EADV Task Force Pruritus White Paper on chronic pruritus and chronic prurigo: Current challenges and future solutions.

Chronic pruritus (CP) is frequent in general medicine and the most common complaint in general dermatology. The prevalence of CP is expected to rise in the future due to the ageing population. The clinical presentation, underlying aetiology and treatment strategy of CP are heterogeneous. Also, individual treatment aims and physical, psychic and economic burdens of patients might vary. Chronic prurigo (CPG) is the most severe disease in the chronic pruritus spectrum, being associated with long-standing scratch-induced skin lesions and a therapy refractory itch-scratch-cycle. It is thus important to raise disease awareness for CP and CPG in the general public and among decision-makers in the health system. Further, there is a need to support a rational clinical framework to optimize both diagnostics and therapeutics. Currently, there is still a shortcoming regarding approved therapies and understanding CP/CPG as severe medical conditions. Therefore, the EADV Task Force Pruritus decided to publish this white paper based on several consensus meetings. The group consented on the following goals: (a) ensure that CP is recognized as a serious condition, (b) increase public awareness and understanding of CP and CPG as chronic and burdensome diseases that can greatly affect a person's quality of life, (c) clarify that in most cases CP and CPG are non-communicable and not caused by a psychiatric disease, (d) improve the support and treatment given to patients with CP to help them manage their disease and (e) publicize existing therapies including current guidelines. We aim to point to necessary improvements in access and quality of care directed to decision-makers in health policy, among payers and administrations as well as in practical care.

European academy of dermatology and venereology European prurigo project: expert consensus on the definition, classification and terminology of chronic prurigo.

BACKGROUND: The term prurigo has been used for many decades in dermatology without clear definition, and currently used terminology of prurigo is inconsistent and confusing. Especially, itch-related prurigo remains unexplored regarding the epidemiology, clinical profile, natural course, underlying causes, available treatments and economic burden, although burdensome and difficult to treat. OBJECTIVE: To address these issues, the multicentre European Prurigo Project (EPP) was designed to increase knowledge on chronic prurigo (CPG). In the first step, European experts of the EADV Task Force Pruritus (TFP) aimed to achieve a consensus on the definition, classification and terminology of CPG. Additionally, procedures of the cross-sectional EPP were discussed and agreed upon. METHODS: Discussions and surveys between members of the TFP served as basis for a consensus conference. Using the Delphi method, consensus was defined as an agreement ≥75% among the present members. RESULTS: Twenty-four members of the TFP participated in the consensus conference. Experts consented that CPG should be used as an umbrella term for the range of clinical manifestations (e.g. papular, nodular, plaque or umbilicated types). CPG is considered a distinct disease defined by the presence of chronic pruritus for ≥6 weeks, history and/or signs of repeated scratching and multiple localized/generalized pruriginous skin lesions (whitish or pink papules, nodules and/or plaques). CPG occurs due to a neuronal sensitization to itch and the development of an itch-scratch cycle. CONCLUSION: This new definition and terminology of CPG should be implemented in dermatology to harmonize communication in the clinical routine, clinical trials and scientific literature. Acute/subacute forms of prurigo are separated entities, which need to be differentiated from CPG and will be discussed in a next step. In the near future, the cross-sectional EPP will provide relevant clinical data on various aspects of CPG leading to new directions in the scientific investigation of CGP.

[Charcot foot masked by erysipelas and peripheral arterial disease]. / Charcot-Fuß coupiert durch Erysipel und periphere arterielle Verschlusskrankheit.

Charcot foot is also known as Charcot disease or Charcot arthropathy. The associated aseptic destruction of the bones and joints of the foot results due to peripheral neuropathy accompanied by impaired pain perception, impaired vasomotricity with increased vasodilation, and an unequal weight distribution. Because it is frequently diagnosed late and, thus, incorrectly treated, serious complications often result. An 86-year-old man in poor health was diagnosed with erysipelas of the right foot. The foot was glossy and edematously swollen, showing necrosis of the distal phalanx of the third toe. The patient experienced pain after a walking distance of approximately 20 m. In addition to erysipelas, confirmed neuropathic arthropathy and radiological indicators for Charcot foot established peripheral artery disease (PAD) as a third diagnosis. Despite multiple systemic antibiotic therapies, there was a progressive disease pattern marked by increasing inflammation parameters with an increasing decline of the patient's overall health. The patient suffered severe deterioration in spite of vascular surgical measures, ultimately leading to his death. In the present case, the indicators and respective confirmation of the three overlapping diagnoses erysipelas, Charcot foot and PAD are elaborated.

[Chronic pruritus : Care in daily practice]. / Chronischer Pruritus : Versorgung in der Praxis.

Chronic pruritus is a highly prevalent, multifactorial symptom requiring extensive diagnostics, treatment and consideration of accompanying symptoms (reduced quality of life, sleep disorders, psychic factors). Patient care is thus complex and requires consideration of individual treatment goals. Patients indicate their wish for a symptom-free life an explanation of the causes and a trustful physician-patient relationship. The targeted use of questionnaires is thus advisable in order to structurally survey the history, pruritus intensity, quality of life and treatment progression. Nevertheless, there are many administrative and economical hurdles in the health care system to overcome in order to provide patients with chronic pruritus the best possible care, also per the recommended guidelines. The development of specialized centers and training courses for medical practitioners is thus urgently needed.

[Medical emergencies in daily dermatological practice]. / Allgemeine Notfälle in der täglichen dermatologischen Praxis.

Many patients and their companions who present daily in dermatological clinics and private practices may have numerous non-dermatological comorbidities, which can cause medical emergencies. Additionally several dermatologic diagnostic or therapeutic procedures which are commonly performed can cause life-threatening complications. Therefore dermatologists can be confronted with acute medical emergencies at any time. Mostly these are internal medicine emergencies. Therefore dermatologists must have the basic emergency medical knowledge; emergency situations should be practiced regularly and this training documented for quality control measures. Every practice must be able to deliver life-saving care until trained emergency medical personnel arrive. The general emergency procedures are presented below and the practical approach is illustrated at different cardinal symptoms such as impaired consciousness, respiratory disorders or cardiocirculatory disorders.