Aetiology, pathogenesis and management of neuropathic itch: A narrative review with recent updates.

Neuropathic itch is a relatively common yet under-reported cause of systemic pruritus. It is a debilitating condition often associated with pain, which impairs the patient's quality of life. Although much literature exists about renal and hepatic pruritus, there is a dearth of information and awareness about neuropathic itch. The pathogenesis of neuropathic itch is complex and can result from an insult at any point along the itch pathway, ranging from the peripheral receptors and nerves until the brain. There are several causes of neuropathic itch, many of which do not produce any skin lesions and are thus, often missed. A detailed history and clinical examination are necessary for the diagnosis, while laboratory and radiologic investigations may be needed in select cases. Several therapeutic strategies currently exist involving both non-pharmacological and pharmacological measures, the latter including topical, systemic, and invasive options. Further research is ongoing to clarify its pathogenesis and to design newer targeted therapies with minimal adverse effects. This narrative review highlights the current understanding of this condition, focusing on its causes, pathogenesis, diagnosis, and management, along with newer investigational drugs.

Cutaneous problems in elderly diabetics: A population-based comparative cross-sectional survey.

BACKGROUND: There are few population-based studies on prevalence of cutaneous problems in diabetes mellitus. AIMS: To identify skin problems associated with diabetes mellitus among elderly persons in a village in Kerala. METHODS: In this population-based cross-sectional survey, we compared the prevalence of skin problems among 287 elderly diabetics (aged 65 years or more) with 275 randomly selected elderly persons without diabetes mellitus. RESULTS: Numbness, tingling and burning sensation of extremities,"prayer sign", finger pebbling, skin tags, stiff joints and acanthosis nigricans were noted more frequently in diabetics as compared to non-diabetics. Ache in extremities, dermatophytosis, candidiasis, seborrheic keratoses/dermatosis papulosa nigra, xerosis/ichthyosis, idiopathic guttate hypomelanosis, nonspecific itching, and eczema were equally frequent in both groups. Among the diagnostic categories, neurovascular, metabolic and autoimmune findings were associated with diabetes mellitus, whereas bacterial and fungal infections were not. LIMITATIONS: Initial misclassification errors, no laboratory confirmation of dermatological diagnosis during survey, coexistence of findings related to aging and not analyzing the effects of glycemic level, concurrent diseases and medications. CONCLUSIONS: Numbness, tingling and burning sensation of extremities, prayer sign, finger pebbling, skin tags, stiff joints and acanthosis nigricans were associated with diabetes mellitus among elderly persons in a village in Kerala.

Lichen simplex chronicus of anogenital region: a clinico-etiological study.

BACKGROUND: Lichen simplex chronicus (LSC) of the anogenital region, is a benign, extremely uncomfortable disease. AIMS: As very little is known about the cause of anogenital LSC (AGLSC), we undertook this study to determine various clinico-etiological factors involved in it and to assess the frequency of AGLSC. METHODS: This was a descriptive study, including 105 patients with AGLSC, who attended the Dermatology clinic in our institute from September 2007 to June 2009. Detailed history, physical examination, and relevant investigations were done. The collected data were tabulated and analyzed. RESULTS: The frequency of AGLSC among patients presenting with anogenital pruritus was 2.54%. Primary AGLSC was more common than secondary AGLSC (69.5% vs. 30.5%). AGLSC manifested more commonly in males than in females (56.2% vs. 43.8%). The mean duration of the disease was 30.6 months. The common triggering factors for itching were sweating (41.9%), rubbing of thighs while walking for long distances (9.5%), and mental stress (5.7%). Pruritus of AGLSC was related to the intake of various food items in 37.1% of patients. In males, scrotum was the predominant site involved (89.8%), whereas in females, labia majora was the predominant site involved (78.2%). Nearly one-third of cases (30.5%) of AGLSC had some other dermatoses in the anogenital region. CONCLUSIONS: Though psychological factors are thought to play an important role in disease causation and perpetuation among AGLSC patients, their significance could not be ascertained by us.

Hanseníase virchowiana pruriginosa em idoso: a importância do exame dermatoneurológico e suspeição diagnóstica / Itching lepromatous leprosy in an elderly man: the importance of dermatologic and neurological examination and the diagnosis' suspicion

INTRODUÇÃO: A hanseníase virchowiana (MHV) polar é forma clínica de diagnóstico mais difícil nas fases iniciais, já que o comprometimento neurológico é tardio e não há presença de placas. Relata-se um caso com sintoma atípico em idoso: o prurido. RELATO DE CASO: Homem, 81 anos, branco, procedente de Itirapina - SP, encaminhado ao serviço de referência com hipótese diagnóstica de "alergia", relatava que há dois anos notou a presença de pápulas, placas e nódulos em corpo, associado a prurido intenso generalizado, mais pronunciado nas lesões. Ao exame físico, havia livedo reticular difuso que poupava a área do polígono de Michaelis, acrocianose, madarose, pápulas, placas e nódulos eritêmato-violáceos em abdome, região perimamilar, membros inferiores e região glútea. Ao exame neurológico, notou-se espessamento de nervos ulnares, radiais, tibiais e fibular esquerdo. Não apresentava garra ulnar e o teste de sensibilidade com monofilamentos não demonstrou perda da sensibilidade tátil nas mãos ou protetora nos pés. A baciloscopia de pontos índices variou entre de 3 a 5+, com índice morfológico de 3%. O teste de Mitsuda foi negativo, e a biópsia de uma das lesões evidenciou MHV. DISCUSSÃO: A MHV polar constitui-se na forma mais bacilífera e de maior dificuldade diagnóstica, quando não se faz a suspeição. A virtual ausência de imunidade permite que o bacilo prolifere na célula nervosa por quase uma década, em média, sem que haja sintomas característicos (nódulos, "manchas", neurite ou deformidades). Embora seja sintoma atípico, a xerose cutâneo-mucosa pode causar prurido, e o comprometimento neurovascular leva ao livedo reticular e acrocianose, sinais que devem alertar o clínico para a suspeita diagnóstica,...

INTRODUCTION: Polar lepromatous leprosy (LLp) is a clinical form which the diagnosis is very difficult in early stages, since nerve damage is not seen, and there are not visible plaques. We report a case with atypical symptoms in an elderly man: the pruritus.CASE REPORT: Male, 81 years, caucasian, coming from Itirapina - SP, referred to the dermatological service with the diagnosis of "allergy", reported that two years ago noted the presence of papules, plaques and nodules on the body, associated with intense pruritus, more pronounced on the lesions. Physical examination revealed diffuse livedo (which was not seen only on the area of the Michaelis polygon), as weel as acrocyanosis, madarosis, papules, plaques, and erythematous-violaceous nodules on the abdomen, perimamilar region, legs and buttocks. On neurological examination it was noted nerves thickening: both ulnars, radials, tibials, and left fibular. He had no ulnar claw and sensitivity test monofilaments showed no loss of tactile sensitivity on the hands, or even loss of protective sensitivity on the feet. Bacilloscopy of smear from index points ranged from 3-5+, with morphological index = 3%. The Mitsuda test was negative, and biopsy of the lesions showed LL.DISCUSSION: The LLp is the most infectious form of leprosy, and it is the most difficult to make diagnosis, mainly when do not suspected. The virtual lack of immunity allows the bacilli proliferate in the nerve cell for nearly a decade, on average, without typical symptoms (lumps, "stains", neuritis or deformities). Although atypical symptom, mucocutaneous xerosis can cause itching, and neurovascular involvement leads to livedo reticularis and acrocyanosis, signs that should alert the clinician to the diagnosis,...

The relationship between symptoms and patient characteristics among psoriasis patients.

BACKGROUND: Pruritus is a common symptom of many dermatological and systemic diseases. It is a common complaint among patients with psoriasis of the chronic plaque type. Patients with pruritus suffer from more severe psoriasis although some authors did not find a significant relationship between pruritus intensity and psoriasis severity. AIMS: In this study, we aimed to investigate the relationship between clinical features and symptoms among psoriasis patients. And also we aimed to evaluate whether the severity of disease, depression and quality of life scores could effect these symptoms or not. METHODS: Eighty seven patients with psoriasis were enrolled in this study. Epidemiological data of patients were noted. Clinical symptoms, such as pruritus, pain, burning, exudation, bleeding, weakness, etc. were interrogated. The answers to these questions were classified as 'never', 'rare', 'sometimes', 'often' and 'all the time'. Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI), Hamilton Anxiety-Depression Scale (HAD) were calculated for each patient. PASI and DLQI scores were classified as > or = and < 10. RESULTS: We found that the most frequent symptom was pruritus (96.6%). Other frequent symptoms were burning (56.3%), exudation (56.3%) and bleeding (49.4%). Hurting, sensitiveness and bothering were more frequent in women. Percentages of hurting, pain, exudation and weakness symptoms had been increasing with age. Frequency of weakness was significantly high in PASI > or = 10 patients. CONCLUSION: Pruritus is a very common symptom in psoriasis. Burning, exudation and bleeding are also common symptoms seen in psoriasis. New scoring systems including symptoms of psoriasis patients may be developed for evaluating the severity of the disease.