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

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

Dermatological patients with itch report more stress, stigmatization experience, anxiety and depression compared to patients without itch: Results from a European multi-centre study.

BACKGROUND: Itch as the most common symptom in dermatology has been shown to be related to psychological factors such as stress, anxiety and depression. Moreover, associations were found between perceived stigmatization and itch. However, studies investigating the differences between patients with dermatoses with and without itch regarding perceived stress, stigmatization, anxiety and depression are missing. Therefore, one of the aims of the second study of the European Society for Dermatology and Psychiatry (ESDaP study II) was to investigate these relationships in a large cohort of patients with different itchy dermatoses. RESULTS: 3399 patients with 14 different itchy dermatoses were recruited at 22 centres in 17 European countries. They filled in questionnaires to assess perceived stigmatization, stress, signs of clinically relevant anxiety or depression, itch-related quality of life, the overall health status, itch duration, frequency and intensity. The most significant association between the severity of itching and the perception of stress was observed among individuals with rosacea (correlation coefficient r = 0.314). Similarly, the strongest links between itch intensity and experiences of stigmatization, anxiety, and depression were found in patients with seborrheic dermatitis (correlation coefficients r = 0.317, r = 0.356, and r = 0.400, respectively). Utilizing a stepwise linear regression analysis, it was determined that within the entire patient cohort, 9.3% of the variation in itch intensity could be accounted for by factors including gender, levels of anxiety, depression, and perceived stigmatization. Females and individuals with elevated anxiety, depression, and perceived stigmatization scores reported more pronounced itch intensities compared to those with contrary attributes. CONCLUSION: This study underscores the connection between experiencing itch and its intensity and the psychological strain it places on individuals. Consequently, psychological interventions should encompass both addressing the itch itself and the interconnected psychological factors. In specific cases, it becomes imperative for dermatologists to direct individuals towards suitable healthcare resources to undergo further psychological assessment.

[Stigmatization and social anxiety in patients with skin diseases]. / Stigmatisierung und soziale Angst bei Patient:innen mit Hauterkrankungen.

Stigmatization of patients with skin diseases has only recently attracted more attention in research. However, both external stigmatization by society and self-stigmatization by the affected patients are widespread in patients with skin diseases. Many studies show that in this group of patients, the experience of both kinds of stigmatization is associated with psychosocial burden, such as social anxiety. This is often independent of the visibility of skin lesions. The psychosocial burden of affected individuals may lead to psychological comorbidities, such as depression or anxiety disorders, making it important to screen patients in dermatologic settings for the presence of these conditions. Interventions to reduce external and self-stigmatization have been developed, but more randomized controlled trials are needed to test the effects of such interventions.

Preparation and characterization of polysulfone-polyurethane membranes for recovery of simulated wastewater from industrial textile processes.

Techniques using membranes for the treatment of wastewaters usually promote higher quality of treated water when compared to other processes. Among them, pervaporation has advantages in terms of selectivity in addition to low working pressure, which can prevent clogging problems. Polysulfone and polyurethane have complementary characteristics and are interesting in the context of membranes for industrial applications. In this sense, the aim of this work was to prepare and characterize polysulfone/polyurethane-based membranes and tested them with a simulated wastewater containing the reactive black dye and sodium chloride by pervaporation. In their manufacture, thermal treatment (at 60°C) and photo-radiation treatment (using ultraviolet light) were also applied. The characterizations were performed using different analytical tools. In general, it was possible to verify that all membranes have a dense layer. The thermal analysis allowed to define that the indicated working temperature is below 50°C. With respect to the simulated wastewater treatment, all membranes reached 100% selectivity. Concerning the saline solution, the mean selectivity was around 98.5%. Moreover, the permeate flow values were within the range presented by commercial membranes ranging from 1.6 to 2.4 kg m-2 h-1. Although for the photoirradiated membranes the photo-graft reaction has occurred, among all membranes, the blend without any treatment stood out from the others, presenting the highest permeate flow of the simulated wastewater. Finally, the results reveal that these membranes are capable of recovering wastewater from textile processes, in addition to having the potential to remove salts from water through the pervaporation process.Highlights Polysulfone/polyurethane-based membranes were not yet evaluated for wastewater recovery.Modifications in the membrane characteristics promoted variations in the permeate flow.Changes in physical-chemical properties of membrane as a result of a photoinitiation reaction.Removal efficiency achieved was 100% for reactive black dye and 98.5% for sodium chloride.A new way of performing pervaporation on the recovery of aqueous solutions.

Itch induction by audiovisual stimuli and histamine iontophoresis: a randomized, controlled noninferiority study.

BACKGROUND: Previous research has mainly used skin-manipulating methods to induce itch. In comparison, itch induced by audiovisual stimuli lacks direct skin manipulation. OBJECTIVES: The aim of this double blind, noninferiority study was to test the experimental hypothesis that itch induced by audiovisual stimuli is noninferior to itch induced by histamine iontophoresis in case of priming and without priming. METHODS: In 80 of 160 healthy volunteers itch was induced by histamine iontophoresis, while in the other 80 itch was induced by audiovisual stimulation. Forty people in each group experienced either an initial resting phase or dermal priming. Itch intensity was measured by visual analogue scales, while scratch duration and frequency were video-recorded and evaluated by two independent raters. In addition, itch quality and location were measured by self-report. RESULTS: Itch induced by audiovisual stimuli was inferior to itch induced by histamine iontophoresis in the absence of dermal priming. However, in the case of priming, maximal itch induced by audiovisual stimuli was not inferior to maximal itch induced by histamine iontophoresis. Additionally, differences in itch quality and location were observed. CONCLUSIONS: The finding that maximal audiovisually-induced itch was comparable with maximal histamine itch only after priming emphasizes that attention plays a dominant role in mentally-induced itch. The comparability of maximal histamine and audiovisually-induced itch in the case of priming opens up new research opportunities. What's already known about this topic? Itch is a multidimensional sensation that is altered by, among other things, attention. To induce itch in basic research, different methods are used, which are partially invasive or cause skin manipulation. Noninvasive audiovisual stimuli can be used to induce itch. What does this study add? This study investigated whether itch induced by audiovisual stimuli is noninferior to itch induced by histamine iontophoresis. Itch induced by audiovisual stimuli is noninferior with regard to maximal intensity in the case of priming. Noninferiority was not shown in the case of no priming, emphasizing the role of attention in itch induction. Histamine and audiovisually-induced itch differ in terms of quality and location, but not in affective reaction.

[Psychological aspects of pruritus and therapy options]. / Psychische Aspekte bei Pruritus und Therapieoptionen.

BACKGROUND: Besides biological factors, which cause or influence chronic pruritus, more and more attention has recently also been paid to psychological and psychoneuroimmunological factors which uphold the symptom. OBJECTIVES: This review article gives an overview of the state of research regarding psychological and psychoneuroimmunological factors and the resulting therapeutic options. MATERIALS AND METHODS: The article is based on a literature search in the PubMed database. RESULTS: Under experimental conditions, pruritus can be induced by verbal instructions and modulated by placebo and nocebo effects. Stressful life events can also induce pruritus or its exacerbation. This can also be demonstrated on a cellular level. CONCLUSION: The knowledge that pruritus intensity is modulated by cognitions, behavioral factors, and stress is important for the development and application of psychological interventions. More research should be done regarding psychological interventions in the treatment of chronic itch and they should be applied clinically more often.

Role of personality and expectations for itch and scratching induced by audiovisual itch stimuli.

Itch is an unpleasant, bodily sensation, which--similar to pain--evokes behavioral reactions. As a response to itch, people start scratching. There are different ways to provoke itch and subsequent scratching in experimental settings. A non-invasive method to induce itch and scratching is the presentation of itch-related (audio-) visual stimulus material, like slide-supported lectures on skin diseases or crawling insects. Also, watching videos showing other people scratching provokes itch and the desire to scratch. In this review, we focus on psychological factors, which were shown to be associated with itch and scratching provoked by (audio-) visual itch stimuli. First, we summarize the findings on the relationship between personality characteristics and (audio-) visually induced itch. Agreeableness and self-consciousness were shown to be associated with induced itch and scratching in patients with chronic skin diseases, while neuroticism was linked to induced itch in healthy subjects. Second, we present results of a recent study, in which we altered the expectations towards audio-visually induced itch and scratching by changing the information given on upcoming itch stimuli. It was shown that subjects being informed about itch stimuli in a neutral way displayed a shorter scratch duration in itch inducing situations than subjects having catastrophizing expectations. Also, the increase in scratch duration and in the number of scratch movements induced by audiovisual itch stimuli was higher when the patients were not informed about itch induction. Thus, in itch patients neither catastrophizing nor trivializing symptoms seems to be helpful.

Agreeableness and Self-Consciousness as Predictors of Induced Scratching and Itch in Patients with Psoriasis.

BACKGROUND: Psoriasis (PS) is a frequent skin disease accompanied by itch, a symptom that has been shown to be related to depression and self-consciousness. PS patients describe themselves as more agreeable than healthy controls (HC), a trait that might be protective against impulsive scratching. PURPOSE: This study is the first to analyze the relationship between agreeableness and induced scratching and between depression, self-consciousness, and induced itch in PS patients. METHODS: Twenty-four PS patients and 24 HC were shown two videos: an itch-inducing experimental video (EV) and a non-itch-inducing control video (CV). Induced itch/scratching was determined by calculating the difference in itch intensity/number of scratch movements between EV and CV. Validated questionnaires were used to measure agreeableness, depression, and self-consciousness. RESULTS: In accordance with our hypothesis, in PS patients, public self-consciousness was significantly positively associated with induced itch (r = 0.564; p < 0.001), and agreeableness was significantly negatively associated with induced scratching (r = -0.444; p < 0.05). In HC, the relationship between public self-consciousness and induced itch and between agreeableness and induced scratching were positive, but not significant. CONCLUSIONS: This study showed distinct findings for PS patients and HC regarding the relationship between agreeableness and induced scratching. The relationship between public self-consciousness and induced itch was positive in both groups. The distinct finding regarding agreeableness supports the idea that scoring low on this scale might be a protective factor for scratching in PS patients. Future research should investigate mediating factors of the outlined relationships.

Contagious itch: what we know and what we would like to know.

All humans experience itch in the course of their life. Even a discussion on the topic of itch or seeing people scratch can evoke the desire to scratch. These events are coined "contagious itch" and are very common. We and others have shown that videos showing people scratching and pictures of affected skin or insects can induce itch in healthy persons and chronic itch patients. In our studies, patients with atopic dermatitis (AD) were more susceptible to visual itch cues than healthy. Also, personality traits like agreeableness and public self-consciousness were associated with induced scratching in skin patients, while neuroticism correlated with induced itch in healthy subjects. The underlying course of contagious itch is not yet fully understood. It is hypothesized that there are human mirror neurons that are active when we imitate actions and/or negative affect. Until now, there has been only limited data on the mechanisms of brain activation in contagious itch though. We have barely begun to understand the underlying physiological reactions and the triggering factors of this phenomenon. We summarize what we currently know about contagious itch and provide some suggestions what future research should focus on.

Role of illness representations and coping in patients with atopic dermatitis: a cross-sectional study.

BACKGROUND: Atopic dermatitis (AD) is a skin disease accompanied by psychological burden. It has been shown for other chronic diseases that illness representations and coping strategies are associated with disease-related burden and other outcome variables like time until patients return to work or health care use. OBJECTIVE: The goal of this cross-sectional study was to investigate whether illness representations and coping strategies are correlated with the severity of AD and self-rated physical impairment of the patients. METHODS: A total of 109 AD patients were examined at the beginning of their stay at a rehabilitation centre. They filled in validated questionnaires to measure illness perceptions (IPQ), coping strategies (EBS) and self-rated physical well-being (FEW). In addition, the severity of AD (SCORAD) was determined by a doctor. RESULTS: Linear regression analysis revealed that a considerable amount of the variance in self-rated physical well-being (51%) could be predicted by particular illness perceptions and coping. Subsequent multiple mediation analyses indicated that certain coping strategies (active problem solving and depressive reactions) mediated the effect of illness representations on self-rated physical well-being. In contrast, only 7.4% of the SCORAD could be predicted by the IPQ scale illness identity. CONCLUSION: This study showed that illness representations and coping are highly associated with self-rated physical impairment in AD patients. Therefore, this patient group might profit from cognitive behavioural interventions designed to alter patients' illness perceptions. The hypothesis that a modification in illness perceptions leads to a faster recovery and a more rapid return to work should be tested in future randomized controlled trials.

[Itch and psyche]. / Juckreiz und Psyche.

Itch is as an unpleasant sensation that is considered as unique, although many similarities to pain exist. Itch is a cardinal symptom in skin diseases like atopic dermatitis or urticaria, but itch is also frequently observed in the general population. Often itch is associated with a decrease in quality of life. Additionally associations between itch and psychological variables like psychological stress, the emotional state and personality factors are shown. In experimental studies itch can be induced not only by the use of pruritogens (e.g. histamine), but also by the presentation of audiovisual stimuli. Because of these factors a biopsychosocial model is postulated regarding the occurrence of itch. In addition to medical treatments, psychological interventions like habit-reversal training or relaxation techniques are used to successfully treat itch. These interventions have positive effects, not only on the psychological well-being, but also on the skin status of patients.

Development of an ELISA for sulfachlorpyridazine and investigation of matrix effects from different sample extraction procedures.

The development of an enzyme-linked immunosorbent assay (ELISA) for the detection of residues of sulfachlorpyridazine (SCP) is described for the first time. The assay is highly specific for SCP, is simple to perform and has a lower detection limit of 0.65 ng/ml in assay buffer. In potential application of the assay to detect residues of SCP at the 0.1 mg/kg level in eggs, milk, beef, lamb, pork, chicken, turkey, porcine kidney, porcine liver and pig feedstuffs is discussed with regard to the effects of sample extracts on the standard curves. The antibody exhibits a rare stability in assay buffers containing up to 30% methanol. It is concluded that the ELISA for SCP has the appropriate characteristics for development into a robust method for the detection of this sulphonamide in agri-food materials.