Effects of Uremic Clearance Granules in Uremic Pruritus: A Meta-Analysis.

Uremic pruritus is common among patients with advanced or end-stage renal disease, with an incidence of >40% among patients on dialysis. Uremic clearance granules (UCGs) are effective in managing uremic pruritus and delay the progression of chronic kidney disease. We conducted a systematic review and a meta-analysis to evaluate the efficacy of UCG in patients with uremic pruritus. Several electronic databases were searched systematically from their inceptions until 19 July 2021. Randomized control trials evaluating the efficacy of UCG in patients with uremic pruritus were selected. Eleven trials including 894 participants were published between 2011 and 2021. Patients administered UCGs had a significantly decreased visual analog scale score (mean difference [MD], -2.02; 95% confidence interval [CI], -2.17 to -1.88), serum levels of hsCRP (MD, -2.07 mg/dL; 95% CI, -2.89 to -1.25; p < 0.00001), TNF-α (MD, -15.23 mg/L; 95% CI, -20.00 to -10.47; p < 0.00001]), ß2-MG (MD, -10.18 mg/L; 95% CI, -15.43 to -4.93; p < 0.00001), and IL-6 (MD, -6.13 mg/L; 95% CI, -7.42 to -4.84; p < 0.00001). In addition, UCGs significantly reduced serum levels of creatinine, BUN, PTH, iPTH, phosphorus, and the overall effectiveness rate. UCGs could be an attractive complementary therapy for patients with uremic pruritus.

The Effect of Acupressure on the Severity of Pruritus and Laboratory Parameters in Patients Undergoing Hemodialysis: A Randomized Clinical Trial.

BACKGROUND: Uremic pruritus is a common boring complaint in patients suffering from chronic renal failure. Owing to cost and the side-effects of medications, complementary therapies are more attractive for pruritus treatment. OBJECTIVES: The aim of this study is to determine the effect of acupressure on the severity of pruritus and some laboratory parameters in patients undergoing hemodialysis. MATERIALS AND METHODS: The present clinical trial was conducted on 90 patients undergoing hemodialysis who were allocated in intervention, sham control, and negative control groups (30 in each group). Pressure was applied on SP6, SP10, ST36, and LI11 points in the intervention group and on ineffective points for the sham control group. The negative control group received routine care. The severity of pruritus was measured using the numeric rating scale before, two weeks, and five weeks after intervention. The laboratory parameters were measured before and after the intervention. RESULTS: There was a significant reduction in the severity of pruritus over the course of the study in the intervention and sham control groups (p = 0.001). In addition, significant differences were observed at the end of the intervention in terms of serum phosphorus (p = 0.045) and parathyroid hormone (p = 0.004) levels between groups. CONCLUSION: Acupressure can improve the severity of pruritus dramatically in hemodialysis patients. It can also reduce serum phosphorus and parathyroid hormone levels, which affect pruritus, significantly. Therefore, this simple and inexpensive intervention may be recommended for reducing uremic pruritus among patients undergoing hemodialysis.

Pruritus secondary to primary biliary cholangitis: a review of the pathophysiology and management with phototherapy.

BACKGROUND: Primary biliary cholangitis (PBC) is an autoimmune hepatobiliary disorder characterized by destruction of liver bile ducts leading to intrahepatic cholestasis. It causes intractable pruritus for which ultraviolet (UV)B phototherapy is an experimental treatment when alternative therapies fail. The pathophysiology of cholestatic itch and the mechanism of action of narrowband UVB in this condition remains poorly understood. OBJECTIVES: To summarize the current literature and propose testable hypotheses for the mechanism of action of phototherapy in attenuating itch. METHODS: A focused PubMed search for articles relating to the pathogenesis of itch in cholestatic disease was performed. A total of 3855 articles were screened and 50 were found suitable for literature review. Evidence from this literature review was combined with author expertise in the area. RESULTS: Formulated hypotheses focus on the role of bile salts, autotaxin and specific receptors including G-protein-coupled bile acid receptor, Gpbar1 (also known as TGR5) and the nuclear transcription factor farnesoid X receptor. CONCLUSIONS: Several testable mechanisms through which phototherapy may exert its effects are discussed in this review. The next steps are to carry out an objective assessment of the efficacy of phototherapy in cholestatic pruritus, gain further knowledge on the underlying pathways, and subsequently trial its use against current licensed therapies. Such studies could lead to increased mechanistic understanding, identification of novel therapeutic targets and the potential to refine phototherapy protocols, leading to improved control of itch and quality of life in patients with PBC. What's already known about this topic? Primary biliary cholangitis (PBC) is frequently associated with intractable pruritus for which current treatment options are often unsuccessful. Phototherapy is used as an experimental treatment for PBC-associated pruritus when alternative better-studied treatments fail. What does this study add? This study reviews the current literature on the pathophysiology and management of cholestatic pruritus, an area which remains poorly understood. We propose testable hypotheses of the mechanisms behind the attenuation of cholestatic pruritus with phototherapy.

Effects of acupuncture on chronic idiopathic pruritus: an uncontrolled pilot study evaluating inflammatory changes with treatment.

Background Conduct a pilot study addressing the efficacy of acupuncture in the treatment of chronic idiopathic pruritus to aid in the design of a larger clinical trial. Routine laboratory tests to assess systemic inflammation in addition to subjective patient surveys were performed provide documentation of efficacy of treatment. Methods Patients with chronic pruritus who did not respond to standard treatment were recruited to participate. After exclusion of systemic or known reversible causes, each patient received up to 10 treatments which were performed approximately one week apart. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured before and after a series of acupuncture treatments to evaluate levels of inflammation and pre- and post-treatment surveys were conducted to evaluate levels of perceived itch. Results Only one of the ten patients in this study possessed an elevation of ESR before treatment. This patient's ESR value returned to normal range after treatment and this participant reported subjective relief of her pruritus. Conclusions Future studies on the efficacy of acupuncture in the treatment of chronic idiopathic pruritus should focus on those patients with measurable levels of inflammation at the initiation of the study or utilize alternative and more comprehensive values to monitor disease response.

Pruritus in hemodialysis patients: association with phosphorus intake and serum calcium level. / Prurido no paciente em hemodiálise: associação com ingestão de fósforo e nível sérico de cálcio.

OBJECTIVE: To analyze the association between the occurrence of pruritus and adherence to the prescribed diet, biochemical indicators of renal function and the quality of hemodialysis in chronic renal patients. METHOD: A cross-sectional study performed at a dialysis clinic in the Northeast of Brazil, with 200 patients undergoing hemodialysis in the first half of 2015.To analyze the data, inferential statistics were used, using Chi-Square and Fisher's Exact tests; and Mann Whitney U test. RESULTS: The pruritus was present in 51% of the sample, being associated statistically with phosphorus consumption (P = 0.024) and elevation of serum calcium (P = 0.009). CONCLUSION: Pruritus in chronic renal patients undergoing hemodialysis is influenced by adequate nonadherence to the prescribed diet, in addition to the elevation of biochemical indicators of renal function.

Prurido no paciente em hemodiálise: associação com ingestão de fósforo e nível sérico de cálcio / Prurido en el paciente en hemodiálisis: asociación con ingestión de fósforo y nivel sérico de cálcio / Pruritus in hemodialysis patients: association with phosphorus intake and serum calcium level

Resumo OBJETIVO Analisar a associação entre a ocorrência do prurido e a adesão à dieta prescrita, indicadores bioquímicos da função renal e a qualidade da hemodiálise, em pacientes renais crônicos. MÉTODO Estudo transversal, realizado em uma clínica de diálise no Nordeste do Brasil, com 200 pacientes submetidos à hemodiálise, no primeiro semestre de 2015. Para análise dos dados fez-se uso da estatística inferencial, através dos testes de Qui-Quadrado e Exato de Fisher; e teste de U de Mann Whitney. RESULTADOS O prurido esteve presente em 51% da amostra, associando-se estatisticamente com o consumo de fósforo (P=0,024) e a elevação do cálcio sérico (P=0,009). CONCLUSÃO O prurido em pacientes renais crônicos submetidos à hemodiálise sofre influência da não adesão adequada à dieta prescrita, além da elevação de indicadores bioquímicos da função renal.

Resumen OBJETIVO Analizar la asociación entre la ocurrencia del prurito y la adhesión a la dieta prescrita, indicadores bioquímicos de la función renal y la calidad de la hemodiálisis, en pacientes renales crónicos. MÉTODO Estudio transversal, realizado en una clínica de diálisis en el Nordeste de Brasil, con 200 pacientes sometidos a la hemodiálisis, en el primer semestre de 2015. Para el análisis de los datos se utilizó la estadística inferencial, a través de las pruebas de Qui-Cuadrado y Exacto de Fisher; y prueba de U de Mann Whitney. RESULTADOS El prurito estuvo presente en el 51% de la muestra, asociándose estadísticamente con el consumo de fósforo (P = 0,024) y la elevación del calcio sérico (P = 0,009). CONCLUSIÓN El prurito en pacientes renales crónicos sometidos a la hemodiálisis sufre influencia de la no adhesión adecuada a la dieta prescrita, además de la elevación de indicadores bioquímicos de la función renal.

Abstract OBJECTIVE To analyze the association between the occurrence of pruritus and adherence to the prescribed diet, biochemical indicators of renal function and the quality of hemodialysis in chronic renal patients. METHOD A cross-sectional study performed at a dialysis clinic in the Northeast of Brazil, with 200 patients undergoing hemodialysis in the first half of 2015.To analyze the data, inferential statistics were used, using Chi-Square and Fisher's Exact tests; and Mann Whitney U test. RESULTS The pruritus was present in 51% of the sample, being associated statistically with phosphorus consumption (P = 0.024) and elevation of serum calcium (P = 0.009). CONCLUSION Pruritus in chronic renal patients undergoing hemodialysis is influenced by adequate nonadherence to the prescribed diet, in addition to the elevation of biochemical indicators of renal function.

Effect of acupuncture on house dust mite specific IgE, substance P, and symptoms in persistent allergic rhinitis.

BACKGROUND: Clinical evidence suggests that acupuncture improves symptoms in persistent allergic rhinitis, but the physiologic basis of these improvements is not well understood. OBJECTIVE: A randomized, sham-controlled trial of acupuncture for persistent allergic rhinitis in adults investigated possible modulation of mucosal immune responses. METHODS: A total of 151 individuals were randomized into real and sham acupuncture groups (who received twice-weekly treatments for 8 weeks) and a no acupuncture group. Various cytokines, neurotrophins, proinflammatory neuropeptides, and immunoglobulins were measured in saliva or plasma from baseline to 4-week follow-up. RESULTS: Statistically significant reduction in allergen specific IgE for house dust mite was seen only in the real acupuncture group, from 18.87 kU/L (95% CI, 10.16-27.58 kU/L) to 17.82 kU/L (95% CI, 9.81-25.83 kU/L) (P = .04). A mean (SE) statistically significant down-regulation was also seen in proinflammatory neuropeptide substance P (SP) 18 to 24 hours after the first treatment from 408.74 (299.12) pg/mL to 90.77 (22.54) pg/mL (P = .04). No significant changes were seen in the other neuropeptides, neurotrophins, or cytokines tested. Nasal obstruction, nasal itch, sneezing, runny nose, eye itch, and unrefreshed sleep improved significantly in the real acupuncture group (postnasal drip and sinus pain did not) and continued to improve up to 4-week follow-up. CONCLUSION: Acupuncture modulated mucosal immune response in the upper airway in adults with persistent allergic rhinitis. This modulation appears to be associated with down-regulation of allergen specific IgE for house dust mite, which this study is the first to report. Improvements in nasal itch, eye itch, and sneezing after acupuncture are suggestive of down-regulation of transient receptor potential vanilloid 1. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry Identifier: ACTRN 12610001052022.

Effects of turmeric on uremic pruritus in end stage renal disease patients: a double-blind randomized clinical trial.

BACKGROUND: Uremic pruritus as a symptom that affects hemodialysis (HD) patients can decrease the quality of life and increase morbidity in these patients. The aim of this study was to evaluate the effects of turmeric on uremic pruritus in HD patients. SUBJECTS AND METHODS: This was a double-blind placebo-controlled trial conducted on 100 HD patients suffering from pruritus. Patients (mean age 53.3 ± 15.8 years) were randomized into two groups: turmeric and placebo. The pruritus score and biochemical determinants including high-sensitivity C-reactive protein (hs-CRP) were compared before and at the end of the study between the two groups. RESULTS: The mean decrease in hs-CRP was significantly higher in the turmeric than the placebo group (-0.8 ± 2.6 vs. 0.4 ± 8.7 mg/l, p = 0.012). Also reduction of pruritus scores was greater in the turmeric than the placebo group (13.6 ± 2.6 vs. 7.2 ± 2.6, p = 0.001). No side effect was observed during the study due to the use of turmeric. CONCLUSIONS: This study demonstrates the possible efficacy of turmeric in decreasing hs-CRP and uremic pruritus in end stage renal disease patients. Future studies are needed to further evaluate the efficacy and safety of turmeric.

Longitudinal predictors of uremic pruritus.

OBJECTIVE: Pruritus is a common problem among hemodialyzed patients. Its causes are poorly understood, and, as a result, itching is often attributed to elevated serum phosphorus and other disorders of bone and minerals. The primary purpose of this study was to analyze the relationship between pruritus and common tests of bone and mineral disease. METHODS: This study was a post hoc analysis of data from a randomized controlled trial of 3 months of ergocalciferol versus placebo treatment in 50 hemodialysis patients with uremic pruritus. A pruritus survey was administered at baseline and then every 2 weeks for 12 weeks. Concurrent serum phosphorus, intact parathyroid hormone (PTH), serum calcium, and calcium-phosphate product were measured. RESULTS: Pruritus score was not found to be associated or correlated with serum phosphate, intact PTH, serum calcium, or calcium-phosphate product at each time interval or over time. Likewise, when analyzed by original study group (placebo or ergocalciferol), no association or correlation between the mineral and bone indicators and itching were found. CONCLUSION: Neither serum phosphate nor other tests of bone and mineral status were found to be significant predictors of pruritus at any point in time or over time.

Uremic pruritus and serum phosphorus level.

Pruritus is a common and bothersome problem among uremic patients which negatively affects life quality and prognosis of the patient. Various factors are known to be involved in the development of pruritus. The aim of this study was to assess the frequency and the factors which may have relationship with uremic pruritus, especially bone mineral metabolism indicators. Current cross-sectional study was done on 99 hemodialysis patients. Having pruritus, its duration, severity and correlation with patient's laboratory data was evaluated. For each patient a questionnaire was filled. The mean age of patients was 55.9±15.4 (23-87) years and 35.7% were female. They were on hemodialysis for 74.79±75.04 months. Frequency of pruritus was 58.6% (58 patients). Considering the severity, 16.2% suffered from severe pruritus, measured by visual analogue scale (VAS). Pruritus was more common in those on dialysis for more than 2 years (0.014). 82.8% of those with VAS of less than 3, in comparison with 37.5% of those with VAS of greater than 7, had no complaint of awakening due to pruritus. The frequency of pruritus and its severity was more in patients with higher serum phosphorus level (P=0.048). It seems that phosphate control which is not mainly attributed to dialysis adequacy and efficiency, needs more attention not only by medical team but also by patient. Decreasing the phosphate content of regimen may be cheap and helpful modality in pruritus management.

Association between pruritus and serum concentrations of parathormone, calcium and phosphorus in hemodialysis patients.

Chronic renal disorders have a progressive course in most cases, and finally result in end-stage renal disease (ESRD). Hemodialysis (HD) is one of the mainstays in the treatment of these patients. Disturbance in calcium (Ca) and phosphorus (P) metabolism and alteration of serum levels of parathormone (PTH) are observed in these patients. One of the most common cutaneous manifestations in patients on HD is pruritus. The aim of this study is to evaluate the association between pruritus and serum concentrations of Ca, P and PTH in patients with chronic renal disease. This analytic, descriptive, cross-sectional study was performed on 120 patients on HD at the Fifth-Azar Hospital in Gorgan, Iran, in 2010. Information related to the patients, including age, gender, pruritus, time of pruritus and duration on dialysis, was extracted from questionnaires. Serum concentrations of intact PTH, Ca and P were measured. Data were analyzed by the chi-square test and SPSS-16 software. A P-value less than 0.05 was considered statistically significant. Among the 120 study patients, 50% were male and the mean age (±SD) was 49 ± 12.3 years. Sixty percent of the patients had pruritus, of whom 33.3% had PTH levels above the normal range. Among the 40% of the patients who did not have pruritus, 39.6% had PTH levels higher than the normal levels. The mean serum Ca and P levels were 8.44 ± 1.65 mg/dL and 5.48 ± 1.81 mg/dL, respectively. The mean (±SD) Ca-P product was 55.46 ± 47.16 and the mean PTH concentration was 274.34 ± 286.53 pg/mL. No significant association was found between pruritus and age, sex, serum PTH and P levels as well as Ca-P product. However, the association between serum Ca levels and pruritus was significant (P = 0.03). Our study showed that most patients with pruritus had serum Ca levels in the abnormal range (lower or higher), and there was no significant correlation between serum iPTH level and pruritis. Thus, good control of serum Ca levels is important to reduce pruritus in these patients.

Relationship between serum intact parathyroid hormone and pruritus in hemodialysis patients.

INTRODUCTION: Pruritus is one of the most common cutaneous complications in hemodialysis patients. There is no consensus on etiologic and pathologic factors. This study is aimed to evaluate the correlation between serum intact parathyroid hormone (PTH) level and the severity of pruritus in hemodialysis patients. MATERIALS AND METHODS: In a cross-sectional study, all of the patients referred to hemodialysis center of two hospitals in Sari, Iran, were primarily examined by a dermatologist and those who had no pathologic findings were included in the study. Serum levels of calcium, phosphorus, albumin, creatinine, and intact PTH were measured and evaluated against the pruritus scores. RESULTS: A total of 153 patients were studied of whom 52.3% (n = 80) were men. The prevalence of pruritus and hyperparathyroidism were 61.4% and 60.7%, respectively, and these were not significantly different between men and women. There was a significant difference in the mean itching score between the patents with and without hyperparathyroidism (5.71 +/- 5.39 and 4.93 +/- 2.93, respectively; P = .005). Serum intact PTH level correlated with itching score in this population (r = 0.294, P < .001), while no correlations were found between itching score and other laboratory parameters. CONCLUSIONS: Our study showed that intact PTH level is correlated to the severity of pruritus in hemodialysis patients. Therefore, control of hyperparathyroidism in hemodialysis patients is very important to overcome pruritus.

Cholestasis-induced pruritus treated with ultraviolet B phototherapy: an observational case series study.

BACKGROUND & AIMS: Pruritus is a disabling complication of cholestatic liver disorders. Its management remains challenging. Ultraviolet B (UVB) phototherapy has been successfully used to treat pruritus in other indications. METHODS: This is an observational case series. The study population consists of 13 patients (10 females, mean age 52 years) with pruritus due to different cholestatic liver disorders: PBC (n=4), PSC (n=2), drug-induced (n=3) and persistent cholestasis after liver transplantation (LT) (n=4). Serum alkaline phosphatase levels were: 686 ± 363 µ/L and serum bile acids levels: 147 ± 15 µmol/L. In all patients, conventional medical treatment had failed to control pruritus. Perception of pruritus was recorded by the visual analogue scale (VAS). RESULTS: The mean follow-up was 3 years. Ten patients (77%) had more than 60% reduction in perceived pruritus of which 4 had more than an 80% reduction. Median [25-75% percentiles] VAS score before and after treatment decreased from 8.0 [8.0-10] to 2.0 [1.5-2.1] (p<0.001). The mean number of irradiations required to obtain this effect was 26 ± 17 (average duration of phototherapy: 8 weeks). No significant changes in cholestatic serum markers were observed. Four patients (30%) needed an additional phototherapy course because of recurrent pruritus and in all of them again a marked improvement of pruritus was observed. The therapy was well tolerated, except in two patients who developed, during retreatment, pronounced erythema in one case and paresthesia in the other case. CONCLUSIONS: UVB phototherapy appears to be a promising and well tolerated treatment also for cholestasis-associated pruritus.

Improvement of sulphur mustard-induced chronic pruritus, quality of life and antioxidant status by curcumin: results of a randomised, double-blind, placebo-controlled trial.

Skin is among the first and most heavily damaged organs upon sulphur mustard (SM) exposure. Pruritus is the most common chronic skin complication of SM, which adversely affects the quality of life (QoL). However, current therapies for the management of SM-induced pruritus are very limited and associated with side effects. The present trial investigated the efficacy of curcumin in the alleviation of SM-induced chronic pruritic symptoms. A total of ninety-six male Iranian veterans (age 37-59 years) were randomised to receive either curcumin (1 g/d, n 46) or placebo (n 50) for 4 weeks. Serum concentrations of substance P and activities of antioxidant enzymes were measured at baseline and at the end of the trial. Assessment of pruritus severity was performed using the pruritus score, visual analogue scale (VAS) and scoring atopic dermatitis (SCORAD) index. QoL was evaluated using the Dermatology Life Quality Index (DLQI) questionnaire. Serum concentrations of substance P (P<0·001) as well as activities of superoxide dismutase (P=0·02), glutathione peroxidase (P=0·006) and catalase (P<0·001) were significantly reduced in the curcumin group, while no significant change was observed in the placebo group. Curcumin supplementation was also associated with significant reductions in measures of pruritus severity including the pruritus score (P<0·001), VAS score (P<0·001), overall (P<0·001) and objective SCORAD (P=0·009), and DLQI's first question (P<0·001). None of these measures was significantly changed in the placebo group. As for the QoL, although DLQI scores decreased in both groups (P<0·001 and P=0·003 in the curcumin and placebo groups, respectively), the magnitude of reduction was significantly greater in the curcumin group (P<0·001). In conclusion, curcumin may be regarded as a natural, safe, widely available and inexpensive treatment for the management of SM-induced chronic pruritus.

Anti-allergic activity of German chamomile (Matricaria recutita L.) in mast cell mediated allergy model.

ETHNOPHARMACOLOGICAL RELEVANCE: Chamomile is most popular used medicinal plant and extensively consumed as a tea or tisanes. Traditionally this plant was used for treatment of many ailments such as allergy disorders and inflammatory mediated diseases. AIM OF THE STUDY: We investigated the effects of anti-allergic activity of Matricaria recutita L. on mast cell mediated allergic models. MATERIALS AND METHODS: The protective effect of methanol extract of Matricaria recutita against compound 48/80 induced anaphylaxis and pruritis models for acute phase of hypersensitivity reactions were carried out. The late phase hypersensitivity reactions by compound 48/80 induced mast cell degranulation and histamine release from blood along with serum nitric oxide (NO), rat peritoneal fluid nitric oxide (NO) and bronchoalveolar fluid nitric oxide (NO) levels were measured. RESULTS: The methanol extract of Matricaria recutita L. showed inhibitory effects on anaphylaxis induced by compound 48/80 and significant dose dependent anti-pruritis property was observed by inhibiting the mast cell degranulation. Mast cell membrane stabilization activity was also observed in compound 48/80 induced mast cell activation. Dose dependent reduction in the histamine release, along with decreased release of serum, rat peritoneal and BAL fluid nitric oxide (NO) levels were observed. CONCLUSION: These results suggest that the methanol extract of Matricaria recutita showed potent anti-allergic activity by inhibition of histamine release from mast cells.

Effects of thermal therapy on uremic pruritus and biochemical parameters in patients having haemodialysis.

TITLE: Effects of thermal therapy on uremic pruritus and biochemical parameters in patients having haemodialysis. AIM: This paper is a report of a trial to identify the effect of thermal therapy with far-infrared rays in comparison with non-thermal therapy on uremic pruritus and biochemical parameters. BACKGROUND: Uremic pruritus remains one of the most frustrating, common, and potentially disabling symptoms in patients undergoing haemodialysis. The mechanism underlying uremic pruritus is poorly understood. Although enough is known to determine a reasonable treatment approach, more research is needed to evaluate more reliable treatments. METHODS: A randomized, double-blind, controlled trial was conducted in 2005 using questionnaires and measurement of blood biochemical parameters. A total of 41 uremic patients on maintenance haemodialysis were randomly assigned either to the thermal therapy group or the control group. The thermal therapy group was treated with 40 degrees C thermal therapy with far-infrared rays at the Sanyinjiao acupoint for 15 minutes once a day on two days a week for a total of 18 sessions. The control group received a plain adhesive patch placed on the same acupoint. FINDINGS: Both groups showed statistically significant improvements but there were no differences between groups, while a relatively large decrease in pruritus scores was found in the thermal therapy group (P < 0.001) as compared with the non-thermal therapy group. Serum calcium level decreased statistically significantly in the thermal therapy group and was statistically significantly different from that of the control group. CONCLUSION: The lack of effect does not necessarily demonstrate that thermal therapy is not effective or has no therapeutic benefits for uremic pruritus in patients having haemodialysis. Further investigation is warranted, with larger samples and longer intervention.

The effect of fexofenadine on pruritus in a mouse model (HR-ADf) of atopic dermatitis.

Fexofenadine, a histamine H1-receptor antagonist, is approved for the treatment of pruritus associated with atopic dermatitis. The effects of fexofenadine on scratching behaviour, and plasma levels of histamine and eotaxin were assessed in a new model of atopic dermatitis. Mice fed a diet low in Mg2+ and Zn2+ (special diet S) were compared with mice on a normal diet (N) or diet S plus fexofenadine HCl for weeks 0-10 (S + F(0-10)), 0-5 (S + F(0-5)) or 6 - 10 (S + F(6-10)) (seven mice per group). Compared with group N, group S mice showed significantly greater scratching frequency, and plasma histamine and eotaxin concentrations; these three variables were significantly lower in group S + F(0-10) than in group S. Scratching frequency increased when fexofenadine was discontinued. Fexofenadine significantly reduced mast cell and eosinophil numbers. Histamine may be important in the pathological changes seen in this model of atopic dermatitis, suggesting that it might aid future development of antihistamines for the treatment of atopic dermatitis.

The therapeutic effect of evening primrose oil in atopic dermatitis patients with dry scaly skin lesions is associated with the normalization of serum gamma-interferon levels.

To see if evening primrose oil (EPO) could be more effective in a certain type of atopic dermatitis, we administered EPO to 14 atopic dermatitis patients characterized by itchy dry scaly skin. Furthermore, we measured serum levels of gamma-interferon (IFN-gamma) and IgE in addition to the clinical severity before and after the treatment to find out whether the treatment effect of EPO is related with an immunological mechanism. After the treatment, the extent of the skin lesions and the pruritus were markedly reduced in all patients. While serum IFN-gamma levels were significantly increased (p < 0.01) after the treatment up to those of the normal control group, serum IgE levels showed a significant decrease (p < 0.05), failing to normalize completely. We concluded that EPO could be highly effective in the treatment of a grossly noninflammatory type of atopic dermatitis. The restoration of serum IFN-gamma levels indicates that EPO might exert its effect through the modulation of the immunological mechanism involving IFN-gamma.

Successful treatment of itching and atopic eczema by transcutaneous nerve stimulation.

Low-frequency (2 Hz) transcutaneous electrical nerve stimulation (TNS) may produce prolonged and widespread sympatho-inhibition resulting in improved skin microcirculation with increased skin temperature in patients with peripheral vascular insufficiency. The method has previously been used successfully to improve peripheral circulation in such patients and to accelerate healing of chronic skin ulcers of various etiology. The present report deals with healing of atopic eczema and relief of pruritus by low-frequency TNS treatment in a patient who was followed for 2 years, the first 8 months with daily recordings of the effects, and then for an additional 16 months during which period TNS only occasionally was used. TNS also produced increased plasma levels of ACTH, cortisol and vasoactive intestinal polypeptides (VIP). The mechanisms of the favourable clinical effects are discussed.

Uremic pruritus: skin divalent ion content and response to ultraviolet phototherapy.

Pruritus is a frequent and troublesome consequence of end-stage renal disease. We have surveyed 155 chronic dialysis patients and found pruritus to be a significant problem in approximately 70%. Seventeen patients reporting severe pruritus were treated thrice weekly with total body exposure to either UVA or UVB light. UVB light resulted in resolution of pruritus in all cases. UVA light was without significant effect. Skin biopsies obtained before and after UV phototherapy revealed elevated contents of calcium, magnesium, and phosphorus in all pruritic patients. The resolution of pruritus following UVB treatment was associated with a reduction of skin phosphorus to values comparable with nonpruritic uremics or healthy volunteers. Uremic pruritus may be due to increased skin divalent ion content resulting in microprecipitation of calcium or magnesium phosphate.