Cure thermale et prise en charge du prurit dans le psoriasis: Thermal cure and management of pruritus in psoriasis.

The classical description of psoriasis does not include any of the subjective symptoms that accompany skin manifestations (pruritus, burning, tingling, pain), which is surprising especially for pruritus, a symptom present in the majority of patients with this disease, in a variable proportion between 60% and more than 90%. For the last two decades, the scientific interest for this symptom has increased. Many studies are evaluating the potential positive effect of various classes of drugs. No therapy is totally free of side effects. Psoriasis is an indication of the thermal treatment. The thermal water from Avène Hydrotherapy Center is known for its anti-inflammatory and immunomodulatory properties, as shown by many scientific studies. In this context, from the year 2016, in the Thermal Center, we studied the prevalence and characteristics of pruritus in patients with psoriasis, who came for a thermal treatment, but also the effect of hydrotherapy. In 2016, a study based on a dedicated questionnaire, administered at the entrance of the thermal station, revealed the presence of pruritus for 92% of patients who responded. In the period 2017-2018, the evaluation of pruritus associated with psoriasis on a numerical scale, in parallel with the evaluation of the severity of the disease by the thermal physician, showed the improvement of the psoriatic pruritus by 42% after the hydrotherapy cure. Recent results suggest that treatment in Avène Hydrotherapy Center might be considered for managing psoriasis accompanied by subjective symptoms, especially pruritus. © 2020 Elsevier Masson SAS. All rights reserved.

Fardeau de la dermatite atopique chez l'enfant et l'adolescent: Burden of atopic dermatitis in children and adolescents.

Atopic dermatitis has a very significant impact on children and adolescents. Having visible lesions, but above all almost permanent pruritus or sometimes skin pain inevitably has consequences on all aspects of daily life, including sleep, education and relationships with others, family and emotional life. It also has an impact on the whole family. Stigmatization may occur. Treatment and especially local care can be very demanding. Adherence to treatment is therefore often difficult. Quality of life can be severely impaired and atopic dermatitis can be a heavy burden. The psychological consequences can be major. Family problems related to the disease often arise. The best way out of it is probably to have very effective and well-tolerated treatments. © 2020 Elsevier Masson SAS. All rights reserved.

[Sensitive skin, reactive skin]. / Peaux sensibles, peaux réactives.

Sensitive skin (or reactive skin) is defined as a syndrome involving the onset of unpleasant sensations (stinging sensation, burning sensation, pain, pruritus, tingling) in response to stimuli that do not normally produce such sensations. These unpleasant sensations cannot be accounted for by lesions attributable to any specific skin disease. The skin may appear normal or erythema may be present. Sensitive skin can occur on any part of the skin but particularly affects the face. Sensitive skin is very common and affects around half of the population to different degrees. The diagnosis is based primarily on clinical examination. The physiopathology of the condition is becoming better known: it appears to be caused by hyperreactivity of the cutaneous nervous system and is associated in particular with activation of sensorial proteins present on keratinocytes and nerve endings. However, there is still no consensus regarding treatment.

[Scalp lipedema]. / Lipœdème du cuir chevelu.

BACKGROUND: Lipedematous scalp, with or without alopecia, is a poorly known and rarely reported entity. It was first described in 1935 by Cornbleet. It involves increased thickness of the subcutaneous tissue of the scalp, responsible for an overall thickening of the scalp, which may be associated with alopecia, pruritus or painful sensations. Currently, fewer than 50 cases of lipedematous scalp, both with and without alopecia, have been reported in the literature. PATIENTS AND METHODS: Herein we present the case of a 36-year-old woman from the Ivory Coast, who presented scalp pain associated with infiltration of the entire subcutaneous tissue of the scalp seen clinically and confirmed at MRI. Histology added nothing. DISCUSSION: We diagnosed a new case of lipedematous scalp in an African woman. No cause was found. Therapeutic abstention appears the best management strategy.

[What's new in dermatological treatment?] / Quoi de neuf en thérapeutique dermatologique?

The therapeutic revolution in the management of inflammatory dermatoses is under way. The therapeutic arsenal is expanding in the field of psoriasis, including biologics (TNF blockers, anti-IL12/IL23, anti-IL17, and anti-IL23 antibodies), new small molecules (tyrosine kinase inhibitor), and a new biologic for generalized pustular psoriasis (anti-IL36 receptor). New biologics will be soon available in the field of atopic dermatitis in addition to anti-IL4/IL13 antibodies. New targeted treatments of pruritus are also coming (biologics and small molecules). A first randomized placebo-controlled trial has confirmed the interest of JAK inhibitors in alopecia areata. These molecules seem to be also promising in dermatomyositis. Another therapeutic revolution will be technological with the development of new therapeutic agents: small interfering RNA. Recent clinical trials confirmed their efficacy in hereditary amyloidosis.

Activités immunomodulatrice, anti-inflammatoire, antiprurigineuse et tolérogénique induites par I-modulia®, un extrait issu de culture d'Aquaphilus dolomiae, dans les modèles pharmacologiques de dermatite atopique: Immunomodulatory, anti-inflammatory, anti-pruritus and tolerogenic activities induced by I-modulia®, an Aquaphilus dolomiae culture extract, in atopic dermatitis pharmacology models.

Atopic dermatitis (AD) is an inflammatory and pruritic dermatosis of multifactorial origin. Topical steroids are the first line treatment for severe AD however alternatives treatment are increasingly needed. A biological concentrate was elaborated from culture of an Avène aquatic microflora isolate namely Aquaphilus dolomiae. Numerous extracts were evaluated in relevant AD in vitro models with human keratinocytes. Among these extracts, a particular one I-modulia® was found to be remarkable in terms of pharmacological activities: innate immunity modulating by agonizing Toll like receptor (TLR)2, TLR4 and TLR5, induction of anti-microbial peptides, inhibition of cytokines characteristics of T helper (Th)1, Th2 and Th17 responses, inhibition of Protease-activated-receptor (PAR) 2 and Thymic-stromal-lymphopoeitin (TSLP) both being known to be upregulated in pruritus. Additionally, when human dendritic cells (DC) were stimulated in vitro by Staphylococcus aureus secretomes from AD children lesions, I-modulia® was capable to induce IL-10 secretion to activate regular T lymphocytes and rendered DC tolerogenic. I-modulia®, extract of biotech origin incorporated in emollient, displays anti-inflammatory, anti-pruritus activities, restores homeostasis immune and ameliorates AD in young infant.

Syringoma: A clinicopathological study of 244 cases.

BACKGROUND: Syringomas are benign tumours of the sweat glands, the most familiar clinical presentation of which is the presence of multiple lesions on the eyelids. The aim of our study was to determine the clinical and histological characteristics of a large series of patients and to examine anatomoclinical correlations. PATIENTS AND METHODS: This was a retrospective study conducted in all of the cases of syringoma analysed at the cutaneous histopathology laboratory in Strasbourg between 1970 and 2008. The clinical elements, patient history and diagnostic data were collated. All slides were re-read in order to determine the microscopic characteristics of the lesions. RESULTS: Two hundred and forty-four lesions were included. The sex ratio was 0.27 and the mean age was 42 years (8 to 85 years). Multiple syringomas were noted in 76% of cases, of which 29.2% were eruptive, and one case occurred in a setting of metastatic melanoma. The sites of predilection were the face (56.7%, of which 36.3% on the eyelids), the chest (18.1%) and the neck (17.5%) for the multiple forms. The lesions were in the form of papules (67%), either brown (34.2%) or flesh-coloured (19.8%). Pruritus was reported in 14 cases, including 4 at vulvar sites (out of a total of 8). A diagnosis of syringoma was made by the clinician in only 30.2% of the multiple forms, with mastocytosis being proposed in 7.1% of cases. The clear-cell forms (18 cases) presented no special clinical features. CONCLUSION: Syringomas are frequently multiple and are seen mainly in women. They are found predominantly on the face and trunk, and lesions are generally brown and pruritic, a little-known feature that accounts for the degree of diagnostic confusion with mastocytosis. The vulvar forms, which are often pruritic, are poorly known. The eruptive forms may include a hormonal component.

[Mucinous nevus of late onset]. / Nævus mucineux de révélation tardive.

INTRODUCTION: Mucinous nevus is a rare disease characterized by mucin deposits in the dermis, with only 23 cases reported to date. It belongs to the connective tissue nevus family and is characterized by dermal mucin deposits. Two histological subtypes have been described: pure mucinous dermal nevus (connective tissue nevus of the proteoglycan [CTNP]) and combined mucinous nevus (combined CTNP) associating epidermal nevus with dermal mucin deposits. Lesions generally appear in childhood or early adulthood. We report herein the case of a 59-year-old man with a symptomatic lesion. OBSERVATION: A 59-year-old man consulted for unilateral lesions occurring linearly along the Blaschko line on the right lower limb, composed of brown verrucous papules, which started at the age of 50. The patient complained of itching caused by friction from clothes. Histological examination of a papule highlighted an acanthotic epidermis, with elongation of rete ridges and mucin deposits in the dermis showing uptake of alcian blue stain. The clinicopathological analysis enabled diagnosis of combined CTNP. We treated this nevus by surgical dermabrasion and observed a slight and cosmetically acceptable scar. DISCUSSION: To our knowledge, our patient is the oldest reported to date and the only one to have complained of symptoms. Our review of the literature highlights the importance of skin biopsy to guide aesthetic or symptomatic treatment. CO2 laser and dermabrasion are recommended for combined CTNP as they treat the epidermal component with low risk of secondary scarring. However, these techniques should be avoided in pure dermal CTNP, where surgical excision alone is acceptable in order to achieve optimal cosmetic results.

[Two cases of severe pruritus revealing Hodgkin's disease in children]. / Prurit sévère révélant un lymphome de Hodgkin chez l'enfant : deux observations.

BACKGROUND: Pruritus in children is a frequent reason for consultation, most often related to a common dermatosis. Where dermatological investigation fails to reveal a dermatological cause, a general cause may be suspected. We report three cases of pruritus revealing Hodgkin's lymphoma in children. PATIENTS AND METHODS: Case 1: a 14-year-old girl presented pruritus with diffuse scratching lesions present for 6 months, associated with right cervical lymph nodes occurring after the onset of pruritus. Tomodensitometry revealed involvement of the supra- and sub-diaphragmatic lymph nodes as well as pulmonary involvement. Lymph node biopsy confirmed nodular sclerosing Hodgkin's lymphoma. Case 2: a 14-year-old boy was hospitalized for suspected psychogenic pruritus. He presented intense itching, predominantly in the lower extremities and at night, occurring over the previous 6 months as well as night sweats. Examination showed that the patient had lost 5kg in 1 month and had a low-grade fever of 38°C; he presented linear striated scratching lesions on both legs. Cervical and inguinal lymphadenopathy was seen. The chest scan also revealed supra-diaphragmatic adenomegalies. The biopsy confirmed Hodgkin's lymphoma. DISCUSSION: Systemic causes of pruritus in children are poorly described in the literature. In these two cases, pruritus allowed a diagnosis of Hodgkin's lymphoma to be made, emphasizing the important role of dermatologists in the early diagnosis of haematological malignancy.

[Definition and psychopathology of chronic hand dermatitis]. / Définition et psychopathologie de la dermite chronique des mains.

Psychopathology in patients with DCM is as complex as its clinical forms where the factors are numerous and often intricate. It combines psychophysiological, psychopathological factors, behavioral disorders which can be the cause or the consequence of DCM but also the negative impact on quality of life and the simplest daily activities. DCM affects the quality of life of every patient, regardless of the severity. Women are more affected by the DCM that man older age, male sex, atopy and the existence of a contact sensitization are independent risk factors of severity. Depression may affect up to 10 % of patients, should involve greater attention from dermatologists and general practitioners. Health authorities and all health actors should be aware of interactions between secondary cognitive troubles or inherent to DCM and efforts required in terms of preventive measures. Thus, the presence of psychiatric comorbidity is more common in patients with chronic dermatoses. Today it is considered that the emotional environment, built by the mother - child relationship must be optimal, otherwise the mental stability of body image may be compromised. Diminished self-esteem, affects less well managed and somatic expression of emotional content. Recently, a surprising study showed that most patients with refractory occupational dermatitis were not able to recognize the warning sign of flare or the role of psychological factors in the formation and maintenance of the dermatose. In fact, they rejected their personal responsibility in the occurrence of the new flare. To address this public health problem, health authorities, trainers and caregivers should be aware of the cognitive impact of DCM in these patients and interactions with current means of prevention. The role of obsessive-compulsive washing as part of an anxiety disorder or personality disorder is most likely a contributing or maintaining factor systematically underestimated in the pathogenesis of DCM and in the therapeutic management.

[From ocular itching to eye rubbing: a review of the literature]. / Du prurit aux frottements oculaires : une revue de la littérature.

Ocular itching and eye rubbing are frequent complaints in an ophthalmology practice. Numerous studies address the consequences of eye rubbing, such as keratoconus. However, there are few studies concerning the pathophysiology of itching, its transmission pathways, or its interactions with eye rubbing. Through this literature review, we will address the various clinical, physiological and therapeutic aspects of this pair of symptoms with a variety of ocular consequences. We will then describe the state of the art in itching and scratching in dermatology, in order to draw a parallel between these two vicious cycles. A better understanding of the pathophysiology of ocular itching and eye rubbing, as well as new studies based on dermatological data, might allow more appropriate clinical management of our patients and their symptoms.

[Intrahepatic cholestasis of pregnancy: French College of Obstetricians and Gynecologists guidelines for clinical practice]. / La cholestase gravidique : recommandations pour la pratique clinique du Collège national des gynécologues obstétriciens français.

OBJECTIVE: To identify strategies for reducing neonatal and maternal morbidity associated with intrahepatic cholestasis pregnancy (ICP). MATERIAL AND METHODS: The quality of evidence of the literature was assessed following the GRADE methodology with questions formulated in the PICO format (Patients, Intervention, Comparison, Outcome) and outcomes defined a priori and classified according to their importance. An extensive bibliographic search was performed on PubMed, Cochrane, EMBASE and Google Scholar databases. The quality of the evidence was assessed (high, moderate, low, very low) and a (i) strong or (ii) weak recommendations or (iii) no recommendation were formulated. The recommendations were reviewed in two rounds with external reviewers (Delphi survey) to select the consensus recommendations. RESULTS: Of the 14 questions (from 12 PICO questions and one definition question outside the PICO format), there was agreement between the working group and the external reviewers on 14 (100%). The level of evidence of the literature was insufficient to provide a recommendation on two questions. ICP is defined by the occurrence of suggestive pruritus (palmoplantar, nocturnal) associated with a total bile acid level>10µmol/L or an alanine transaminase level above 2N after ruling out differential diagnoses. In the absence of suggestive symptoms of a differential diagnosis, it is recommended not to carry out additional biological or ultrasound tests. In women with CIP, ursodeoxycholic acid is recommended to reduce the intensity of maternal pruritus (Strong recommendation. Quality of the evidence moderate) and to decrease the level of total bile acids and alanine transaminases. (Strong recommendation. Quality of the evidence moderate). S-adenosyl-methionine, dexamethasone, guar gum or activated charcoal should not be used to reduce the intensity of maternal pruritus (Strong recommendation. Quality of evidence low), and there is insufficient data to recommend the use of antihistamines (No recommendation. Quality of evidence low). Rifampicin (Weak recommendation. Very low quality of evidence) or plasma exchange (Strong recommendation. Very low quality of evidence) should not be used to reduce maternal pruritus and perinatal morbidity. Serum monitoring of bile acids is recommended to reduce perinatal morbidity and mortality (stillbirth, prematurity) (Low recommendation. Quality of the evidence low). The level of evidence is insufficient to determine whether fetal heart rate or fetal ultrasound monitoring are useful to reduce perinatal morbidity (No recommendation). Birth is recommended when bile acid level is above 99µmol/L from 36 weeks gestation to reduce perinatal morbidity, in particular stillbirth. When bile acid level is above 99µmol/L is below 100µmol/L, women should be informed that induction of labor could be considered 37 and 39 weeks gestation to reduce perinatal morbidity. (Strong recommendation. Quality of evidence low). In postpartum, total bile acids and alanine transaminases level should be checked and normalized before prescribing estrogen-progestin contraception, ideally with a low estrogen dose (risk of recurrence of pruritus and cytolysis) (Low recommendation. Quality of evidence very low). CONCLUSION: Although the quality of evidence regarding ICP gestational cholestasis remains low, there is a strong consensus in France, as shown by our Delphi study, on how to manage women with ICP. The reference first-line treatment is ursodeoxycholic acid.

A Lymphocytic Variant of Hypereosinophilic Syndrome Presenting With Isolated Cutaneous Manifestations.

Hypereosinophilic syndrome (HES) is a rare disease defined by a persistent increase in eosinophilic cells associated with organ damage without any underlying cause. Three variants have been identified: myeloproliferative, lymphocytic, and idiopathic syndrome. The symptomatology is variable because it depends on the involvement of different organs, including the circulatory system, skin, lungs, digestive tract, peripheral and central nervous system, and eyes. Although cutaneous involvement may frequently reveal an underlying HES. We report a case of a 52-year-old man with a 12-year history of skin lesions with intense pruritus. On examination, the patient presented with erythroderma, extensive infiltrated plaques, excoriated itchy papules, palmoplantar pustules, ear infiltration, periorbital edema, and cutaneous xerosis. Histopathology showed lichenoid dermatitis without epidermotropism. Inflammatory infiltrates in the dermis were principally composed of eosinophilic cells and lymphocytes. Serum immunoglobulin E and peripheral blood immunophenotyping showed atypical T lymphocyte proliferation CD4+CD3-, and clonal TCR gene rearrangement was in favor of lymphocytic HES. The patient was treated with prednisone (1 mg/kg/day) and pegylated interferon alpha with improvement. This case shows that HES should be suspected in patients with dermatological lesions and hypereosinophilia, without obvious cause. Elimination of secondary causes of eosinophilia, evaluation of deep organ involvement, and cytogenetic studies to assess prognosis are paramount. Pegylated interferon alpha 2a may be an effective treatment option for steroid-resistant or refractory patients with lymphocytic HES.

Nouvelles thérapies dans la prise en charge du patient avec maladie rénale chronique souffrant de prurit : une revue de la littérature New therapies in the management of chronic kidney disease associated pruritus.

Chronic Kidney Disease associated Pruritus (CKD-aP) is a well-established and frequent complication observed in patient with CKD, especially in dialysis patients. However, the management of CKD-aP remains a challenge as the pathophysiology and research studies are too small. Finally, there are a few proposed treatment options with significant clinical benefits. This general review will summarize all the available treatments for the CKD-aP and will highlight the clinical efficacy and limits of the current drugs. Notably, we will focus on the implication of the opioid receptor in the pathophysiology of the CKD-aP and the recently Kappa opioid receptor agonist. © 2022 Published by Elsevier Masson SAS on behalf of Société francophone de néphrologie, dialyse et transplantation.

[Epidemiological and etiological profile of vulvovaginal candidiasis in women in consultation in the gynecology-obstetrics department, CHU Gabriel Toure, Bamako - Mali]. / Profil epidemiologique et etiologique des candidoses vulvovaginales chez les femmes en consultation dans le service de gynecologie-obstetrique, CHU Gabriel Toure, Bamako - Mali.

Vulvovaginal candidiasis (VVC) is a fungal infection caused by yeasts of the genus Candida that leads to vulvar pruritus and vaginal discharge. METHOD: In order to evaluate the epidemiological and etiological Profile of vvc, we carried out a cross-sectional study among women in consultation in the gynecological department of the CHU-Gabriel Toure in Bamako. Two swabs were taken from each woman for mycological diagnosis. The presence of yeasts and pseudo-filaments was observed on direct examination. The culture was performed on Sabouraud-Chloramphenicol medium and at 37°C for 24 to 48 hours. Identification was based on the macroscopic and microscopic characteristics of the colonies, the germinative tube test and the Vitek•2 instrument. of the colonies, the germinative tube test and the VITEK® 2 instrument. RESULT: A total of 240 women were included with a mean age of 31.5 ± 3.15 [15-64 years]. Married women represented 91.67% (n=220) and 51.25% were housewises. Pruritus 49.17% (118/240) and dyspareunia 42.08% (101/240) were the most frequent clinical signs. Previous use of antifungals was demonstrated in 85.83% of women. Candida species were confirmed in 60.42% (145/240) of cases. C. albicans was the most frequent species followed by C. famata, C. dubliniensis, C. krusei.. This study allowed us to identify the most frequent cases of C. albicans, followed by C. famata, C. dubliniensis, and C. krusei..Further studies are still needed to characterize the antifungal susceptibility profile of the Candida species involved.

La candidose vulvo-vaginale (CVV) est une infection fongique causée par des levures du genre Candida provoquant du prurit vulvaire et des pertes vaginales. MÉTHODE: Afin d'évaluer le profil épidémiologique et étiologique des CVV, nous avons réalisé une étude transversale chez les femmes en consultation dans le service de gynécologie du CHU-Gabriel TOURE de Bamako. Deux écouvillons vaginaux ont été prélevés sur chaque femme pour le diagnostic mycologique. La présence de levures et de pseudo-filaments a été observée à l'examen direct. La culture a été réalisée sur milieu Sabouraud-Chloramphénicol et à 37°C pendant 24 à 48 heures. L'identification a été basée sur les caractéristiques macroscopiques et microscopiques des colonies, le test du tube germinatif et l'instrument VITEK® 2. RÉSULTAT: Un total de 240 femmes ont été incluses avec un âge moyen de 31,5 ans ± 3,15 [15-64 ans]. Les femmes mariées représentaient 91,67% et 51,25% étaient des menagères. Le prurit 49,17 % et la dyspareunie 42,08 % (101/240) étaient les signes cliniques les plus fréquents. La prise antérieure d'antifongiques a été retrouvée chez 85,83% des femmes. La présence des espèces de Candida a été confirmée dans 60,42 % des cas. L'espèce C. albicansétait lus fréquente suivies de C. famata, C. dubliniensis, C. krusei.. CONCLUSION: Les résultats de cette étude permettent d'élargir les connaissances sur l'épidémiologie du CVV au Mali. D'autres études restent nécessaires pour caractériser le profil de sensibilité aux antifongiques des espèces de Candida impliquées.

Causes of Pruritus in Patients Treated With Immune Checkpoint Inhibitors for Melanomas or Skin Carcinomas.

Background: Pruritus is a frequent adverse event during the use of immune checkpoint inhibitors (ICIs), with a frequency estimated to be between 11 and 47%. The underlying causes remain poorly understood. Objectives: The main goal was to search for putative causes of pruritus occurring in patients treated with ICIs for melanomas and cutaneous carcinomas. Other objectives were to assess the association between the occurrence of pruritus and survival and between the occurrence of pruritus and other adverse events. Methods: A monocentric retrospective descriptive study was performed using data for patients treated with ICIs (nivolumab, pembrolizumab, ipilimumab, and cemiplimab) between August 2010 and November 2019. Results: A total of 181 patients were included (mean age: 69 years). Pruritus was reported by 25 patients (13.8%). We were able to determine three subgroups of pruritus causes under ICI use: pruritus directly related to immunotherapy, pruritus indirectly related through other pruritus-inducing side effects and pruritus unrelated to ICIs. In 6/25 patients, no more specific cause of pruritus was found at the onset of pruritus or in their backgrounds, other than ICI use. Limitations: The study has some limitations due to unicentric and retrospective design. Conclusion: Pruritus was found in 25/181 patients in this series; only in 6/25 patients no potential cause other than ICI could be found, and pruritus was not associated with differences in survival.

[Pruritus associated chronic kidney disease]. / Prurit associé à la maladie rénale chronique.

Pruritus associated with chronic kidney disease is a frequent and disabling symptom in patients with severe chronic kidney disease treated by dialysis. It is associated with a poor quality of life, an increased risk of comorbidities and even mortality. Nevertheless, its prevalence is underestimated by nephrologists. The pathophysiology of pruritus associated with chronic kidney disease is not well understood, but several mechanisms seem to contribute to its occurrence: accumulation and skin deposition of uremic toxins, peripheral neuropathy causing an activation of the pruritogenic cowhage pathway, chronic microinflammation, opioid imbalance, and kidney disease-related skin xerosis. Optimization of the treatment of chronic kidney disease treatment, of dialysis parameters, and general skin care measures should always be performed prior to the introduction of systemic therapy targeting one or more of these mechanisms. The available therapeutic trials remain mostly at high risk of bias, with small patient numbers. Gabapentinoids are the molecules recommended as first-line therapy. Peripheral opioid agonists could find a place of choice in the treatment of pruritus associated with chronic kidney disease and will soon be available in France. The low level of evidence for the other molecules does not currently allow us to specify a second-line treatment for this condition.

Presumptive spondylogenic pruritus: a case study.

OBJECTIVE: To describe a case of a patient with chronic pruritus of the upper back and arms who underwent complete resolution of his complaint following a short course of chiropractic care. CASE PRESENTATION: A 36-year-old male suffering with chronic, severe pruritus affecting the upper back and both arms, presented for chiropractic treatment after pharmacological treatment and dietary restrictions failed to resolve his complaint. Physical examination revealed restrictions of thoracic and cervical intervertebral motion. However, radiological examination did not identify any substantial pathology of the spine. Following a short course of chiropractic treatment, which included spinal manipulation and home exercises, his complaint of pruritus resolved completely. SUMMARY: In this case, a severe and chronic complaint of pruritus which was refractory to other forms of care resolved quickly after the institution of chiropractic care. It is therefore hypothesized that the patient's pruritus was etiologically linked to biomechanical problems of the spine.

OBJECTIF: Décrire le cas d'un patient présentant un prurit chronique à la partie supérieure du haut du dos et aux bras qui est complètement disparu après une courte période de traitements chiropratiques. EXPOSÉ DU CAS: Un homme de 36 ans souffrant d'un prurit chronique grave à la partie supérieure du dos et aux deux bras s'est présenté à une clinique chiropratique après avoir suivi un traitement pharmacologique et un régime alimentaire qui se sont avérés infructueux. L'examen physique a révélé une limitation de la mobilité articulaire de la colonne dorsale et de la colonne cervicale. L'examen radiologique n'a révélé aucune pathologie grave de la colonne vertébrale. Après une brève période de séances chiropratiques par manipulations vertébrales et un programme d'exercices à domicile, le prurit est complètement disparu. RÉSUMÉ: Dans ce cas, un prurit grave et chronique, réfractaire à d'autres formes de traitement, est disparu rapidement après le commencement des traitements chiropratiques. On peut donc supposer que le prurit du patient était lié à des troubles biomécaniques de la colonne vertébrale.