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1.
Rev Prat ; 70(2): 187-189, 2020 Feb.
Artigo em Francês | MEDLINE | ID: mdl-32877138

RESUMO

Prurigo nodularis. Prurigo nodularis is the most severe degree of chronic prurigo. Disseminated nodules (mostly on the 4 members) are associated with skin excoriations and an intense pruritus. Whatever the etiology, prurigo nodularis is autonomous disease which is related to itch sensitization (similar to pain sensitization). The burden is high. A management with different levels is recommended and the opinion of a dermatologist is frequently required. Research gives promising therapeutic perspectives.


Assuntos
Prurigo , Humanos , Prurido
2.
Medicine (Baltimore) ; 99(34): e21936, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846862

RESUMO

RATIONALE: IgG4-related disease (IgG4-RD) is a systemic disease that can involve various organs and is characterized by the infiltrations of IgG4-positive plasma cells and lymphocytes, fibrosis, and elevated serum IgG4 levels. IgG4-related sclerosing cholangitis (IgG4-RSC) is a subtype of IgG4-RD. No certain relationship between IgG4-RSC and cholangiocarcinoma has been established as yet, and there have been few reports of the simultaneous diagnosis of IgG4-RSC and cholangiocarcinoma. PATIENT CONCERNS: A 76-year-old male visited our gastroenterology department due to the recent occurrence of pruritus and jaundice. DIAGNOSIS: Computed tomography (CT) scan showed ductal wall swelling and enhancement from both intrahepatic duct confluence to the common bile duct, upper biliary dilatation, and accompanying autoimmune pancreatitis (a sub type of IgG4-RD). Biopsy of the distal common bile duct by endoscopic retrograde cholangiopancreatography (ERCP) resulted in a diagnosis of IgG4-RSC. Subsequently, adenocarcinoma was identified by repeated cytology of bile juice. Finally, Klatskin tumor type IIIA and IgG4-RSC were concurrently diagnosed. INTERVENTIONS: IgG4-RSC was treated with steroid and Klatskin tumors by gemcitabine + cisplatin chemotherapy. OUTCOMES: The jaundice had improved and CT showed substantial improvement of the intrahepatic duct dilatation. LESSONS: IgG4-RSC and cholangiocarcinoma are easily confused, but their treatments are quite different, and thus, care must be taken during diagnosis. Furthermore, these 2 diseases may co-exist. Therefore, even if IgG4-RSC is diagnosed first, the possibility of accompanying cholangiocarcinoma should be thoroughly investigated.


Assuntos
Colangiocarcinoma/complicações , Colangite Esclerosante/patologia , Imunoglobulina G/imunologia , Tumor de Klatskin/complicações , Tumor de Klatskin/patologia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Colangiocarcinoma/patologia , Colangiopancreatografia Retrógrada Endoscópica , Colangite Esclerosante/diagnóstico por imagem , Colangite Esclerosante/tratamento farmacológico , Cisplatino/uso terapêutico , Ducto Colédoco/patologia , Desoxicitidina/análogos & derivados , Desoxicitidina/uso terapêutico , Diagnóstico Diferencial , Humanos , Doença Relacionada a Imunoglobulina G4/patologia , Icterícia/diagnóstico , Icterícia/etiologia , Tumor de Klatskin/classificação , Tumor de Klatskin/tratamento farmacológico , Masculino , Prurido/diagnóstico , Prurido/etiologia , Esteroides/uso terapêutico , Tomografia Computadorizada por Raios X , Resultado do Tratamento
3.
Lancet ; 396(10247): 345-360, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32738956

RESUMO

Atopic dermatitis is a common inflammatory skin disorder characterised by recurrent eczematous lesions and intense itch. The disorder affects people of all ages and ethnicities, has a substantial psychosocial impact on patients and relatives, and is the leading cause of the global burden from skin disease. Atopic dermatitis is associated with increased risk of multiple comorbidities, including food allergy, asthma, allergic rhinitis, and mental health disorders. The pathophysiology is complex and involves a strong genetic predisposition, epidermal dysfunction, and T-cell driven inflammation. Although type-2 mechanisms are dominant, there is increasing evidence that the disorder involves multiple immune pathways. Currently, there is no cure, but increasing numbers of innovative and targeted therapies hold promise for achieving disease control, including in patients with recalcitrant disease. We summarise and discuss advances in our understanding of the disease and their implications for prevention, management, and future research.


Assuntos
Dermatite Atópica/epidemiologia , Dermatite Atópica/fisiopatologia , Inflamação/fisiopatologia , Linfócitos T/imunologia , Adolescente , Asma/epidemiologia , Criança , Pré-Escolar , Comorbidade , Dermatite Atópica/prevenção & controle , Dermatite Atópica/terapia , Eczema/patologia , Hipersensibilidade Alimentar/epidemiologia , Predisposição Genética para Doença/genética , Carga Global da Doença , Humanos , Lactente , Transtornos Mentais/epidemiologia , Microbiota/fisiologia , Terapia de Alvo Molecular/métodos , Fototerapia/métodos , Prevalência , Prurido/patologia , Qualidade de Vida , Rinite Alérgica/epidemiologia , Linfócitos T/patologia
4.
Niger J Clin Pract ; 23(8): 1039-1043, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32788478

RESUMO

Aim: The aim of this study was to investigate the relationship between the presence of Demodex on the face and within the eyelash follicles in patients with rosacea. Subjects and Methods: This prospective cross-sectional study included 80 participants, 40 patients with rosacea and 40 individuals with no rosacea as controls. The presence of Demodex on the face was assessed by standard superficial skin biopsy. Sixteen eyelashes were epilated from each patient and control. Results: The rate of Demodex infestation and severe infestation on the face in patients with rosacea was significantly higher than the control group. Demodex count within the eyelash follicle was significantly higher in patients with erythematotelangiectatic type rosacea than the control group. There was no increase in blepharitis in rosacea patients but when blepharitis was present, the rate of the presence of Demodex was higher in this group. There was a statistically significant relationship between the presence of Demodex within the eyelashes and itchy eyes in people without blepharitis. Conclusion: When at least one Demodex is found on the face in rosacea patients, the eyelashes should be examined for effective treatment of the mite. Itchy eyes may be an important sign of the presence of Demodex in people without blepharitis.


Assuntos
Infecções Oculares Parasitárias/parasitologia , Pestanas/parasitologia , Infestações por Ácaros/parasitologia , Rosácea/parasitologia , Pele/patologia , Adulto , Animais , Biópsia , Blefarite/diagnóstico , Blefarite/epidemiologia , Blefarite/parasitologia , Estudos de Casos e Controles , Conjuntivite , Estudos Transversais , Infecções Oculares Parasitárias/diagnóstico , Infecções Oculares Parasitárias/epidemiologia , Face , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infestações por Ácaros/diagnóstico , Infestações por Ácaros/epidemiologia , Ácaros , Estudos Prospectivos , Prurido , Rosácea/diagnóstico , Rosácea/epidemiologia
7.
Clin Ter ; 171(4): e288-e290, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32614359

RESUMO

Dermatitis artefacta is a psychosomatic disorder characterized by cutaneous lesions that are self-inflicted by the patient, apparently due to itchy sensation. Usually, the patient denies any direct involvement with this condition and is rarely conscious of the underlying psychosomatic etiology. Authors report a case of a flight assistant with hypertrophic scars, symmetrically located on both upper arms. She referred chronic itchy sensation localized at the site where lesions were present; she referred relief only through continuous and forceful scratching. Considering the clinical history and after excluding other dermatological disorders, the diagnosis of dermatitis artefacta was made.


Assuntos
Dermatite Ocupacional/diagnóstico , Comportamento Autodestrutivo , Adulto , Braço , Dermatite Ocupacional/etiologia , Feminino , Humanos , Prurido/diagnóstico
9.
N Engl J Med ; 383(2): 141-150, 2020 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-32640132

RESUMO

BACKGROUND: Nemolizumab is a subcutaneously administered humanized monoclonal antibody against interleukin-31 receptor A, which is involved in pruritus and inflammation in atopic dermatitis. In phase 2 studies, nemolizumab lessened the severity of atopic dermatitis. METHODS: In a 16-week, double-blind, phase 3 trial, we randomly assigned Japanese patients with atopic dermatitis and moderate-to-severe pruritus and an inadequate response to topical agents in a 2:1 ratio to receive subcutaneous nemolizumab (60 mg) or placebo every 4 weeks until week 16, with concomitant topical agents. The primary end point was the mean percent change in the visual-analogue scale (VAS) score for pruritus (range, 0 to 100, with higher scores indicating worse pruritus) from baseline to week 16. Secondary end points included the time course of change in the VAS score for pruritus up to week 4, the change in the Eczema Area and Severity Index (EASI) score (range, 0 to 72, with higher scores indicating greater severity), a score of 4 or less on the Dermatology Life Quality Index (DLQI; range, 0 to 30, with higher scores indicating a greater effect on daily life), a score of 7 or less on the Insomnia Severity Index (ISI; range, 0 to 28, with higher scores indicating greater severity), and safety. RESULTS: A total of 143 patients were randomly assigned to receive nemolizumab and 72 to receive placebo. The median VAS score for pruritus at baseline was 75. At week 16, the mean percent change in the VAS score was -42.8% in the nemolizumab group and -21.4% in the placebo group (difference, -21.5 percentage points; 95% confidence interval, -30.2 to -12.7; P<0.001). The mean percent change in the EASI score was -45.9% with nemolizumab and -33.2% with placebo. The percentage of patients with a DLQI score of 4 or less was 40% in the nemolizumab group and 22% in the placebo group; the percentage of patients with an ISI score of 7 or less was 55% and 21%, respectively. The incidence of injection-related reactions was 8% with nemolizumab and 3% with placebo. CONCLUSIONS: In this 16-week trial, the use of subcutaneous nemolizumab in addition to topical agents for atopic dermatitis resulted in a greater reduction in pruritus than placebo plus topical agents. The incidence of injection-site reactions was greater with nemolizumab than with placebo. Longer and larger trials are necessary to determine whether nemolizumab has a durable effect and is safe for atopic dermatitis. (Funded by Maruho; JapicCTI number, 173740.).


Assuntos
Anticorpos Monoclonais Humanizados/administração & dosagem , Inibidores de Calcineurina/administração & dosagem , Dermatite Atópica/tratamento farmacológico , Glucocorticoides/administração & dosagem , Antagonistas dos Receptores Histamínicos/uso terapêutico , Prurido/tratamento farmacológico , Administração Tópica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais Humanizados/efeitos adversos , Dermatite Atópica/induzido quimicamente , Dermatite Atópica/complicações , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Humanos , Injeções Subcutâneas/efeitos adversos , Análise de Intenção de Tratamento , Masculino , Pessoa de Meia-Idade , Prurido/etiologia , Escala Visual Analógica , Adulto Jovem
10.
Medicine (Baltimore) ; 99(24): e20603, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: covidwho-593909

RESUMO

In December 2019, a new coronavirus was found in Wuhan, Hubei Province, China, and spread rapidly throughout the country, attracting global attention. On February 11, the World Health Organization (WHO) officially named the disease caused by 2019-nCoV coronavirus disease 2019 (COVID-19). With the increasing number of cases, health care workers (HCWs) from all over China volunteered to work in Hubei Province. Because of the strong infectivity of COVID-19, HCWs need to wear personal protective equipment (PPE), such as N95 masks, latex gloves, and protective clothing. Due to the long-term use of PPE, many adverse skin reactions may occur. Therefore, the purpose of this study is to explore the adverse skin reactions among HCWs using PPE.Questionnaires were used for the research; a quantitative study was carried out to determine the incidence of adverse skin reactions among HCWs using PPE.A total of 61 valid questionnaires were collected. The most common adverse skin reactions among HCWs wearing N95 masks were nasal bridge scarring (68.9%) and facial itching (27.9%). The most common adverse skin reactions among HCWs wearing latex gloves were dry skin (55.7%), itching (31.2%), and rash (23.0%). The most common adverse skin reactions among HCWs wearing protective clothing were dry skin (36.1%) and itching (34.4%).When most HCWs wear PPE for a long period of time, they will experience adverse skin reactions. The incidence of adverse skin reactions to the N95 mask was 95.1%, that to latex gloves was 88.5%, and that to protective clothing was 60.7%.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Pessoal de Saúde , Doenças Profissionais/etiologia , Pandemias/prevenção & controle , Equipamento de Proteção Individual/efeitos adversos , Pneumonia Viral/prevenção & controle , Dermatopatias/etiologia , Dermatite de Contato/etiologia , Exantema/etiologia , Feminino , Humanos , Masculino , Máscaras/efeitos adversos , Roupa de Proteção/efeitos adversos , Prurido/etiologia , Dispositivos de Proteção Respiratória/efeitos adversos , Inquéritos e Questionários
11.
Support Care Cancer ; 28(9): 3991-3993, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32514616

RESUMO

Stringent measures have been taken to contain COVID-19 spread, limiting access only for urgent visits, surgery procedures, or hospitalizations and using teledermatology services for non-urgent cases. Management of oncological patients affected by chemo-, immune-, and radiotherapy-related cutaneous and mucosal adverse events is a challenge. Firstly because of the differential diagnosis of cutaneous rash (e.g., drug-related rash or paraviral exanthema). Secondly, oncological patients can suffer from xerosis, pruritus, and mucositis that contribute to cutaneous and mucosal barrier lesions, thus becoming vulnerable site for viral or bacterial colonization. These lesions can also be aggravated by the use of protective mask and gloves. Here, we report also our results of a teledermatological survey on 87 oncological patients, where the health status of oncological patients referred to our dedicated clinic was assessed during the COVID-19 pandemic. Therefore, it is fundamental that oncological patients are followed up by their dermatologists even if the clinics are closed. Teledermatology represents a crucial means of communication. Patients can contact the dermatological staff by emails and telephone, 24 h a day, 7 days a week, for video calls and dermatological consultations.


Assuntos
Infecções por Coronavirus/prevenção & controle , Membrana Mucosa/patologia , Neoplasias/terapia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pele/patologia , Distância Social , Administração Cutânea , Betacoronavirus , Erupção por Droga/diagnóstico , Exantema/patologia , Exantema/virologia , Humanos , Itália , Masculino , Prurido/patologia , Prurido/virologia , Inquéritos e Questionários , Telemedicina/métodos
12.
Nat Commun ; 11(1): 3052, 2020 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-32546780

RESUMO

Itch, in particular chronic forms, has been widely recognized as an important clinical problem, but much less is known about the mechanisms of itch in comparison with other sensory modalities such as pain. Recently, considerable progress has been made in dissecting the circuit mechanisms of itch at both the spinal and supraspinal levels. Major components of the spinal neural circuit underlying both chemical and mechanical itch have now been identified, along with the circuits relaying ascending transmission and the descending modulation of itch. In this review, we summarize the progress in elucidating the neural circuit mechanism of itch at spinal and supraspinal levels.


Assuntos
Encéfalo/metabolismo , Prurido/etiologia , Animais , Peptídeo Liberador de Gastrina/genética , Peptídeo Liberador de Gastrina/metabolismo , Humanos , Neurônios/patologia , Neurônios/fisiologia , Prurido/psicologia , Receptores da Bombesina/genética , Receptores da Bombesina/metabolismo , Transdução de Sinais , Medula Espinal/metabolismo
13.
Expert Opin Pharmacother ; 21(13): 1629-1636, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32515664

RESUMO

INTRODUCTION: Pruritus is a debilitating symptom that significantly affects the quality of life of patients who suffer from it. Many current and emerging systemic treatments targeting the neural system have been successful in treating itch of various underlying etiologies. AREAS COVERED: A complete search of the PUBMED and Google Scholar databases was completed and literature pertinent to current and emerging systemic anti-pruritic drugs which target the neural system was compiled. The purpose of this review is to give the reader with an overview of the current and emerging systemic therapeutic options which target the neural system for chronic pruritus. The authors then provide the reader with their expert perspectives on the future of these therapies. EXPERT OPINION: Exciting new anti-pruritic therapies targeting the neural system which show promise include NK-1 inhibitors, opioid receptor modulators, and drugs targeting specific itch receptors such as Mrgpr, Nav1.7, and PAR2, as well as selective GABA modulators. Future studies should be conducted in order to fully understand these exciting therapeutic options.


Assuntos
Antipruriginosos/uso terapêutico , Vias Neurais/efeitos dos fármacos , Prurido/tratamento farmacológico , Prurido/etiologia , Células Receptoras Sensoriais/efeitos dos fármacos , Doença Crônica , Humanos , Prurido/metabolismo , Qualidade de Vida , Células Receptoras Sensoriais/metabolismo
14.
Medicine (Baltimore) ; 99(24): e20603, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541493

RESUMO

In December 2019, a new coronavirus was found in Wuhan, Hubei Province, China, and spread rapidly throughout the country, attracting global attention. On February 11, the World Health Organization (WHO) officially named the disease caused by 2019-nCoV coronavirus disease 2019 (COVID-19). With the increasing number of cases, health care workers (HCWs) from all over China volunteered to work in Hubei Province. Because of the strong infectivity of COVID-19, HCWs need to wear personal protective equipment (PPE), such as N95 masks, latex gloves, and protective clothing. Due to the long-term use of PPE, many adverse skin reactions may occur. Therefore, the purpose of this study is to explore the adverse skin reactions among HCWs using PPE.Questionnaires were used for the research; a quantitative study was carried out to determine the incidence of adverse skin reactions among HCWs using PPE.A total of 61 valid questionnaires were collected. The most common adverse skin reactions among HCWs wearing N95 masks were nasal bridge scarring (68.9%) and facial itching (27.9%). The most common adverse skin reactions among HCWs wearing latex gloves were dry skin (55.7%), itching (31.2%), and rash (23.0%). The most common adverse skin reactions among HCWs wearing protective clothing were dry skin (36.1%) and itching (34.4%).When most HCWs wear PPE for a long period of time, they will experience adverse skin reactions. The incidence of adverse skin reactions to the N95 mask was 95.1%, that to latex gloves was 88.5%, and that to protective clothing was 60.7%.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Pessoal de Saúde , Doenças Profissionais/etiologia , Pandemias/prevenção & controle , Equipamento de Proteção Individual/efeitos adversos , Pneumonia Viral/prevenção & controle , Dermatopatias/etiologia , Dermatite de Contato/etiologia , Exantema/etiologia , Feminino , Humanos , Masculino , Máscaras/efeitos adversos , Roupa de Proteção/efeitos adversos , Prurido/etiologia , Dispositivos de Proteção Respiratória/efeitos adversos , Inquéritos e Questionários
16.
Hautarzt ; 71(7): 493-499, 2020 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-32488462

RESUMO

Chronic pruritus is a common and burdensome symptom in medicine. The care of patients with chronic pruritus is very complex not only because of the high prevalence, but also because of the multifactorial character of itch and the lack of approved therapies. In addition to the main patient need to alleviate the pruritus, patients wish to find the cause of chronic pruritus. This article summarizes some clinical shortcuts. Simple procedures such as taking a detailed medical history can provide clues to the underlying cause of chronic pruritus in order to achieve targeted diagnostic workup or to avoid unnecessary testing. If clinical shortcuts are not identified, we recommend a structured medical history, which is also discussed in this article.


Assuntos
Prurido/diagnóstico , Doença Crônica , Diagnóstico Diferencial , Humanos
17.
Acta Derm Venereol ; 100(10): adv00152, 2020 May 28.
Artigo em Inglês | MEDLINE | ID: covidwho-361180

RESUMO

Little is known about itch related to the use of face masks. This internet survey study investigated the prevalence, intensity and clinical characteristics of itch related to the use of face masks by the general public during the COVID-19 pandemic. A total of 2,315 replies were received, of which 2,307 were included in the final analysis. Of the respondents, 1,393 (60.4%) reported using face masks during the previous week, and, of these, 273 (19.6%) participants reported having itch. Subjects who reported sensitive skin and atopic predisposition, and those with facial dermatoses (acne, atopic dermatitis or seborrhoeic dermatitis) were at significantly higher risk of itch development. The high-est rating of itch for the whole group on the Itch Numeral Rating Scale was 4.07 ± 2.06 (itch of moderate intensity). Responders who wore masks for longer periods more frequently reported itch. Almost 30% of itchy subjects reported scratching their face without removing the mask, or after removing the mask and then scratching. Wearing face masks is linked to development of itch, and scratching can lead to incorrect use of face masks, resulting in reduced protection.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/prevenção & controle , Dermatoses Faciais/epidemiologia , Máscaras/efeitos adversos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Prurido/epidemiologia , Autorrelato , Adolescente , Adulto , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Dermatoses Faciais/diagnóstico , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Polônia/epidemiologia , Prevalência , Prurido/diagnóstico , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Adulto Jovem
18.
N Engl J Med ; 382(21): 2065-2066, 2020 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-32433848
19.
N Engl J Med ; 382(21): 2064, 2020 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-32433845
20.
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