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}
Pub Date : 2020-07-01DOI: 10.1097/itx.0000000000000040
Joshua J. Wheeler, Katherine Allen-Moyer, John M. Davis, S. Mishra
Introduction: Pruritus (or itch) research has gained momentum in the last decades and use of animal models to study itch behavior are a vital part of the research. Recent studies have found that many fields using animal models, including neuroscience, are predisposed toward using male animals in preclinical research. To address sex bias in animal research, the National Institutes of Health (NIH) began requiring researchers to include sex as a variable beginning in June 2015. Here, we test whether researchers studying itch are biased toward using males in preclinical research. Methods: The NIH’s PubMed database was searched for primary research articles written between August 2007 and December 2018 using the words “Itch” and “Pruritus.” The following information was extracted from articles fitting our inclusion criteria: type of itch (acute or chronic), the animal model and the sex of the animals used, and whether researchers considered sex as a variable. z-Tests, binomial tests, and the Cochran-Armitage test for trend were used to explore relationships between animal models and the usage of both sexes. Results: We found 5.3%±1.2% of papers in a given year used 1 of our 4 animal models. Mice were the most frequently used animal model, followed by rats, nonhuman primates, and dogs. Overall, researchers used male animals regardless of the animal model used. In preclinical research conducted on both male and female animals, sex was not considered a variable in a majority of these studies. Finally, since 2015, there has not been a change in the usage of male or female mice. Briefly, the incidence of papers utilizing both sexes has not changed. Discussion: We have found that itch researchers have a bias towards males in animal research. This bias has not changed since the NIH’s mandate to include sex as a variable in preclinical research.
{"title":"A systematic review of animal models and sex as a variable in itch research","authors":"Joshua J. Wheeler, Katherine Allen-Moyer, John M. Davis, S. Mishra","doi":"10.1097/itx.0000000000000040","DOIUrl":"https://doi.org/10.1097/itx.0000000000000040","url":null,"abstract":"Introduction: Pruritus (or itch) research has gained momentum in the last decades and use of animal models to study itch behavior are a vital part of the research. Recent studies have found that many fields using animal models, including neuroscience, are predisposed toward using male animals in preclinical research. To address sex bias in animal research, the National Institutes of Health (NIH) began requiring researchers to include sex as a variable beginning in June 2015. Here, we test whether researchers studying itch are biased toward using males in preclinical research. Methods: The NIH’s PubMed database was searched for primary research articles written between August 2007 and December 2018 using the words “Itch” and “Pruritus.” The following information was extracted from articles fitting our inclusion criteria: type of itch (acute or chronic), the animal model and the sex of the animals used, and whether researchers considered sex as a variable. z-Tests, binomial tests, and the Cochran-Armitage test for trend were used to explore relationships between animal models and the usage of both sexes. Results: We found 5.3%±1.2% of papers in a given year used 1 of our 4 animal models. Mice were the most frequently used animal model, followed by rats, nonhuman primates, and dogs. Overall, researchers used male animals regardless of the animal model used. In preclinical research conducted on both male and female animals, sex was not considered a variable in a majority of these studies. Finally, since 2015, there has not been a change in the usage of male or female mice. Briefly, the incidence of papers utilizing both sexes has not changed. Discussion: We have found that itch researchers have a bias towards males in animal research. This bias has not changed since the NIH’s mandate to include sex as a variable in preclinical research.","PeriodicalId":73523,"journal":{"name":"Itch (Philadelphia, Pa.)","volume":"5 1","pages":"e40 - e40"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44778671","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.0000000000000038
E. Westby, K. Purdy, K. Tennankore
Uremic pruritus (UP) is a common and distressing symptom experienced by up to half of all patients with end-stage renal disease (ESRD) receiving dialysis. It is associated with multiple health-related quality of life impairments and has been independently associated with mortality. Despite the prevalence and associated impact on quality of life, UP remains a difficult symptom to treat because of the relative lack of existing high quality evidence on which to base recommendations and the sheer volume of poorly studied therapeutic options. This review outlines the existing data of available treatment options including topical therapy, systemic therapy, and phototherapy as well as explore emerging data on therapies that are targeting novel pruritus pathways including the cannabinoid and opioid pathways. Overall, neuromodulators, in particular gabapentin, appear to have the most robust data in the treatment of UP. In individuals who cannot tolerate oral systemic therapy or in those with refractory generalized UP, ultraviolet phototherapy, specifically broad-band UVB, has shown significant promise. However, access is often a limiting factor. Lastly, the emergence of new therapies targeting a peripheral acting κ-opioid agonist, difelikefalin, has demonstrated effect in both early phase 2 and 3 clinical trials.
{"title":"A review of the management of uremic pruritus: current perspectives and future directions","authors":"E. Westby, K. Purdy, K. Tennankore","doi":"10.1097/itx.0000000000000038","DOIUrl":"https://doi.org/10.1097/itx.0000000000000038","url":null,"abstract":"Uremic pruritus (UP) is a common and distressing symptom experienced by up to half of all patients with end-stage renal disease (ESRD) receiving dialysis. It is associated with multiple health-related quality of life impairments and has been independently associated with mortality. Despite the prevalence and associated impact on quality of life, UP remains a difficult symptom to treat because of the relative lack of existing high quality evidence on which to base recommendations and the sheer volume of poorly studied therapeutic options. This review outlines the existing data of available treatment options including topical therapy, systemic therapy, and phototherapy as well as explore emerging data on therapies that are targeting novel pruritus pathways including the cannabinoid and opioid pathways. Overall, neuromodulators, in particular gabapentin, appear to have the most robust data in the treatment of UP. In individuals who cannot tolerate oral systemic therapy or in those with refractory generalized UP, ultraviolet phototherapy, specifically broad-band UVB, has shown significant promise. However, access is often a limiting factor. Lastly, the emergence of new therapies targeting a peripheral acting κ-opioid agonist, difelikefalin, has demonstrated effect in both early phase 2 and 3 clinical trials.","PeriodicalId":73523,"journal":{"name":"Itch (Philadelphia, Pa.)","volume":"5 1","pages":"e38 - e38"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/itx.0000000000000038","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41380163","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.0000000000000041
C. Kursewicz, E. Fowler, J. Rosen, D. Castillo, Y. Chan, L. Nattkemper, G. Yosipovitch
Using cross-sectional survey data from 335 patients with chronic itch, we analyzed differences in itch intensity, characteristics, and quality of life between males and females. The intensity of chronic pruritus was significantly greater in females compared with males (7.70 vs. 6.95; P<0.05) and females more often described their pruritus as dreadful, unbearable, hurting, and oppressive (P<0.05). In addition, females achieved a greater overall quality of life mean score compared with males (3.65 vs. 3.19; P<0.05), indicating a more negative impact on quality of life. Overall, our study shows that significant differences exist between females and males with chronic pruritus, and clinicians should be aware of these distinctions.
{"title":"Sex differences in the perception of itch and quality of life in patients with chronic pruritus in the United States","authors":"C. Kursewicz, E. Fowler, J. Rosen, D. Castillo, Y. Chan, L. Nattkemper, G. Yosipovitch","doi":"10.1097/itx.0000000000000041","DOIUrl":"https://doi.org/10.1097/itx.0000000000000041","url":null,"abstract":"Using cross-sectional survey data from 335 patients with chronic itch, we analyzed differences in itch intensity, characteristics, and quality of life between males and females. The intensity of chronic pruritus was significantly greater in females compared with males (7.70 vs. 6.95; P<0.05) and females more often described their pruritus as dreadful, unbearable, hurting, and oppressive (P<0.05). In addition, females achieved a greater overall quality of life mean score compared with males (3.65 vs. 3.19; P<0.05), indicating a more negative impact on quality of life. Overall, our study shows that significant differences exist between females and males with chronic pruritus, and clinicians should be aware of these distinctions.","PeriodicalId":73523,"journal":{"name":"Itch (Philadelphia, Pa.)","volume":"5 1","pages":"e41 - e41"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/itx.0000000000000041","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48834410","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 : 2020-04-01DOI: 10.1097/itx.0000000000000035
Rose Z. Hill, Ziad Rifi, Cliff Vuong, D. Bautista
Here we examine the role of sphingosine 1-phosphate receptor 3 (S1PR3) in chronic itch. We used 2 mouse models—the MC903 model of atopic dermatitis and the imiquimod model of psoriasis—to examine the contribution of S1PR3 to chronic itch. We measured scratching behaviors in these mouse models in S1PR3−/−, +/−, and +/+ animals. Whereas we observed no effect of loss of S1PR3 on itch behaviors in the MC903 model, imiquimod-evoked itch behaviors were reduced in S1PR3−/− animals. Overall, the data support a role for S1PR3 signaling in the development of psoriatic but not atopic itch.
{"title":"Loss of S1PR3 attenuates scratching behaviors in mice in the imiquimod model of psoriasis, but not in the MC903 model of atopic dermatitis","authors":"Rose Z. Hill, Ziad Rifi, Cliff Vuong, D. Bautista","doi":"10.1097/itx.0000000000000035","DOIUrl":"https://doi.org/10.1097/itx.0000000000000035","url":null,"abstract":"Here we examine the role of sphingosine 1-phosphate receptor 3 (S1PR3) in chronic itch. We used 2 mouse models—the MC903 model of atopic dermatitis and the imiquimod model of psoriasis—to examine the contribution of S1PR3 to chronic itch. We measured scratching behaviors in these mouse models in S1PR3−/−, +/−, and +/+ animals. Whereas we observed no effect of loss of S1PR3 on itch behaviors in the MC903 model, imiquimod-evoked itch behaviors were reduced in S1PR3−/− animals. Overall, the data support a role for S1PR3 signaling in the development of psoriatic but not atopic itch.","PeriodicalId":73523,"journal":{"name":"Itch (Philadelphia, Pa.)","volume":"5 1","pages":"e35 - e35"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/itx.0000000000000035","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47586829","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 : 2020-04-01DOI: 10.1097/itx.0000000000000033
S. Shah, R. S. Golpanian, T. Hashimoto, J. Rosen, L. Nattkemper, C. Albornoz, Y. Chan, G. Yosipovitch
Supplemental Digital Content is available in the text. Fibromyalgia (FM) is a disease characterized by chronic widespread pain and tenderness for at least 3 months and is associated with various dermatologic symptoms including itch. This study investigated the prevalence and characteristics of itch in female FM patients and whether or not it correlated to their pain. Our data revealed that 60% of FM patients in an outpatient rheumatology clinic suffered from chronic itch. Itch intensity had no correlation with pain intensity, but it was associated with both sleep disturbance and quality of life impairment. Also, itch intensity had no correlation with the intake of gamma aminobutyric acidergic or antidepressant drugs.
{"title":"Itch intensity and characteristics in fibromyalgia patients in an outpatient rheumatology clinic","authors":"S. Shah, R. S. Golpanian, T. Hashimoto, J. Rosen, L. Nattkemper, C. Albornoz, Y. Chan, G. Yosipovitch","doi":"10.1097/itx.0000000000000033","DOIUrl":"https://doi.org/10.1097/itx.0000000000000033","url":null,"abstract":"Supplemental Digital Content is available in the text. Fibromyalgia (FM) is a disease characterized by chronic widespread pain and tenderness for at least 3 months and is associated with various dermatologic symptoms including itch. This study investigated the prevalence and characteristics of itch in female FM patients and whether or not it correlated to their pain. Our data revealed that 60% of FM patients in an outpatient rheumatology clinic suffered from chronic itch. Itch intensity had no correlation with pain intensity, but it was associated with both sleep disturbance and quality of life impairment. Also, itch intensity had no correlation with the intake of gamma aminobutyric acidergic or antidepressant drugs.","PeriodicalId":73523,"journal":{"name":"Itch (Philadelphia, Pa.)","volume":"5 1","pages":"e33 - e33"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49171924","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 : 2020-01-01DOI: 10.1097/itx.0000000000000031
J. Bonchak, P. Lio
Chronic pruritus, traditionally defined as itch persisting for >6 weeks, is a common affliction that can be associated with cutaneous or systemic disease, or may be idiopathic in nature. It affects patients of all ages and backgrounds and seems to have no predilection for sex or socioeconomic status. The lifetime prevalence has been estimated between 22% and 26%. It accounts for millions of outpatient clinic encounters every year. Pruritus is associated with significant morbidity ranging from sleep disturbance to suicidal ideation in both pediatric and adult patients. The pathophysiology of pruritus is complex and multifactorial. An intricate and incompletely understood interplay between cytokines, sensory neurons, and a variety of cutaneous and central nervous system receptors and effector cells are responsible for the development of itch. Scores of therapies exist, with enormous variation in efficacy, for the amelioration of itch. Drugs aimed at virtually all of the aforementioned pathogenic factors in pruritus have been trialed or are being developed. Nonpharmacologic therapies for chronic pruritus encompass a variety of methods for altering itch signaling or for changing the patient’s perception of pruritus. Although some of these interventions may be used as monotherapy, they are usually best utilized in combination with more conventional pharmacologic antipruritic therapies. This review evaluates the current understanding of the mechanisms and efficacy of these nonpharmacologic interventions and serves to expand the dermatologist's armamentarium against chronic pruritus.
{"title":"Nonpharmacologic interventions for chronic pruritus","authors":"J. Bonchak, P. Lio","doi":"10.1097/itx.0000000000000031","DOIUrl":"https://doi.org/10.1097/itx.0000000000000031","url":null,"abstract":"Chronic pruritus, traditionally defined as itch persisting for >6 weeks, is a common affliction that can be associated with cutaneous or systemic disease, or may be idiopathic in nature. It affects patients of all ages and backgrounds and seems to have no predilection for sex or socioeconomic status. The lifetime prevalence has been estimated between 22% and 26%. It accounts for millions of outpatient clinic encounters every year. Pruritus is associated with significant morbidity ranging from sleep disturbance to suicidal ideation in both pediatric and adult patients. The pathophysiology of pruritus is complex and multifactorial. An intricate and incompletely understood interplay between cytokines, sensory neurons, and a variety of cutaneous and central nervous system receptors and effector cells are responsible for the development of itch. Scores of therapies exist, with enormous variation in efficacy, for the amelioration of itch. Drugs aimed at virtually all of the aforementioned pathogenic factors in pruritus have been trialed or are being developed. Nonpharmacologic therapies for chronic pruritus encompass a variety of methods for altering itch signaling or for changing the patient’s perception of pruritus. Although some of these interventions may be used as monotherapy, they are usually best utilized in combination with more conventional pharmacologic antipruritic therapies. This review evaluates the current understanding of the mechanisms and efficacy of these nonpharmacologic interventions and serves to expand the dermatologist's armamentarium against chronic pruritus.","PeriodicalId":73523,"journal":{"name":"Itch (Philadelphia, Pa.)","volume":"5 1","pages":"e31 - e31"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/itx.0000000000000031","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41928914","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 : 2019-10-01DOI: 10.1097/itx.0000000000000029
M. Pereira, S. Ständer
Chronic pruritus is a subjective, multidimensional and highly impairing symptom of difficult assessment. Its clinical features and secondary burdens may vary substantially between affected individuals and within the same patient across time. Standardized scales and questionnaires have been developed to assess the various dimensions of chronic pruritus. Instruments addressing the intensity, distribution, qualities of associated symptoms, skin status and course over time are available for clinical trials. In addition, patient-oriented questionnaires on reactive conditions, including sleep disorders, anxiety, depression, and impairment of quality of life can be used. Assessing the individual patient’s needs before and throughout the treatment is valuable in directing therapeutic priorities and maximizing patient’s satisfaction. Along with a detailed medical history and a comprehensive physical examination, these instruments should be implemented in the clinical routine to achieve a comprehensive assessment of each patient. European experts of the European Academy of Dermatology and Venereology (EADV) considered a priority the use of intensity scales and questionnaires on quality of life. Harmonization of the assessment procedures should be aimed for across attending physicians. New technologies including electronic diaries or the use of tablet computers to complete assessment tools constitute helpful aids in the clinical practice by facilitating data collection and saving time.
{"title":"Measurement tools for chronic pruritus: assessment of the symptom and the associated burden: a review","authors":"M. Pereira, S. Ständer","doi":"10.1097/itx.0000000000000029","DOIUrl":"https://doi.org/10.1097/itx.0000000000000029","url":null,"abstract":"Chronic pruritus is a subjective, multidimensional and highly impairing symptom of difficult assessment. Its clinical features and secondary burdens may vary substantially between affected individuals and within the same patient across time. Standardized scales and questionnaires have been developed to assess the various dimensions of chronic pruritus. Instruments addressing the intensity, distribution, qualities of associated symptoms, skin status and course over time are available for clinical trials. In addition, patient-oriented questionnaires on reactive conditions, including sleep disorders, anxiety, depression, and impairment of quality of life can be used. Assessing the individual patient’s needs before and throughout the treatment is valuable in directing therapeutic priorities and maximizing patient’s satisfaction. Along with a detailed medical history and a comprehensive physical examination, these instruments should be implemented in the clinical routine to achieve a comprehensive assessment of each patient. European experts of the European Academy of Dermatology and Venereology (EADV) considered a priority the use of intensity scales and questionnaires on quality of life. Harmonization of the assessment procedures should be aimed for across attending physicians. New technologies including electronic diaries or the use of tablet computers to complete assessment tools constitute helpful aids in the clinical practice by facilitating data collection and saving time.","PeriodicalId":73523,"journal":{"name":"Itch (Philadelphia, Pa.)","volume":"4 1","pages":"e29 - e29"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/itx.0000000000000029","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44999313","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 : 2019-07-01DOI: 10.1097/itx.0000000000000027
Joseph S. Blythe, K. Peerdeman, D. Veldhuijzen, A. V. Van Laarhoven, A. Evers
Itch is a commonly experienced symptom of acute and chronic dermatological and systemic conditions. Placebo and nocebo effects, positive and negative effects experienced after both real and sham interventions, putatively due to positive or negative outcome expectancies, can have a significant impact on the experience of itch and its treatment. Experimental methods to induce and study placebo and nocebo effects on itch have been developed, utilizing various combinations of expectancy-induction methods (eg, conditioning, verbal suggestions) and short-acting itch-evoking stimuli (eg, histamine, electrical, or mechanical stimulation). The aim of this review is to describe the current research methods used to induce placebo and nocebo effects on itch, and the results of these studies. The benefits and drawbacks of different expectancy-induction methods and itch-evoking stimuli are described, and future directions for research and clinical application are discussed.
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