Pruritus Intensity Scales across Europe: a prospective validation study.

BACKGROUND: Chronic pruritus (CP) is a subjective symptom, and it is necessary to assess its intensity with validated patient-reported outcome tools in order to allow determination of the treatment course. OBJECTIVES: So far, the itch intensity scales were validated in small cohorts and in single languages. Here, we report the validation of the numerical rating scale, the verbal rating scale and the visual analogue scale for the worst and average pruritus intensity in the last 24h in several languages across Europe and across different pruritic dermatoses. METHODS: After professional translation, the intensity scales were digitized for use as a tablet computer application. Validation was performed in clinics for Dermatology in Austria, France, Germany, Italy, Poland, Russia, Spain, Switzerland and Turkey. RESULTS: A total of 547 patients with contact dermatitis, chronic nodular prurigo, psoriasis vulgaris, lichen planus or cutaneous T-cell lymphoma were included. The intensity scales showed a high level of reproducibility and inter-correlations with each other. The correlation with the Dermatology Life Quality Index was weak to strong in nearly all countries and dermatoses with the exception of France and patients with chronic nodular prurigo, for which no statistically significant correlations were found. CONCLUSIONS: The numerical rating scale, the verbal rating scale und the visual analogue scales are valid instruments with good reproducibility and internal consistency in German (Germany, Austria, Switzerland), French, Italian, Polish, Russian, Spanish and Turkish for different pruritic dermatoses. VAS worst was the best reproducible and consistent measuring instrument in all countries.

Chronic nodular prurigo: clinical profile and burden. A European cross-sectional study.

BACKGROUND: Chronic nodular prurigo (CNPG) is a condition characterized by chronic itch, a prolonged scratching behaviour and the presence of pruriginous nodules. A comprehensive understanding of this condition, especially regarding its clinical characteristics and impact on quality of life is still lacking. OBJECTIVES: Aim of this pan-European multicentre cross-sectional study was to establish the clinical profile of CNPG, including its associated burden. METHODS: Fifteen centres from 12 European countries recruited CNPG patients presenting at the centre or using the centres' own databases. Patients were asked to complete a questionnaire in paper or electronic format. Demography, current co-morbidities, underlying disease, itch intensity, additional sensory symptoms, quality of life, highest burden and emotional experience of itch were assessed. RESULTS: A total of 509 patients (210 male, median age: 64 years [52; 72]) were enrolled. Of these, 406 reported itch and CNPG lesions in the previous 7 days and qualified to complete the whole questionnaire. We recorded moderate to severe worst itch intensity scores in the previous 24 h. Scores were higher in patients with lower educational levels and those coming from Eastern or Southern Europe. Most patients experience itch often or always (71%) and report that their everyday life is negatively affected (53%). Itch intensity was considered to be the most burdensome aspect of the disease by 49% of the patients, followed by the visibility of skin lesions (21%) and bleeding of lesions (21%). The majority of patients was unaware of an underlying condition contributing to CNPG (64%), while psychiatric diseases were the conditions most often mentioned in association with CNPG (19%). CONCLUSIONS: This multicentre cross-sectional study shows that itch is the dominant symptom in CNPG and reveals that the profile of the disease is similar throughout Europe.

Cross-European validation of the ItchyQoL in pruritic dermatoses.

BACKGROUND: Chronic pruritus (CP) is a frequently occurring symptom in inflammatory dermatoses, causing a high burden and limitations to health-related quality of life (HRQoL). OBJECTIVE: The ItchyQoL was developed to assess the impairment to HRQoL in patients with CP. However, it has only been validated in English and German. Here, we report the validation in several languages across Europe. METHODS: After professional translation, the versions of ItchyQoL were digitized for use as a tablet application. Validation was performed in clinics for dermatology in Austria, France, Germany, Italy, Poland, Russia, Spain, Switzerland and Turkey. RESULTS: Five hundred and thirty-five patients with either contact dermatitis, chronic prurigo - nodular type, psoriasis vulgaris, lichen planus or mycosis fungoides/Sézary syndrome and with CP ≥ 3 on the numerical rating scale were included. ItchyQoL showed a high level of consistency (Cronbach's-α, all: 0.95) and test-retest reliability (intraclass correlation: 0.91). It strongly correlated with the Dermatology Life Quality Index (r = 0.72, P < 0.001) and moderately correlated with itch intensity scales in the study population (visual analogue scale r = 0.46; numerical rating scale r = 0.51; verbal rating scale r = 0.51, for all: P < 0.001). CONCLUSION: ItchyQoL is now also validated in French, Italian, Polish, Russian, Spanish and Turkish and can be used in clinical trials in countries speaking these languages.

Effects of expression of transcriptional factor AP-1 FOSL1 gene on psoriatic process.

We performed quantitative analysis of FOSL1 gene expression in lesional psoriatic skin. The expression of this gene in lesional psoriatic skin was significantly increased compared to that in unaffected areas. Enhanced FOSL1 expression significantly correlated with high psoriasis area and severity index (PASI). High level of FOSL1 gene expression was proposed to be a marker of pathological process activity in psoriasis.

[Pretibial myxedema: pathogenetic features and clinical aspects].

Pretibial myxedema (PTM) or thyroid dermopathy is a rare extrathyroidal manifestation of Graves' disease. The condition is accompanied by mucinous skin changes, mainly in the anterior tibial surface. Severe forms may lead to lymphatic congestion and disability. Prolonged and intense autoimmune aggression is supposed to be necessary for PTM manifestation. However, data on the role of TSHR antibodies in the development of thyroid dermopathy are very ambiguous; evidence of IGF-1 receptor involvement in the pathogenesis was reported recently. Typically, PTM is localized on the anterior and lateral surfaces of both tibias and can be represented by diffuse, tumorous, plaque-like, or elephantiasic forms. Currently, early diagnostics involves regular preventive examination of the pretibial area. A diagnostic biopsy is indicated only in complex cases. Maintaining euthyroidism, smoking cessation, preventing injuries, and avoiding tight shoes that disturb lymphatic drainage are measures reducing the risk of PTM in GD patients. Currently, there are no accepted clinical guidelines for the diagnosis and treatment of thyroid dermopathy. This review provides the recent scientific data on etiopathogenesis and management of patients with PTM.

[Clinical manifestations and the problems of classification of HIV infection]. / KLinicheskie proiavleniia i voprosy klassifikatsii VICh-infektsii.

The clinical manifestations and some immunological parameters (CD4 lymphocytes, CD4/CD8 ratio, IgM, IgA, IgG levels, skin test) were examined in 226 adult patients (148 males and 78 females) infected with HIV. These included 58 (26%) asymptomatic patients with seropositive test, 109 (48%) with the only clinical manifestation generalized lymphadenopathy; 54 (24%) with AIDS-related infections, 5 (2%) with AIDS. A subsequent follow-up of 3 months to 3 years demonstrated that AIDS developed in 7 patients, 9 died. The period of infection with HIV and death ranged from 1.5 to 9 years. The signs of cell immunodeficiency were found in 70% of the examinees. Recommendations are given on the classification of HIV infection.

[Detection of the human immunodeficiency virus in a lymphocyte culture from a patient from Central Africa with acquired immunodeficiency syndrome and Kaposi's sarcoma]. / Obnaruzhenie virusa immunodefitstita cheloveka v kul'ture limfotsitov ot bol'nogo iz Tsentral'noi Afriki s sindromom priobretennogo immunodefitsita i sarkomoi Kaposhi.

The results of HIV virus isolation from patient A. T., resident of Central Africa, are discussed, in whom Kaposi sarcoma was diagnosed clinically and histologically, and immunological examinations revealed the acquired immunodeficiency syndrome (AIDS). Cocultivation of the peripheral blood leukocytes of the patient with normal donor leukocytes yielded a leukocyte culture in which HIV virus expression was demonstrated. The HIV antigen was detected in the ultracentrifugate of the cultures by means of indirect enzyme-immunoassay using sera to the virus from the standard kits of Organon (Netherlands) and Abbot (USA). HIV antigen was also detected on the surface of lymphocytes in the culture by indirect immunofluorescence using the same sera. Besides, reverse transcriptase activity was demonstrated in ultracentrifugates of the culture fluid by exogenous reverse transcription test using poly(zA)-oligo(dT) matrix.

[Pathohistological characteristics of dermatophytic onychomycosis]. / Patogistologicheskie osobennosti dermatofitiinogo onikhomikoza.

A pathohistological study was made of the tissues taken from the distal phalanx of the great toe of 30 dead bodies with clinical picture of mycotic infection of nail plates. Onychomycosis was confirmed by the presence of pathogenic fungal myceliem detected microscopically. It is established that the fungus, in total onychomycosis, penetrates from the nail plate into the skin epidermis, connective tissue, bone and into the bone marrow of the phalanx. Cyst formation was found deep in the prickle-cell layer. Inflammation was rather weak reflecting a weak reactive response to the fungus presence.

[Bacillary generalized angiomatosis in HIV infection]. / Batsilliarnyi generalizovannyi angiomatoz pri VICh-infektsii.

A unique case of generalized bacillary angiomatosis (BA) in a patient who died of HIV infection is described. Apart from widely spread skin lesions there were also manifestations in the brain, lungs, heart, esophagus and intestine. Gram-negative bacteria were found in the histological sections. Oval and roundish bacteria with a predominantly perivascular location were found electron microscopically in the archives material.

[The first case of HIV infection in a citizen of the USSR]. / Pervyi sluchai VICh-infektsii u grazhdanina SSSR.

The first AIDS patient was a homosexual male who contacted HIV infection in 1982 in Tanzania. In December 1985 the first sign of Kaposi's sarcoma was noted in this patient. HIV infection was diagnosed in him only in February 1987. He was treated with AZT, reaferon, immunoglobulin and underwent electronic therapy. His state of health was stable till February 1991. Then he got severe bacterial pneumonia, candidosis. Pancytopenia progressed. The dose of AZT (0.8 g daily) was increased and intensive antibiotic therapy and the course of diflucan were prescribed. In spite of this treatment the number of CD4 lymphocytes catastrophically decreased (CD4 = 0.01 x 10(9)/l) and the patient died. Thus, more than 63 months passed from the date of the appearance of the first symptoms of AIDS in the patient to his death.

[Cutaneous pseudolymphomas]. / Psevdolimfomy kozhi.

Histological and immunohistochemical characteristics of principal types of skin pseudolymphomas, their differential diagnosis with true skin lymphomas are outlined.

[An unusual variant of secondary recurrent syphilis in an HIV-infected patient]. / Neobychnyi variant vtorichnogo retsidivnogo sifilisa u infitsirovannogo VICh.

Asymptomatic syphilis eventually manifesting with symptoms of the secondary disease was observed in a male with HIV-infection. Large focuses of alopecia reported in this male are suggested as a clinical marker of HIV-infection. A defective antibody response to T. pallidum in HIV-infection has been confirmed. Levomycetin (0.5 g 4 times a day in 5-20-day courses at two-week intervals) proved highly effective as compared to penicillin, erythromycin and tetracycline administration due to poor tolerance of the above antibiotics.

[Pyoderma vegetans as an early sign of HIV infection]. / Vegetiruiushchaia piodermiia kak rannii priznak VICh-infektsii.

Skin and mucosal lesions are described in a 40-year-old man who suffered from HIV infection in the stage of secondary diseases. The diagnosis was supported by demonstration of antibodies to HIV in the immune blotting test. The clinical manifestations were reduced to steady fever, generalized lymphadenopathy, pyoderma vegetans and chancriform pyoderma, candidiasis of the oral cavity, and seborrheic dermatitis, HIV infection was diagnosed 4 years after the appearance of pyoderma which initially was amenable by external antibacterial agents and then became resistant to them. Eruptions of pyoderma vegetans simulating wide condylomas were located in inguinal folds, on the internal surface of the thighs and scrotum; the chancriform focus was located in the internal preputial layer. The treatment with azothymidine combined with antibacterial and antimycotic agents led to the improvement of the patient's general status and to the reduction of local lesions. However, on recommendations of an unknown witch doctor who started treating him with the aid of reflexotherapy, phytotherapy and bioenergetic actions the patient stopped receiving the treatment prescribed and did not report for control examinations. After 5 months he died of brain edema.

[Phaeohyphomycosis of the skin caused by Scytalidium lignicola (the first case of a clinical observation in the USSR)]. / Feogifomikoz kozhi, vyzvannyi Scytalidium lignicola (pervyi sluchai klinicheskogo nabliudeniia v SSSR).

The authors made a short review of literature on phaeohyphomycosis and described the first case of this disease in the USSR. It was diagnosed on the basis of mycological investigation. This type of investigation was recommended for patients at risk of developing opportunistic infections.

[Acquired immunodeficiency syndrome and generalized lymphadenopathy in persons seropositive for the HIV virus]. / Sindrom priobretennogo immunodefitsita i generalizovannaia limfoadenopatiia u lits, seropozitivnykh k virusu HIV.

Of 20 examined Africans who were seropositive to HIV in the Western Blot technique, the syndrome of acquired immunodeficiency was found in 2, generalized lymphoadenopathy in 17; in one patient infection was asymptomatic. A decrease in the T-helper/T-suppressor ratio was noted in all the examinees, in 88% of the patients the Ig level was elevated. Each case was described.

[HIV infection: the venereological aspects of the problem]. / VICh-infektsiia: venerologicheskie aspekty problemy.

The paper is concerned with the diagnosis, clinical picture and the treatment policy of 7 patients suffering from associated syphilis and HIV infection. Some peculiarities were marked in the course and clinical picture of the syphilitic infection: the reduction of the time of the development of secondary syphilis, odd clinical manifestations, and early damage to the nervous system. Recommendations are given for CSF examination and treatment of all the patients with associated syphilis and HIV infection. Attention is paid to the necessity of examining all the patients with HIV infection for diseases transmitted sexually and vice versa.

[Plasmapheresis in dermatology]. / Plazmaferez v dermatologii.

Overall 105 patients with different dermatoses were placed under observation. The patients received plasmapheresis (PA) treatment. PA was tolerated well by the majority of the patients, with the method efficacy amounting to 96%. PA eliminated disseminated intravascular coagulation which was initially seen in the majority of the patients, led to the normalization of hemostasis and microcirculation. At the same time PA exerted an immunocorrective action which showed up by a decrease of the most parameters of humoral and cellular immunity, the level of CIC, complement activity with a simultaneous rise of the phagocytic index, which may attest to macrophagal system activation.

[Evaluation of plasmapheresis effectiveness in patients with psoriasis]. / Otsenka éffektivnosti plasmafereza u bol'nykh psoriazom.

A pronounced therapeutic effect of plasmapheresis recorded in 21 psoriasis patients correlated with changes in hemostasis and immune status supporting the conception of autoimmune origin of the disease. Using present-day methods of immunological and hemostatic investigation it becomes possible to manage the oriented correction which is an important factor in psoriasis therapy.

[Radiation therapy of Kaposi's sarcoma with accelerated electrons]. / Luchevaia terapiia sarkomy Kaposhi uskorennymi élektronami.

Kaposi's sarcoma and AIDS-associated Kaposi's sarcoma resistant to chemotherapy were irradiated locally in 14 and 1 patient, respectively, and followed up for 1--6 years. The energy (10 MeV) in the total focal dose of 24--40 Gy was emitted as high-speed electrons from a medical accelerator. An immediate response was obtained in all the patients. The recurrence occurred in AIDS-associated sarcoma only. It is recommended that Kaposi's sarcoma should be treated by high-speed electron radiation covering the lesion and adjacent sites of the intact skin. Total focal dose must not exceed 30 Gy, in case of circulatory disturbances in the low limbs the dose is to be reduced to 20 Gy.

[Experience with the combined treatment of recurrent herpes using larifan and a herpetic vaccine]. / Opyt kombinirovannogo lecheniia retsidiviruiushchego gerpesa larifanom i gerpeticheskoi vaktsinoi.

Interferon inductor larifan used parenterally was combined with herpetic vaccine to treat severe recurrent herpes in 32 patients. This combination therapy started at initiation of herpetic infection activation and resulted in amelioration of the clinical symptoms of the recurrence, a more favourable course of the disease due to stimulation of the interferon system and natural killer activity. In combination the above modalities proved more effective than in monotherapy.