Pub Date : 2019-06-26DOI: 10.1097/itx.0000000000000026
F. Dominick, A. V. Van Laarhoven, A. Evers, E. Weisshaar
Supplemental Digital Content is available in the text. Introduction: Itch can be perceived differently across patients and it can affect daily life in various ways. It is essential to assess those aspects that are relevant for the individual patient’s needs to improve treatment of patients suffering from acute or chronic itch. The International Forum for the Study on Itch (IFSI) Special Interest Group on “Questionnaires” aims to propose tools to assess different dimensions of itch and improve patient care. As a first step, this study aimed at a systematically reviewing existing patients’ self-report questionnaires on itch. Materials and methods: The databases PubMed, PsycINFO, and CINAHL were systematically searched for any scientific publication describing patients’ self-report questionnaires that assess itch-related information (≥2 items). Information about the publication was extracted by 2 experts as well as which of the 14 predefined dimensions of itch (by the IFSI Special Interest Group) were assessed within the questionnaire, for instance, duration of itch, itch aggravating or relieving factors, and effects on quality of life. Results: From a total of 5282 records, 58 articles were derived describing 62 questionnaires. Over half of the questionnaires were developed for dermatological conditions, and the vast majority targeted at adults. Most questionnaires address itch-related disability and itch intensity. Affective qualities of itch, coping with itch, response to current itch treatment, and the opinion on the origin of itch are infrequently asked for. Discussion: The number and content of the items within a dimension vary greatly. Measurement properties of the questionnaires were not systematically addressed, as these were often not reported in the original publication. Future research should focus on selecting adequate and reliable (sub)scales to develop a modular questionnaire system in order to uniformly assess the individual patient’s demands and improve care.
{"title":"A systematic review of questionnaires on itch by the Special Interest Group “Questionnaires” of the International Forum for the Study of Itch (IFSI)","authors":"F. Dominick, A. V. Van Laarhoven, A. Evers, E. Weisshaar","doi":"10.1097/itx.0000000000000026","DOIUrl":"https://doi.org/10.1097/itx.0000000000000026","url":null,"abstract":"Supplemental Digital Content is available in the text. Introduction: Itch can be perceived differently across patients and it can affect daily life in various ways. It is essential to assess those aspects that are relevant for the individual patient’s needs to improve treatment of patients suffering from acute or chronic itch. The International Forum for the Study on Itch (IFSI) Special Interest Group on “Questionnaires” aims to propose tools to assess different dimensions of itch and improve patient care. As a first step, this study aimed at a systematically reviewing existing patients’ self-report questionnaires on itch. Materials and methods: The databases PubMed, PsycINFO, and CINAHL were systematically searched for any scientific publication describing patients’ self-report questionnaires that assess itch-related information (≥2 items). Information about the publication was extracted by 2 experts as well as which of the 14 predefined dimensions of itch (by the IFSI Special Interest Group) were assessed within the questionnaire, for instance, duration of itch, itch aggravating or relieving factors, and effects on quality of life. Results: From a total of 5282 records, 58 articles were derived describing 62 questionnaires. Over half of the questionnaires were developed for dermatological conditions, and the vast majority targeted at adults. Most questionnaires address itch-related disability and itch intensity. Affective qualities of itch, coping with itch, response to current itch treatment, and the opinion on the origin of itch are infrequently asked for. Discussion: The number and content of the items within a dimension vary greatly. Measurement properties of the questionnaires were not systematically addressed, as these were often not reported in the original publication. Future research should focus on selecting adequate and reliable (sub)scales to develop a modular questionnaire system in order to uniformly assess the individual patient’s demands and improve care.","PeriodicalId":73523,"journal":{"name":"Itch (Philadelphia, Pa.)","volume":"4 1","pages":"e26 - e26"},"PeriodicalIF":0.0,"publicationDate":"2019-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/itx.0000000000000026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44906860","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 : 2019-04-01DOI: 10.1097/itx.0000000000000024
T. Ebata, Keiko Takahashi
We compared the status of chronic kidney disease-associated pruritus among outpatients of a hemodialysis (HD) clinic in 2008 and 2014, using identical questionnaires. All outpatients receiving HD participated in the study. The prevalence of pruritus over the week before questionnaire administration was not significantly different between 2008 (58.6%) and 2014 (50.0%). However, the percentage of patients with moderate to extreme itch decreased from 48.5% to 29.0% (P<0.01). The rate of patient satisfaction with the antipruritic treatment increased from 22.6% to 68.0% (P<0.01). Our experience may encourage physicians to modify antipruritic treatments for better patient care.
{"title":"Changes in prevalence and severity of chronic kidney disease-associated pruritus over 6 years in a community hemodialysis clinic: a retrospective observational study","authors":"T. Ebata, Keiko Takahashi","doi":"10.1097/itx.0000000000000024","DOIUrl":"https://doi.org/10.1097/itx.0000000000000024","url":null,"abstract":"We compared the status of chronic kidney disease-associated pruritus among outpatients of a hemodialysis (HD) clinic in 2008 and 2014, using identical questionnaires. All outpatients receiving HD participated in the study. The prevalence of pruritus over the week before questionnaire administration was not significantly different between 2008 (58.6%) and 2014 (50.0%). However, the percentage of patients with moderate to extreme itch decreased from 48.5% to 29.0% (P<0.01). The rate of patient satisfaction with the antipruritic treatment increased from 22.6% to 68.0% (P<0.01). Our experience may encourage physicians to modify antipruritic treatments for better patient care.","PeriodicalId":73523,"journal":{"name":"Itch (Philadelphia, Pa.)","volume":"4 1","pages":"e24 - e24"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/itx.0000000000000024","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42315616","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 : 2019-03-01DOI: 10.1097/itx.0000000000000019
A. C. Fostini, R. S. Golpanian, J. Rosen, R. Xue, G. Yosipovitch
Mosquito bites are the most common cause of acute itch in humans. The pathophysiology of itch in mosquito bites is not well understood, but 3 mechanisms have been hypothesized. These mechanisms are based on the assumption that mosquito salivary components are somehow implicated in the pruritus that results after a bite. In the first mechanism, salivary components such as histamine are said to directly induce itch via classic pruritic pathways. The second mechanism involves an IgE-dependent hypersensitivity response to salivary components. Finally, in the third mechanism, salivary components modulate an IgE-independent inflammatory response. Individuals’ susceptibility to being bitten relies on factors that may be altered by genetics, as certain immune-related loci have been associated with mosquito bite trait characteristics. Furthermore, certain disease states such as hematologic cancers and HIV may exaggerate the response to mosquito bites. Several preventative measures such as mosquito repellants should be used to prevent the bite of a mosquito, and in cases where bites cannot be avoided, most treatment options serve to relieve symptoms.
{"title":"Beat the bite: pathophysiology and management of itch in mosquito bites","authors":"A. C. Fostini, R. S. Golpanian, J. Rosen, R. Xue, G. Yosipovitch","doi":"10.1097/itx.0000000000000019","DOIUrl":"https://doi.org/10.1097/itx.0000000000000019","url":null,"abstract":"Mosquito bites are the most common cause of acute itch in humans. The pathophysiology of itch in mosquito bites is not well understood, but 3 mechanisms have been hypothesized. These mechanisms are based on the assumption that mosquito salivary components are somehow implicated in the pruritus that results after a bite. In the first mechanism, salivary components such as histamine are said to directly induce itch via classic pruritic pathways. The second mechanism involves an IgE-dependent hypersensitivity response to salivary components. Finally, in the third mechanism, salivary components modulate an IgE-independent inflammatory response. Individuals’ susceptibility to being bitten relies on factors that may be altered by genetics, as certain immune-related loci have been associated with mosquito bite trait characteristics. Furthermore, certain disease states such as hematologic cancers and HIV may exaggerate the response to mosquito bites. Several preventative measures such as mosquito repellants should be used to prevent the bite of a mosquito, and in cases where bites cannot be avoided, most treatment options serve to relieve symptoms.","PeriodicalId":73523,"journal":{"name":"Itch (Philadelphia, Pa.)","volume":"4 1","pages":"e19"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/itx.0000000000000019","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48885019","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 : 2019-03-01DOI: 10.1097/itx.0000000000000023
H. Mochizuki, L. Hernandez, G. Yosipovitch
Understanding the mechanism of itch as well as the pathophysiology of chronic itch is important for the development of effective treatments. In the past 25 years, researchers have investigated the cerebral mechanism of itch in healthy subjects and chronic itch patients using functional brain imaging techniques. These studies have demonstrated that a variety of cortical and subcortical areas are associated with itch. In addition, it has been found that there are differences in brain activity and brain anatomy between healthy subjects and chronic itch patients. In this review article, we discuss potential roles of those identified brain regions in itch perception, and associations of the functional and structural changes in the brain with chronic itch. Brain imaging studies of psychological modulations of itch are also discussed.
{"title":"What does brain imaging tell us about itch?","authors":"H. Mochizuki, L. Hernandez, G. Yosipovitch","doi":"10.1097/itx.0000000000000023","DOIUrl":"https://doi.org/10.1097/itx.0000000000000023","url":null,"abstract":"Understanding the mechanism of itch as well as the pathophysiology of chronic itch is important for the development of effective treatments. In the past 25 years, researchers have investigated the cerebral mechanism of itch in healthy subjects and chronic itch patients using functional brain imaging techniques. These studies have demonstrated that a variety of cortical and subcortical areas are associated with itch. In addition, it has been found that there are differences in brain activity and brain anatomy between healthy subjects and chronic itch patients. In this review article, we discuss potential roles of those identified brain regions in itch perception, and associations of the functional and structural changes in the brain with chronic itch. Brain imaging studies of psychological modulations of itch are also discussed.","PeriodicalId":73523,"journal":{"name":"Itch (Philadelphia, Pa.)","volume":"4 1","pages":"e23"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/itx.0000000000000023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48755376","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 : 2019-01-01DOI: 10.1097/itx.0000000000000022
T. Olivry, P. Bizikova
Introduction: Human atopic dermatitis (AD) keratinocytes overexpress nerve growth factor (NGF). Its inhibition, or that of its receptor, reduces itch in a mouse model of AD. In this study, we evaluated the expression of NGF in canine AD and assessed the effect of a caninized anti-NGF monoclonal antibody to delay flares of itch in dogs with natural AD. Methods: We used archived frozen skin biopsies from 6 house dust mite–sensitized atopic dogs after allergen challenge, 4 dogs with spontaneous AD and 1 dog with normal skin. The expression of NGF was evaluated by immunofluorescence. We also conducted a pilot crossover trial with 8 dogs with glucocorticoid-responsive AD. In both phases, the dogs were first treated for 28 days with oral prednisolone at 0.5 mg/kg/d. On the first day of the first phase, they received a saline subcutaneous injection, while on that of the second phase, they were injected with 0.2 mg/kg once of the caninized anti-dog NGF ranevetmab. The primary outcome measure was the time-to-flare, defined as the number of days between that of the last prednisolone administration and the day when the pruritus reached a score of at least 5.5/10, or 8 weeks, whichever came first. Results: In normal canine skin, the highest intensity of NGF staining was in stratum granulosum keratinocytes. After allergen challenge and in atopic canine skin, the NGF expression also extended downward to the upper stratum spinosum. In the pilot trial, the time-to-flare after prednisolone cessation was not significantly different between saline and ranevetmab-treated dogs. Discussion: While NGF is overexpressed in the atopic canine epidermis and after allergen challenge in sensitized dogs, the anti-NGF antibody ranevetmab did not delay pruritus flares after the discontinuation of prednisolone. Further studies are needed to assess if NGF is a relevant contributor for canine atopic itch.
{"title":"Investigations on the expression and relevance of nerve growth factor in dogs with atopic dermatitis","authors":"T. Olivry, P. Bizikova","doi":"10.1097/itx.0000000000000022","DOIUrl":"https://doi.org/10.1097/itx.0000000000000022","url":null,"abstract":"Introduction: Human atopic dermatitis (AD) keratinocytes overexpress nerve growth factor (NGF). Its inhibition, or that of its receptor, reduces itch in a mouse model of AD. In this study, we evaluated the expression of NGF in canine AD and assessed the effect of a caninized anti-NGF monoclonal antibody to delay flares of itch in dogs with natural AD. Methods: We used archived frozen skin biopsies from 6 house dust mite–sensitized atopic dogs after allergen challenge, 4 dogs with spontaneous AD and 1 dog with normal skin. The expression of NGF was evaluated by immunofluorescence. We also conducted a pilot crossover trial with 8 dogs with glucocorticoid-responsive AD. In both phases, the dogs were first treated for 28 days with oral prednisolone at 0.5 mg/kg/d. On the first day of the first phase, they received a saline subcutaneous injection, while on that of the second phase, they were injected with 0.2 mg/kg once of the caninized anti-dog NGF ranevetmab. The primary outcome measure was the time-to-flare, defined as the number of days between that of the last prednisolone administration and the day when the pruritus reached a score of at least 5.5/10, or 8 weeks, whichever came first. Results: In normal canine skin, the highest intensity of NGF staining was in stratum granulosum keratinocytes. After allergen challenge and in atopic canine skin, the NGF expression also extended downward to the upper stratum spinosum. In the pilot trial, the time-to-flare after prednisolone cessation was not significantly different between saline and ranevetmab-treated dogs. Discussion: While NGF is overexpressed in the atopic canine epidermis and after allergen challenge in sensitized dogs, the anti-NGF antibody ranevetmab did not delay pruritus flares after the discontinuation of prednisolone. Further studies are needed to assess if NGF is a relevant contributor for canine atopic itch.","PeriodicalId":73523,"journal":{"name":"Itch (Philadelphia, Pa.)","volume":"4 1","pages":"e22"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/itx.0000000000000022","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61764982","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 : 2018-12-01DOI: 10.1097/itx.0000000000000020
Seema P. Kini, Kuang‐Ho Chen, Suephy C. Chen
Introduction: Chronic pruritus (CP) is a common symptom, but can be a diagnostic and therapeutic challenge. Our objective was to determine how personality traits, and more specifically personality styles, influence quality of life (QoL) impact of CP. Methods: Cross-sectional study of patients with CP from 2 main groups: (1) National Eczema Association and (2) US Veterans Health Administration (VHA) National Patient Care Database. Participants (N=483) answered questions regarding demographics, characteristics of CP, personality traits (NEO Five-Factor Model) and pruritus impact (ItchyQoL). A multivariate linear regression was performed to determine which of 15 covariates (age, race, marital status, itch duration, itch frequency, and each of the 10 personality styles) were significantly associated with greater total mean ItchyQoL score (ie, greater burden of CP). Secondary outcome measures included the 3 ItchyQoL subscale scores (symptom, emotion, function). Results: The Lethargic personality style (low extraversion, low conscientiousness) was significantly associated with greater total mean ItchyQoL score (&bgr;=11.65, P=0.04) while the Overcontrolled (high neuroticism, high conscientiousness) and Undercontrolled (high neuroticism, low conscientiousness) styles were significantly associated with greater symptomatic impact from CP (&bgr;=2.76, P=0.01 and &bgr;=2.34, P=0.03), respectively. African American race was significantly associated with greater mean ItchyQoL score (&bgr;=8.14, P=0.002), ItchyQoL emotional score (&bgr;=2.98, P=0.02) and trended to significance for ItchyQoL symptom score (&bgr;=1.23, P=0.06). Curiously, white race was associated with higher ItchyQoL scores for the function construct (&bgr;=1.2, P=0.04). “Single” marital status trended to significance for higher mean ItchyQoL score (&bgr;=3.79, P=0.06). Discussion: Our results highlight certain personality styles (Lethargic, Overcontrolled, Undercontrolled) and important demographics (ie, African American race, single marital status) that may influence itch-related QoL impact. In the clinical setting these findings may suggest a role for support structures and other integrative measures (eg, support groups, cognitive and mindfulness based therapies) to augment traditional therapeutics for CP.
{"title":"Personality traits and styles may affect the reporting of chronic pruritus: a cross-sectional study","authors":"Seema P. Kini, Kuang‐Ho Chen, Suephy C. Chen","doi":"10.1097/itx.0000000000000020","DOIUrl":"https://doi.org/10.1097/itx.0000000000000020","url":null,"abstract":"Introduction: Chronic pruritus (CP) is a common symptom, but can be a diagnostic and therapeutic challenge. Our objective was to determine how personality traits, and more specifically personality styles, influence quality of life (QoL) impact of CP. Methods: Cross-sectional study of patients with CP from 2 main groups: (1) National Eczema Association and (2) US Veterans Health Administration (VHA) National Patient Care Database. Participants (N=483) answered questions regarding demographics, characteristics of CP, personality traits (NEO Five-Factor Model) and pruritus impact (ItchyQoL). A multivariate linear regression was performed to determine which of 15 covariates (age, race, marital status, itch duration, itch frequency, and each of the 10 personality styles) were significantly associated with greater total mean ItchyQoL score (ie, greater burden of CP). Secondary outcome measures included the 3 ItchyQoL subscale scores (symptom, emotion, function). Results: The Lethargic personality style (low extraversion, low conscientiousness) was significantly associated with greater total mean ItchyQoL score (&bgr;=11.65, P=0.04) while the Overcontrolled (high neuroticism, high conscientiousness) and Undercontrolled (high neuroticism, low conscientiousness) styles were significantly associated with greater symptomatic impact from CP (&bgr;=2.76, P=0.01 and &bgr;=2.34, P=0.03), respectively. African American race was significantly associated with greater mean ItchyQoL score (&bgr;=8.14, P=0.002), ItchyQoL emotional score (&bgr;=2.98, P=0.02) and trended to significance for ItchyQoL symptom score (&bgr;=1.23, P=0.06). Curiously, white race was associated with higher ItchyQoL scores for the function construct (&bgr;=1.2, P=0.04). “Single” marital status trended to significance for higher mean ItchyQoL score (&bgr;=3.79, P=0.06). Discussion: Our results highlight certain personality styles (Lethargic, Overcontrolled, Undercontrolled) and important demographics (ie, African American race, single marital status) that may influence itch-related QoL impact. In the clinical setting these findings may suggest a role for support structures and other integrative measures (eg, support groups, cognitive and mindfulness based therapies) to augment traditional therapeutics for CP.","PeriodicalId":73523,"journal":{"name":"Itch (Philadelphia, Pa.)","volume":"3 1","pages":"e20"},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/itx.0000000000000020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45327889","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 : 2018-12-01DOI: 10.1097/itx.0000000000000017
T. Hashimoto, J. Rosen, K. M. Sanders, G. Yosipovitch
Interactions between keratinocytes, immune cells, and sensory nerve endings strongly influence the sensation of itch. Mast cells, eosinophils, and T cells are commonly mentioned as immune cells involved in itch, meanwhile the role of neutrophils in pruritus is rarely discussed. However, neutrophils are capable of producing and releasing a variety of pruritogens such as histamine, proteases (neutrophil elastase and cathepsin S), prostaglandin E2, leukotriene B4, and platelet-activating factor. The purpose of this review is to highlight the role of neutrophils in the pathogenesis of several pruritic diseases, such as psoriasis, palmoplantar pustulosis, atopic dermatitis, malignant skin tumors (squamous cell carcinoma and basal cell carcinoma), bullous pemphigoid, dermatitis herpetiformis, chronic prurigo/prurigo nodularis, subacute prurigo, and prurigo pigmentosa.
{"title":"Possible role of neutrophils in itch","authors":"T. Hashimoto, J. Rosen, K. M. Sanders, G. Yosipovitch","doi":"10.1097/itx.0000000000000017","DOIUrl":"https://doi.org/10.1097/itx.0000000000000017","url":null,"abstract":"Interactions between keratinocytes, immune cells, and sensory nerve endings strongly influence the sensation of itch. Mast cells, eosinophils, and T cells are commonly mentioned as immune cells involved in itch, meanwhile the role of neutrophils in pruritus is rarely discussed. However, neutrophils are capable of producing and releasing a variety of pruritogens such as histamine, proteases (neutrophil elastase and cathepsin S), prostaglandin E2, leukotriene B4, and platelet-activating factor. The purpose of this review is to highlight the role of neutrophils in the pathogenesis of several pruritic diseases, such as psoriasis, palmoplantar pustulosis, atopic dermatitis, malignant skin tumors (squamous cell carcinoma and basal cell carcinoma), bullous pemphigoid, dermatitis herpetiformis, chronic prurigo/prurigo nodularis, subacute prurigo, and prurigo pigmentosa.","PeriodicalId":73523,"journal":{"name":"Itch (Philadelphia, Pa.)","volume":"3 1","pages":"e17"},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/itx.0000000000000017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44875388","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 : 2018-12-01DOI: 10.1097/itx.0000000000000018
Stuart Sedlack, G. Yosipovitch, Matthew B. Kerby, Paul C Nagle, S. Ständer
Introduction: Chronic pruritus (CP) is a symptom of many diseases, but there is a scarcity of data on this condition in the US. Methods: We surveyed practicing, community-based US dermatologists about aspects of CP, including the number of patients seen annually, patient characteristics, treatments, and level of unmet need. US dermatologists who responded to a screening survey and reported managing ≥10 patients with CP per year were administered a 55-question web-based survey. The survey was conducted from March 27 to April 10, 2015. Results: A total of 212 survey responses were included in the analysis. The prevalence of CP in the dermatologists’ practices in the previous year was reported as 4.8%. Of 9 dermatologic conditions in the survey, CP was rated as having the highest level of unmet need (8.6 on a 10-point scale). Respondents reported that 32.7% of their patients had CP classified as severe/very severe, with 53.7% of patients having CP lasting for >1 year. Most dermatologists prescribed antihistamines (77.5%) or corticosteroids (76.1%) as first-line therapy to their patients with severe/very severe CP, and 36.3% of their patients did not respond to currently available treatments. Discussion: The combined prevalence of CP and its high level of unmet need necessitate the development of effective/tolerable treatments for this patient population.
{"title":"High unmet need in severe chronic pruritus in the United States: results from a survey of practicing community dermatologists","authors":"Stuart Sedlack, G. Yosipovitch, Matthew B. Kerby, Paul C Nagle, S. Ständer","doi":"10.1097/itx.0000000000000018","DOIUrl":"https://doi.org/10.1097/itx.0000000000000018","url":null,"abstract":"Introduction: Chronic pruritus (CP) is a symptom of many diseases, but there is a scarcity of data on this condition in the US. Methods: We surveyed practicing, community-based US dermatologists about aspects of CP, including the number of patients seen annually, patient characteristics, treatments, and level of unmet need. US dermatologists who responded to a screening survey and reported managing ≥10 patients with CP per year were administered a 55-question web-based survey. The survey was conducted from March 27 to April 10, 2015. Results: A total of 212 survey responses were included in the analysis. The prevalence of CP in the dermatologists’ practices in the previous year was reported as 4.8%. Of 9 dermatologic conditions in the survey, CP was rated as having the highest level of unmet need (8.6 on a 10-point scale). Respondents reported that 32.7% of their patients had CP classified as severe/very severe, with 53.7% of patients having CP lasting for >1 year. Most dermatologists prescribed antihistamines (77.5%) or corticosteroids (76.1%) as first-line therapy to their patients with severe/very severe CP, and 36.3% of their patients did not respond to currently available treatments. Discussion: The combined prevalence of CP and its high level of unmet need necessitate the development of effective/tolerable treatments for this patient population.","PeriodicalId":73523,"journal":{"name":"Itch (Philadelphia, Pa.)","volume":"3 1","pages":"e18"},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/itx.0000000000000018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43583265","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}
Inactivation of descending pathways enhanced responses of spinal dorsal horn neurons to noxious stimuli, but little is known regarding tonic descending modulation of spinal itch transmission. To study effects of cervical spinal cold block on responses of dorsal horn neurons to itch-evoking and pain-evoking stimuli, single-unit recordings were made from superficial dorsal horn wide dynamic range and nociceptive-specific-type neurons in pentobarbital-anesthetized mice. Intradermal histamine excited 17 units. Cold block starting 1 minute after intradermal injection of histamine caused a marked decrease in firing. The histamine-evoked response during and following cold block was significantly lower compared with control histamine-evoked responses in the absence of cold block. A similar but weaker depressant effect of cold block was observed for dorsal horn unit responses to chloroquine. Twenty-six units responded to mustard oil allyl isothiocyanate (AITC), with a further significant increase in firing during the 1-minute period of cold block beginning 1 minute after AITC application. Activity during cold block was significantly greater compared with the same time period of control responses to AITC in the absence of cold block. Ten units' responses to noxious heat were significantly enhanced during cold block, while 6 units' responses were reduced and 18 unaffected. Cold block had no effect on mechanically evoked responses. These results indicate that spinal chemonociceptive transmission is under tonic descending inhibitory modulation, while spinal pruriceptive transmission is under an opposing, tonic descending facilitatory modulation.
{"title":"Opposing effects of cervical spinal cold block on spinal itch and pain transmission.","authors":"Earl Carstens, Mirela Iodi Carstens, Tasuku Akiyama, Auva Davoodi, Masaki Nagamine","doi":"10.1097/itx.0000000000000016","DOIUrl":"10.1097/itx.0000000000000016","url":null,"abstract":"<p><p>Inactivation of descending pathways enhanced responses of spinal dorsal horn neurons to noxious stimuli, but little is known regarding tonic descending modulation of spinal itch transmission. To study effects of cervical spinal cold block on responses of dorsal horn neurons to itch-evoking and pain-evoking stimuli, single-unit recordings were made from superficial dorsal horn wide dynamic range and nociceptive-specific-type neurons in pentobarbital-anesthetized mice. Intradermal histamine excited 17 units. Cold block starting 1 minute after intradermal injection of histamine caused a marked decrease in firing. The histamine-evoked response during and following cold block was significantly lower compared with control histamine-evoked responses in the absence of cold block. A similar but weaker depressant effect of cold block was observed for dorsal horn unit responses to chloroquine. Twenty-six units responded to mustard oil allyl isothiocyanate (AITC), with a further significant increase in firing during the 1-minute period of cold block beginning 1 minute after AITC application. Activity during cold block was significantly greater compared with the same time period of control responses to AITC in the absence of cold block. Ten units' responses to noxious heat were significantly enhanced during cold block, while 6 units' responses were reduced and 18 unaffected. Cold block had no effect on mechanically evoked responses. These results indicate that spinal chemonociceptive transmission is under tonic descending inhibitory modulation, while spinal pruriceptive transmission is under an opposing, tonic descending facilitatory modulation.</p>","PeriodicalId":73523,"journal":{"name":"Itch (Philadelphia, Pa.)","volume":"3 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9e/db/nihms-1596930.PMC8204798.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9561274","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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