eruption (P=0.002), and contact dermatitis due to plants (P<0.001). Our results demonstrate that seasonal variation in itch is not universal for all diseases, and it does not occur for many of the most common diseases.","PeriodicalId":73523,"journal":{"name":"Itch (Philadelphia, Pa.)","volume":"6 1","pages":"e48 - e48"},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49000356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1097/itx.0000000000000045
S. Muddasani, A. Fleischer
It would provide insight to know if Google queries for “itch” relate to the probability of a patient visit for common itching diseases in the National Ambulatory Medical Care Survey. There was a negative predictive value of visits for vaginitis, vulvitis, and vulvovaginitis [odds ratio 0.983 (95% confidence interval 0.977, 0.989)], psoriasis [0.986 (0.980, 0.992)], and dermatitis [0.983 (0.979, 0.986)] with increased normalized search interest (P<0.0001). There was no relationship between search interest and visits for urticaria [0.997 (0.986, 1.01), P=0.5] or atopic dermatitis [1.02 (0.994, 1.01), P=0.9]. This demonstrates that internet search behavior can affect real world patient visits.
{"title":"Prediction of ambulatory visits for itching diseases using Google Trends data","authors":"S. Muddasani, A. Fleischer","doi":"10.1097/itx.0000000000000045","DOIUrl":"https://doi.org/10.1097/itx.0000000000000045","url":null,"abstract":"It would provide insight to know if Google queries for “itch” relate to the probability of a patient visit for common itching diseases in the National Ambulatory Medical Care Survey. There was a negative predictive value of visits for vaginitis, vulvitis, and vulvovaginitis [odds ratio 0.983 (95% confidence interval 0.977, 0.989)], psoriasis [0.986 (0.980, 0.992)], and dermatitis [0.983 (0.979, 0.986)] with increased normalized search interest (P<0.0001). There was no relationship between search interest and visits for urticaria [0.997 (0.986, 1.01), P=0.5] or atopic dermatitis [1.02 (0.994, 1.01), P=0.9]. This demonstrates that internet search behavior can affect real world patient visits.","PeriodicalId":73523,"journal":{"name":"Itch (Philadelphia, Pa.)","volume":"6 1","pages":"e45 - e45"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45659798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.1097/itx.0000000000000043
K. L'herondelle, L. Miséry, C. Le Gall‐Ianotto, R. Philippe, M. Talagas, O. Mignen, R. Lewis, Raphaele Le Garrec
Introduction: Ciguatera fish poisoning (CFP), the most common seafood poisoning worldwide, is caused by the consumption of seafood contaminated with ciguatoxins (CTXs). Pruritus is one of the most distressing symptoms, associated with other cutaneous sensory disorders, including paresthesia and cold dysesthesia. No specific treatment exists. CTXs are known to primarily activate voltage-gated sodium channels, but the downstream molecular events that lead to sensory disturbances remain poorly defined. Peptidergic sensory neurons were recently identified as major players in CFP sensory disturbances. Methods: In this study, we examined the role of molecular actors in 2 effects induced by Pacific CTX-2 (P-CTX-2): the increase in cytosolic calcium levels in rat primary sensory neurons; and the release of the neuropeptide substance P (SP) in sensory neurons co-cultured with keratinocytes. Results: Our results (i) rule out the involvement of the Na+/Ca2+ exchanger (NCX) and the transient receptor potential channels transient receptor potential ankyrin 1 and and transient receptor potential vanilloid 1; (ii) show that N-type voltage-gated calcium (Cav) channels contribute to the initiation of the calcium signal elicited by P-CTX-2 in rat sensory neurons, while N-type and L-type Cav channels play equal parts in the SP release in the co-culture; and (iii) identify store-operated calcium entry supported by Orai calcium release-activated calcium modulator 1 (ORAI1) as a critical effector of the late phase of the calcium signal and the subsequent SP release elicited by P-CTX-2. Discussion: Our in vitro findings indicate that Cav and ORAI1 channels may be promising pharmacological targets for specifically relieving the sensory effects of CTXs.
{"title":"Ciguatera poisoning: the role of high-voltage-activated and store-operated calcium channels in ciguatoxin-induced sensory effects","authors":"K. L'herondelle, L. Miséry, C. Le Gall‐Ianotto, R. Philippe, M. Talagas, O. Mignen, R. Lewis, Raphaele Le Garrec","doi":"10.1097/itx.0000000000000043","DOIUrl":"https://doi.org/10.1097/itx.0000000000000043","url":null,"abstract":"Introduction: Ciguatera fish poisoning (CFP), the most common seafood poisoning worldwide, is caused by the consumption of seafood contaminated with ciguatoxins (CTXs). Pruritus is one of the most distressing symptoms, associated with other cutaneous sensory disorders, including paresthesia and cold dysesthesia. No specific treatment exists. CTXs are known to primarily activate voltage-gated sodium channels, but the downstream molecular events that lead to sensory disturbances remain poorly defined. Peptidergic sensory neurons were recently identified as major players in CFP sensory disturbances. Methods: In this study, we examined the role of molecular actors in 2 effects induced by Pacific CTX-2 (P-CTX-2): the increase in cytosolic calcium levels in rat primary sensory neurons; and the release of the neuropeptide substance P (SP) in sensory neurons co-cultured with keratinocytes. Results: Our results (i) rule out the involvement of the Na+/Ca2+ exchanger (NCX) and the transient receptor potential channels transient receptor potential ankyrin 1 and and transient receptor potential vanilloid 1; (ii) show that N-type voltage-gated calcium (Cav) channels contribute to the initiation of the calcium signal elicited by P-CTX-2 in rat sensory neurons, while N-type and L-type Cav channels play equal parts in the SP release in the co-culture; and (iii) identify store-operated calcium entry supported by Orai calcium release-activated calcium modulator 1 (ORAI1) as a critical effector of the late phase of the calcium signal and the subsequent SP release elicited by P-CTX-2. Discussion: Our in vitro findings indicate that Cav and ORAI1 channels may be promising pharmacological targets for specifically relieving the sensory effects of CTXs.","PeriodicalId":73523,"journal":{"name":"Itch (Philadelphia, Pa.)","volume":"5 1","pages":"e43 - e43"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42905054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.1097/itx.0000000000000042
S. Ständer, M. Pereira, T. Berger, C. Zeidler, M. Augustin, S. Bobko, E. Brenaut, Suephy C. Chen, S. Chisolm, F. Dalgard, J. Elberling, S. Elmariah, A. Evers, S. Garcovich, M. Gonçalo, J. A. Halvorsen, Brian S. Kim, J. Kupfer, J. Lambert, F. Legat, E. Lerner, T. Leslie, L. Lönndahl, A. Lvov, M. Metz, L. Miséry, E. Papadavid, N. Potekaev, Anna Reich, E. Savk, G. Schneider, C. Schut, E. Serra-Baldrich, H. Ständer, M. Streit, J. Szepietowski, Tharp, J. Wallengren, A. Nast, E. Weisshaar, G. Yosipovitch
Chronic prurigo (CPG) is a highly burdensome pruritic disease characterized by chronic itch, a prolonged scratching behavior and the development of localized or generalized hyperkeratotic pruriginous lesions. Neuronal sensitization and the development of an itch-scratch cycle contribute to the augmentation of pruritus and the chronicity of the disease. We provide here the first international guideline for a rational diagnostic and therapeutic approach for CPG. Recommendations are based on available evidence and expert opinion. The diagnosis of CPG is made clinically. A detailed medical history together with laboratory and radiological examinations are advised in order to determine the severity of CPG, identify the underlying origin of the itch and assist in the elaboration of a treatment plan. Therapeutically, it is advised to adopt a multimodal approach, including general strategies to control itch, treatment of the underlying pruritic conditions, and of the pruriginous lesions. Topical (corticosteroids, calcineurin inhibitors, capsaicin) and systemic antipruritic agents (eg, gabapentinoids, immunosuppressants, and opioid modulators) as well as physical treatment modalities (phototherapy, cryotherapy) should be employed in a step-wise approach. Psychosomatic or psychological interventions may be recommended in CPG patients with signs of psychiatric/psychological comorbidities.
{"title":"IFSI-guideline on chronic prurigo including prurigo nodularis","authors":"S. Ständer, M. Pereira, T. Berger, C. Zeidler, M. Augustin, S. Bobko, E. Brenaut, Suephy C. Chen, S. Chisolm, F. Dalgard, J. Elberling, S. Elmariah, A. Evers, S. Garcovich, M. Gonçalo, J. A. Halvorsen, Brian S. Kim, J. Kupfer, J. Lambert, F. Legat, E. Lerner, T. Leslie, L. Lönndahl, A. Lvov, M. Metz, L. Miséry, E. Papadavid, N. Potekaev, Anna Reich, E. Savk, G. Schneider, C. Schut, E. Serra-Baldrich, H. Ständer, M. Streit, J. Szepietowski, Tharp, J. Wallengren, A. Nast, E. Weisshaar, G. Yosipovitch","doi":"10.1097/itx.0000000000000042","DOIUrl":"https://doi.org/10.1097/itx.0000000000000042","url":null,"abstract":"Chronic prurigo (CPG) is a highly burdensome pruritic disease characterized by chronic itch, a prolonged scratching behavior and the development of localized or generalized hyperkeratotic pruriginous lesions. Neuronal sensitization and the development of an itch-scratch cycle contribute to the augmentation of pruritus and the chronicity of the disease. We provide here the first international guideline for a rational diagnostic and therapeutic approach for CPG. Recommendations are based on available evidence and expert opinion. The diagnosis of CPG is made clinically. A detailed medical history together with laboratory and radiological examinations are advised in order to determine the severity of CPG, identify the underlying origin of the itch and assist in the elaboration of a treatment plan. Therapeutically, it is advised to adopt a multimodal approach, including general strategies to control itch, treatment of the underlying pruritic conditions, and of the pruriginous lesions. Topical (corticosteroids, calcineurin inhibitors, capsaicin) and systemic antipruritic agents (eg, gabapentinoids, immunosuppressants, and opioid modulators) as well as physical treatment modalities (phototherapy, cryotherapy) should be employed in a step-wise approach. Psychosomatic or psychological interventions may be recommended in CPG patients with signs of psychiatric/psychological comorbidities.","PeriodicalId":73523,"journal":{"name":"Itch (Philadelphia, Pa.)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45978962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-07-01DOI: 10.1097/itx.0000000000000039
E. Cole, T. DeGrazia, S. Alshamekh, R. Feldman
Introduction: Autoimmune blistering diseases (AIBD) produce a range of debilitating symptoms potentially greatly impacting quality of life (QoL). We sought to compare the disease-related and itch-related QoL impact between AIBD including pemphigus, bullous pemphigoid (BP), and mucous membrane pemphigoid (MMP). Methods: We performed a retrospective cohort study of patients attending a specialty Autoimmune Blistering Disease Clinic at a single academic center between July 2017 and April 2019. Patients with an established histopathologic or serological diagnosis of pemphigus, BP or MMP with mucosal and/or cutaneous lesions on clinical examination, or patient-reported QoL impact in the past week were recruited to participate. Patients completed Autoimmune Blistering Disease Quality of Life (ABQoL), Treatment of Autoimmune Blistering Disease Quality of Life (TABQoL), and ItchyQoL survey instruments, and disease severity was assessed using the Pemphigus Disease Area Index (PDAI) (pemphigus), Bullous Pemphigoid Disease Area Index (BPDAI) (BP), and Mucous Membrane Pemphigoid Disease Area Index (MMPDAI) (MMP). Statistical analyses were performed using IBM SPSS 26. Results: BP and pemphigus demonstrated similar itch-related QoL impact, greater than that of MMP. Disease severity was significantly associated with itch-related QoL in BP and pemphigus, as was use of biological/targeted therapies in BP alone. Discussion: Itch is a significant symptom in both BP and pemphigus and can negatively affect QoL. Disease severity and treatment type play a role in itch-related QoL in pemphigus and BP. Additional studies are needed to elucidate the mechanisms for itch in AIBD, particularly in pemphigus where this symptom has only recently been described.
{"title":"Itch-related quality of life impact across 3 autoimmune blistering diseases: a retrospective cohort study","authors":"E. Cole, T. DeGrazia, S. Alshamekh, R. Feldman","doi":"10.1097/itx.0000000000000039","DOIUrl":"https://doi.org/10.1097/itx.0000000000000039","url":null,"abstract":"Introduction: Autoimmune blistering diseases (AIBD) produce a range of debilitating symptoms potentially greatly impacting quality of life (QoL). We sought to compare the disease-related and itch-related QoL impact between AIBD including pemphigus, bullous pemphigoid (BP), and mucous membrane pemphigoid (MMP). Methods: We performed a retrospective cohort study of patients attending a specialty Autoimmune Blistering Disease Clinic at a single academic center between July 2017 and April 2019. Patients with an established histopathologic or serological diagnosis of pemphigus, BP or MMP with mucosal and/or cutaneous lesions on clinical examination, or patient-reported QoL impact in the past week were recruited to participate. Patients completed Autoimmune Blistering Disease Quality of Life (ABQoL), Treatment of Autoimmune Blistering Disease Quality of Life (TABQoL), and ItchyQoL survey instruments, and disease severity was assessed using the Pemphigus Disease Area Index (PDAI) (pemphigus), Bullous Pemphigoid Disease Area Index (BPDAI) (BP), and Mucous Membrane Pemphigoid Disease Area Index (MMPDAI) (MMP). Statistical analyses were performed using IBM SPSS 26. Results: BP and pemphigus demonstrated similar itch-related QoL impact, greater than that of MMP. Disease severity was significantly associated with itch-related QoL in BP and pemphigus, as was use of biological/targeted therapies in BP alone. Discussion: Itch is a significant symptom in both BP and pemphigus and can negatively affect QoL. Disease severity and treatment type play a role in itch-related QoL in pemphigus and BP. Additional studies are needed to elucidate the mechanisms for itch in AIBD, particularly in pemphigus where this symptom has only recently been described.","PeriodicalId":73523,"journal":{"name":"Itch (Philadelphia, Pa.)","volume":"5 1","pages":"e39 - e39"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/itx.0000000000000039","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41904545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-07-01Epub Date: 2020-07-24DOI: 10.1097/itx.0000000000000036
Dan Domocos, Taylor Follansbee, Amanda Nguyen, Tony Nguyen, Mirela I Carstens, Earl Carstens
Introduction: Cinnamaldehyde (CA) elicits itch sensation in humans. We investigated if CA elicits scratching behavior in mice and determined the roles for TRPV1, TRPA1, and TRPV4.
Materials and methods: Scratching behavior elicited by intradermal injection of CA was assessed in wildtype (WT) mice and knockout (KO) mice lacking TRPV1, TRPA1, TRPV4, or deficient in mast cells. We also assessed scratching and wet dog shakes elicited by low-threshold mechanical stimulation of skin treated topically with CA or vehicle. Using calcium imaging we tested if CA activates dorsal root ganglion (DRG) neurons of each genotype.
Results: Intradermal cheek injection of CA elicited dose-dependent hindlimb scratch bouts, with fewer forelimb wipes and facial groom bouts that were not dose-dependent. CA elicited significantly fewer scratch bouts in TRPV1 and TRPV4 KO mice, but not TRPA1KOs, compared with WTs. There were no sex differences across genotypes. The histamine H1 antagonist cetirizine did not affect CA-evoked scratching, which was normal in mast cell deficient mice, indicating lack of histamine involvement. Scores for alloknesis were significantly greater following topical application of CA compared with vehicle. Post-CA alloknesis scores were significantly higher in TRPV4KOs of both sexes and in female TRPV1 and TRPA1KOs, compared with WTs. Low threshold mechanical stimuli also elicited significantly more wet dog shakes in mice treated topically with 20% CA, with significantly fewer in TRPV1, TRPA1, and TRPV4KOs compared with WTs. In calcium imaging studies, CA excited 24% of WT DRG cells, significantly fewer (11.5%) in cells from TRPV4KOs, and none in TRPA1KOs. Responses of cells of all genotypes exhibited significant sensitization to repeated CA stimulation. Sensitization was significantly enhanced by IL-4, which itself excited 16% of WT DRG cells and none from TRPA1KOs.
Discussion: The results indicate that TRPA1 is dispensable for CA-evoked scratching, which depends partly on TRPV1 and TRPV4.
{"title":"Cinnamaldehyde elicits itch behavior via TRPV1 and TRPV4 but not TRPA1.","authors":"Dan Domocos, Taylor Follansbee, Amanda Nguyen, Tony Nguyen, Mirela I Carstens, Earl Carstens","doi":"10.1097/itx.0000000000000036","DOIUrl":"https://doi.org/10.1097/itx.0000000000000036","url":null,"abstract":"<p><strong>Introduction: </strong>Cinnamaldehyde (CA) elicits itch sensation in humans. We investigated if CA elicits scratching behavior in mice and determined the roles for TRPV1, TRPA1, and TRPV4.</p><p><strong>Materials and methods: </strong>Scratching behavior elicited by intradermal injection of CA was assessed in wildtype (WT) mice and knockout (KO) mice lacking TRPV1, TRPA1, TRPV4, or deficient in mast cells. We also assessed scratching and wet dog shakes elicited by low-threshold mechanical stimulation of skin treated topically with CA or vehicle. Using calcium imaging we tested if CA activates dorsal root ganglion (DRG) neurons of each genotype.</p><p><strong>Results: </strong>Intradermal cheek injection of CA elicited dose-dependent hindlimb scratch bouts, with fewer forelimb wipes and facial groom bouts that were not dose-dependent. CA elicited significantly fewer scratch bouts in TRPV1 and TRPV4 KO mice, but not TRPA1KOs, compared with WTs. There were no sex differences across genotypes. The histamine H1 antagonist cetirizine did not affect CA-evoked scratching, which was normal in mast cell deficient mice, indicating lack of histamine involvement. Scores for alloknesis were significantly greater following topical application of CA compared with vehicle. Post-CA alloknesis scores were significantly higher in TRPV4KOs of both sexes and in female TRPV1 and TRPA1KOs, compared with WTs. Low threshold mechanical stimuli also elicited significantly more wet dog shakes in mice treated topically with 20% CA, with significantly fewer in TRPV1, TRPA1, and TRPV4KOs compared with WTs. In calcium imaging studies, CA excited 24% of WT DRG cells, significantly fewer (11.5%) in cells from TRPV4KOs, and none in TRPA1KOs. Responses of cells of all genotypes exhibited significant sensitization to repeated CA stimulation. Sensitization was significantly enhanced by IL-4, which itself excited 16% of WT DRG cells and none from TRPA1KOs.</p><p><strong>Discussion: </strong>The results indicate that TRPA1 is dispensable for CA-evoked scratching, which depends partly on TRPV1 and TRPV4.</p>","PeriodicalId":73523,"journal":{"name":"Itch (Philadelphia, Pa.)","volume":"5 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/itx.0000000000000036","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39366253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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