Association of pruritus and chronic cough: an all of us database study.

PURPOSE: Based on a potential shared pathophysiology tied to mast cell activity and neurogenic inflammation that may link pruritus and chronic cough (CC), this study, leveraging the All of Us database, examines the association between the two conditions. MATERIALS AND METHODS: A nested case-control comparison was used to examine the association, identifying cases with SNOMED codes 418363000 (pruritus) and 68154008 (CC). Matching was performed on a 1:4 ratio by age, sex, and ethnicity using the MatchIt package in R, followed by maximum likelihood method to estimate odds ratios (ORs) and 95% confidence intervals from 2x2 contingency tables. RESULTS: CC patients (n = 2,388) were more than twice as likely to be diagnosed with pruritus (OR: 2.65) and pruritus patients (n = 22,496) were more than twice as likely to be diagnosed with CC (OR: 2.57), than respective matched controls. CONCLUSIONS: These results highlight the potential bidirectional relationship between CC and pruritus, suggesting possible shared immune and neural pathways. Treatments like difelikefalin and nalbuphine that modulate these pathways, alongside P2X3 targeting agents, are emerging as potential therapeutic approaches for itch and chronic cough given the possible interconnected pathophysiology. This study's insights into the associations between pruritus and CC may pave the way for targeted therapeutic strategies that address their shared mechanisms.

Atopic Dermatitis in Children.

Atopic dermatitis (AD) is extremely common in the pediatric population, and most children with AD will first present to their primary care provider (PCP). The PCP can recognize AD by its clinical features, including itch, a chronic relapsing course, and the characteristic eruption. The cornerstone of AD therapy is dry skin care, typically a short daily bath/shower followed by an emollient applied to all skin. Most children with AD will also require topical medications, such as topical corticosteroids and/or topical nonsteroidal therapies. For children with more severe disease, systemic agents, including several novel therapies, may be required. In managing AD, the clinician must monitor for side effects of medications as well as complications of the AD itself, the most common of which is secondary infection. An understanding of the pathogenesis, treatments, and complications of AD is essential for the PCP, as untreated (or undertreated) AD has a significant impact on the quality of life of affected children and their caregivers. [Pediatr Ann. 2024;53(4):e121-e128.].

Associations between Atopic Dermatitis and Behavior Difficulties in Children.

Background and Objectives: There has been increasing evidence that atopic dermatitis (AD) is associated with behavioral difficulties (BDs). There is currently a lack of evidence of how the severity of the disease determines BDs and what additional factors may contribute to their manifestation. The aim is to determine what kind of BDs occur in children with AD compared to healthy children and to find out what additional factors may contribute to the development of BDs in AD patients. Materials and Methods: This is a cross-sectional, prospective study with the application of a risk assessment instrument for behavior difficulties (Child Behavior Checklist, CBCL 6/18) in pediatric patients with AD and healthy controls (6-17 years) between 1 January 2020 and 31 December 2022. For statistical comparison, mainly Wilcoxon-Mann-Whitney and Student's t-test were used, considering a significance level of 5%. Results: This study included a total of 101 children: 48% with AD, 52% non-AD. The mean age was 10 ± 2.7 years for AD, and10.5 ± 3.1 years for the control patients. AD patients had higher internal behavior scale scores and T-scores (6.6 ± 6.4 vs. 9.6 ± 6.9 and 47.9 ± 9.5 vs. 52.3 ± 10.2, p = 0.01), anxiety/depression scale score and T-score (2.8 ± 2.7 vs. 4.3 ± 3.5 and 47.7 ± 8.4 vs. 52.5 ± 11, p = 0.02), and somatic problems scale score and T-score (2.1 ± 2.3 vs. 3.5 ± 3 and 47.6 ± 8.5 vs. 52.7 ± 10.9, p = 0.005). Patients with severe AD had sleep disturbance and itching scores higher than those with mild-moderate AD (5.4 ± 2.6 vs. 2.4 ± 2.2, p = 0.000 and 6.6 ± 2.4 vs. 4 ± 2.8, p = 0.001). The mean morning serum cortisol concentration was lower in AD patients compared to controls (252.91 ± 304.34 vs. 351.55 ± 126.09 nmol/L, p = 0.047). Conclusions: Children with AD present a higher risk of BDs than healthy controls. Patients with severe AD experience more sleep disturbances and a greater intensity of itching compared to mild-moderate AD. The occurrence of BDs was not related to serum cortisol levels. The cortisol level, severity, age, gender, duration of illness, intensity of pruritus, and sleep disturbance did not affect the development of BDs.

Pruritus in primary biliary cholangitis is under-recorded in patient medical records.

OBJECTIVE: Cholestatic pruritus in primary biliary cholangitis (PBC) reduces patients' health-related quality of life (HRQoL). Despite this, existing research suggests that pruritus is under-recorded in patients' health records. This study assessed the extent to which pruritus was recorded in medical records of patients with PBC as compared with patient-reported pruritus, and whether patients reporting mild itch were less likely to have pruritus recorded. We also evaluated clinico-demographic characteristics and HRQoL of patients with medical record-documented and patient-reported pruritus. DESIGN: This cross-sectional study used clinical information abstracted from medical records, together with patient-reported (PBC-40) data from patients with PBC in the USA enrolled in the PicnicHealth cohort. Medical record-documented pruritus was classified as 'recent' (at, or within 12 months prior to, enrolment) or 'ever' (at, or any point prior to, enrolment). Patient-reported pruritus (4-week recall) was assessed using the first PBC-40 questionnaire completed on/after enrolment; pruritus severity was classified by itch domain score (any severity: ≥1; clinically significant itch: ≥7). Patient clinico-demographic characteristics and PBC-40 domain scores were described in patients with medical record-documented and patient-reported pruritus; overlap between groups was evaluated. Descriptive statistics were reported. RESULTS: Pruritus of any severity was self-reported by 200/225 (88.9%) patients enrolled; however, only 88/225 (39.1%) had recent medical record-documented pruritus. Clinically significant pruritus was self-reported by 120/225 (53.3%) patients; of these, 64/120 (53.3%) had recent medical record-documented pruritus. Patients reporting clinically significant pruritus appeared to have higher mean scores across PBC-40 domains (indicating reduced HRQoL), versus patients with no/mild patient-reported pruritus or medical-record documented pruritus. CONCLUSION: Compared with patient-reported measures, pruritus in PBC is under-recorded in medical records and is associated with lower HRQoL. Research based only on medical records underestimates the true burden of pruritus, meaning physicians may be unaware of the extent and impact of pruritus, leading to potential undertreatment.

Anti-SAE dermatomyositis: clinical and histologic characteristics from a monocentric Italian cohort.

OBJECTIVES: Multiple myositis-specific antibodies have been identified, each associated with different clinical subsets of dermatomyositis (DM). Anti-SAE associated DM is considered the least studied subset. Our study aimed to evaluate the clinical and histological characteristics of DM patients with anti-SAE antibodies. As reference, patients with anti-Mi2 antibodies associated DM, representing a well-characterised subset, were analysed. METHODS: We recorded data from our DM cohort in the INflammatory MYositis REgistry (INMYRE). Patients were divided into two groups: those positive for anti-SAE and those positive for anti-Mi2 antibodies. Clinical characteristics, including skin, muscle, and extra-muscular involvements, were recorded. Available muscle biopsies were compared between the two groups. RESULTS: Of 92 DM patients, 10 (10.9%) were positive for anti-SAE and 17 (18.5%) for anti-Mi2. Anti-SAE positive DM patients showed classic DM findings but were characterised by a higher prevalence of skin itching (60% vs. 11.8%, p<0.01), shawl sign (40% vs. 5.9%, p<0.05) and lung involvement (30% vs. 0%, p<0.05) compared to anti-Mi2 positive patients. Furthermore, anti-SAE positive DM patients showed lower creatine kinase levels than those with anti-Mi2 (median [IQR]: 101 [58-647] vs. 1984 [974-3717], p<0.05) and a lower percentage of muscle fibre degeneration and necrosis (1.5%±1.7 vs. 5.9%±3.2, p<0.05) in muscle biopsies. No other differences were observed. CONCLUSIONS: Anti-SAE DM represents a disease subset characterised by classic cutaneous involvement often associated with itching, less severe muscle involvement, but potential pulmonary involvement that should always be investigated in these patients.

Impact of neurofibromatosis type 1 on quality of life using the Skindex-29 questionnaire quality of life in NF1.

BACKGROUND: Neurofibromatosis type 1 (NF1) is one of the most common RASopathies predisposing affected patients to melanic lesions and benign tumors. NF1 is associated with considerable esthetic and functional burden negatively affecting the patient's quality of life (QoL). This study aims to assess the clinical features of NF1 patients and evaluate their impact on QoL. We identified NF1 patients from a public health database of a region in Spain. All patients underwent clinical and ophthalmological evaluation for NF1 features. We measured QoL using the Spanish version of the Skindex-29. RESULTS: Forty patients fulfilled the NF1 National Institute of Health criteria when we recruited patients. The median age was 42.00 years (IQR 26.5 -53.75). The median total Skindex-29 score was 12.3 (IQR 5.9-22.4); (emotion: 15.0, IQR 5.0-37.5; symptoms 8.9, IQR 0.0-17.9 and functioning 8.3; IQR 0.5-18.3). Women and NF1 patients with lower educational levels were associated with poorer QoL scores. We identified itching and sleep troubles to influence NF1 patients' QoL negatively. CONCLUSION: NF1 considerably influences the psychological well-being of NF1 patients. We observed that female and low-educated patients scored higher on the emotional dimension of the Skindex-29 and could, therefore, be more at risk of depression. We also pointed out some "minor symptoms" that negatively impact NF1 patients' QoL such, as itching and sleep troubles which doctors could treat if sought by doctors.

Symptom severity reflected by NYHA grade is independently associated with pruritus in chronic heart failure patients.

BACKGROUND: Pruritus is a symptom profoundly impairing patients' quality of life (QoL). It is a common symptom in chronic heart failure (CHF) patients of yet unknown nature. The aim of this study was to evaluate the risk factors of pruritus in CHF patients. METHODS: For this monocentric, prospective cohort study, CHF patients were recruited and CHF symptoms, comorbidities and drug intake were assessed using a structured report. Additionally, a questionnaire evaluated pruritus symptoms. Detailed medical histories including laboratory test results were retrieved from patient files for all participants. RESULTS: We evaluated data from 550 CHF patients. Of those, 25.3% reported pruritus to occur frequently (3-5 times per week), often (1-2 times per week) or daily. Patients of higher NYHA classes (NYHA III + IV) experienced significantly more pruritus (31.2%) than lower NYHA classes (NYHA I + II) (21.1%, p = 0.024). Patients with pruritus reported disproportionately often concomitant stasis dermatitis (p = 0.026) and chronic lung disease (p = 0.014). Other parameters reflecting cardiac, liver, kidney and thyroid function, as well as medical therapies showed no significant differences between patients with and without pruritus. In the multivariate logistic regression analysis, only NYHA class (p = 0.016, OR 1.55, 95% confidence interval (CI): [1.09; 2.20]) and elevated leukocyte count (p = 0.007, OR 1.11, CI [1.03; 1.21]) remained significantly associated with pruritus in CHF patients. CONCLUSIONS: NYHA class is an independent predictor for pruritus in CHF patients. Besides NYHA class, leukocyte count was also associated with increased pruritus. Pruritus may impair QoL in CHF patients and should thus be included in the assessment of those patients. We suggest that providing best care for CHF patients can be achieved through an interdisciplinary approach of cardiologists and dermatologists and should include a pruritus assessment.

Hybrid cooperative complexes to decrease VAS score and enhance sexual function in women with vulvar lichen sclerosus.

OBJECTIVE: Lichen sclerosus is a chronic, inflammatory, progressive skin disease predominantly affecting anogenital areas. Vulvar lichen sclerosus (VLS) is one of the most common conditions treated in vulvar clinics; most patients report distressing symptoms of itching, burning, stinging, and pain (particularly during or after sexual intercourse). A preliminary, prospective, single-center study was performed to investigate the efficacy of hyaluronan hybrid cooperative complex (HCC) comprising high and low molecular weight hyaluronic acid to treat menopausal women with VLS. PATIENTS AND METHODS: Patients (N = 30) received two HCC injections at 32 mg/ml (one month apart). At baseline and one and six months after treatment, patients completed validated psychometric questionnaires to assess their self-reported pain, itching, and dryness using the Visual Analogue Scale (VAS) and sexual function by the Female Sexual Function Index (FSFI). RESULTS: After treatment with HCC, no side effects or complications were reported. VAS scores showed a trend towards reduced pain and itching intensity, and there was a statistically significant reduction in median VAS score for dryness at follow-up vs. baseline (p=0.038). For sexual function, there was a statistically significant improvement in lubrication (p=0.001) and orgasm (p=0.001) FSFI domains. CONCLUSIONS: Overall, this preliminary study demonstrated the promising efficacy of HCC in menopausal women with VLS without side effects.

[Clinical and pathological analysis of 345 cases of vulvar lichen sclerosus and a preliminary study on the frequency of maintenance treatment].

Objective: To analyze and summarize the clinical and pathological characteristics, management, and efficacy of patients with vulvar lichen sclerosus (VLS) through a single center large sample study, and preliminarily to explore the frequency of maintenance treatment medication for VLS. Methods: The clinical data of VLS patients in Obstetrics and Gynecology Hospital of Fudan University from 2018 to 2021 were retrospectively collected. The clinicopathological characteristics (patients' age, course of disease, complicated disease history, family history, symptoms, signs and pathology), treatment and effects were retrospectively analyzed. The patients in the maintenance treatment stage were followed up regularly to explore the minimum frequency of individual medication to maintain the stability of the disease. Results: (1) General situation: a total of 345 patients with VLS were included in this study. The average age was (50.4±14.7) years (ranged from 8 to 84 years old), prevalence was highest in the 50-59 years group (30.1%, 104/345). Immune diseases occurred in 18.6% (33/177) of patients, 24.3% (43/177) of patients had allergic skin diseases, and 5.6% (10/177) of the patients' immediate family members had chronic vulvar pruritus or vulvar hypopigmentation. (2) Clinical features: the most common symptom was vulvar pruritus (96.1%, 196/204) among 204 patients with recorded symptoms. The most common sign was hypopigmentation of the vulva (96.3%, 206/214). The most common involved sites were labia minora (70.3%, 142/202), labia majora (67.8%, 137/202), and labial sulcus (59.4%, 120/202). The cumulative number of sites involved in 62 vulvar atrophy patients (2.7±1.1) was significantly higher than that in 152 non-atrophy patients (2.2±1.0; t=3.48, P=0.001). The course of vulvar atrophy was (9.3±8.5) years, which was significantly longer than that of non-atrophy patients [(6.6±5.6) years; t=2.04, P=0.046]. (3) Pathological features: among the 286 patients with electronic pathological sections, the most common pathological feature in the epidermis was epithelial nail process passivation (71.3%, 204/286). The common pathological features in the dermis were interstitial collagenization (84.6%, 242/286), and inflammatory cell infiltration (73.8%, 211/286). (4) Treatment: 177 patients received standardized treatment after diagnosis and were followed up regularly in our hospital. In the initial treatment stage, 26.0% (46/177) of the patients were treated with 0.05% clobetasol propionate cream, and 74.0% (131/177) of the patients were treated with 0.1% mometasone furoate ointment. The complete remission rates of the two methods were respectively 80.4% (37/46) and 74.0% (97/131), and there was no statistically significant difference (χ²=0.76, P=0.385). During maintenance treatment, 27.1% (48/177) of the patients took the medication twice a week, 35.0% (62/177) took the medication once a week, and 37.9% (67/177) took the medication once every 10 days. During follow-up after 6 months of maintenance treatment, there were no patients with recurrence of pruritus or progression of vulvar signs. Conclusions: The majority of VLS patients have itching, hypopigmentation, involvement of labia minora and labia majora, progressive atrophy, and inflammatory infiltration of dermis. Local treatments of mometasone furoate and clobetasol propionate have good initial therapeutic effects. The frequency exploration of individualized maintenance treatment could minimize the occurrence of adverse reactions when ensuring the stability of the patients' condition.

Anestesia espinal con morfina y bupivacaína en la cirugía de próstata / Spinal anesthesia with morphine and bupivacaine in prostate surgery

Introducción: El dolor posoperatorio constituye la principal causa de dolor agudo en el mundo. Brindar analgesia adecuada en el posquirúrgico garantiza la disminución de la estadía hospitalaria y tiene un impacto positivo en el resultado final de las intervenciones. Objetivo: Evaluar la efectividad de la analgesia posoperatoria con bupivacaína más morfina intratecal en la cirugía de próstata. Métodos: Se realizó una investigación cuasiexperimental, entre enero de 2015 y enero de 2018. La muestra quedó conformada de manera no probabilística por los pacientes que dieron su consentimiento informado y reunieron criterios para entrar en el estudio. Quedaron distribuidos de manera aleatoria en dos grupos denominados bupivacaína (B) y morfina-bupivacaína (MB). Para recolectar la información se emplearon las historias clínicas anestésicas y un formulario elaborado al efecto. Los resultados se mostraron en tablas y gráficos, se expresaron en frecuencias absolutas y en porcientos, se determinaron algunas medidas descriptivas de interés que mostraron el comportamiento de las variables que lo requirieron. Resultados: El resultado más relevante fue el efecto analgésico muy significativo en el grupo MB en las primeras 24 h del posoperatorio. La reacción adversa más frecuente fue el prurito y solo se presentó en el grupo que recibió morfina. Conclusiones: La anestesia espinal con morfina y bupivacaína es efectiva y segura, proporcionando mejor analgesia en el posoperatorio inmediato cuando se compara con bupivacaína sola(AU)

Introduction: Postoperative pain is the main cause of acute pain worldwide. Providing suitable analgesia in the postoperative period guarantees the reduction of hospital stay and has a positive impact on the final outcome of the interventions. Objective: To evaluate the effectiveness of postoperative analgesia with intrathecal administration of bupivacaine plus morphine in prostate surgery. Methods: A quasiexperimental research was carried out between January 2015 and January 2018. The sample was nonprobabilistic and made up by the patients who gave their informed consent and met criteria to enter the study. They were randomly distributed into two groups called bupivacaine (B) and morphine-bupivacaine (MB). To collect the information, the anesthetic medical records and a form prepared for this purpose were used. The results were shown in tables and graphs, expressed in absolute frequencies and percentages, some descriptive measures of interest were determined which showed the behavior of the variables that required it. Results: The most relevant result was the very significant analgesic effect in the MB group in the first 24 hours after surgery. The most frequent adverse reaction was pruritus and only occurred in the group that received morphine. Conclusions: Spinal anesthesia with morphine and bupivacaine is effective and safe, providing better analgesia in the immediate postoperative period when compared with bupivacaine alone(AU)

Aplicación de la técnica de Schultz a un caso de neurodermatitis / Application of the Schultz technique in a neurodermatitis case

Se presenta el tratamiento de un caso con neurodermatitis congénita, de una profesional psicóloga de 30 años, quien no podía controlar su conducta de rascarse, produciéndose permanentemente escoriaciones en su piel. Se aplicó el entrenamiento autógeno de Schultz, abreviado en ocho, registrándose los valores electromiográficos, a nivel frontal, y la temperatura de ambas manos, durante la práctica del procedimiento. Los resultados del tratamiento fueron exitosos en lo inmediato, con posterioridad a dicho tratamiento y a los tres meses de seguimiento. El éxito se operacionalizó en términos de lograr controlar la conducta de rascarse y posibilitar la cicatrización de las escoriaciones

Larva migrans cutanea y albendazol / Cutaneous larva migrans and albendazol

Con el objeto de evaluar otras terapeuticas en Larva Migrans cutanea, se efectuo tratamiento controlado en 14 pacientes con ALBENDAZOL. Las edades variaron entre 5 a 41 años (Media: 16 años). Cada paciente presentaba una a multiples larvas y referian historia de la enfermedad entre 3 y 18 dias, 3 de ellos con infeccion agregada. En 10 pacientes (Grupo A), se administro 400 mgs. de Albendazol de una sola toma, durante 3 dias. Otros 4 pacientes (GrupoB), recibieron una sola dosis de 400 mg. En ambos grupos se obtuvo curacion completa con desaparicion del prurito a partir del tercer dia y sin reaparicion de molestias durante los 30 dias de control. Los controles se los realizaron a los 3,10 y 30 dias. En 2 pacientes se empleo Albendazol topicamente (10 por ciento ) no se observo mejoria hasta el quinto dia, por lo que paso al grupo A