Information and consensus document for the diagnostic and therapeutic management of pruritus associated with chronic kidney disease in patients on haemodialysis in Spain.

Chronic kidney disease-associated pruritus (CKD-aP) is one of the most common and disabling comorbidities in patients with advanced CKD. In addition, it is associated with an increased risk of mortality, poorer quality of life, sleep disorders, mental health disorders, and increased use of health care resources. The clinical presentation of CKD-aP is very heterogeneous, making it difficult to diagnose and treat. Currently, there are no national guidelines on the management of CKD-aP. The aim of this document is to provide national consensus recommendations for the diagnostic and therapeutic management of CKD-aP. The document was prepared in three phases: a diagnostic and therapeutic management algorithm was proposed by a small group of nephrology specialists; the proposal was validated by a larger group of nephrologists; and a second validation by a multidisciplinary group that also included dermatology specialists. The diagnostic and therapeutic management algorithm attempts to cover the current need of a lack of specific guidelines for the adequate management of CKD-aP. At the same time, it introduces the use of difelikefalin, the first and only drug specifically approved for CKD-aP, with a good safety and efficacy profile.

A new paradigm in the management of scalp pruritus: findings from the SCALP-PR trial.

PURPOSE: The "Impact of scalp pruritus in dermatological consultations in Spain: The SCALP-PR trial" was initiated to address the common yet often insufficiently examined issue of scalp pruritus in dermatology. This condition leads to an uncontrollable urge to scratch, affecting the patients' quality of life and potentially causing scalp damage. This study aimed to explore the prevalence, patient profile, underlying conditios, and therapeutic approaches for scalp pruritus in Spain, and to assess the safety and efficacy profile, as well as the tolerability of a non-pharmacologic treatment. METHODS: From 2021 through 2022, 75 dermatologists enrolled a total of 359 patients in a study on scalp pruritus, approved by the Bellvitge University Hospital Research Ethics Committee, Barcelona, Spain. This evidence-based research combined a meta-analysis with observational study techniques focused on real-world evidence to examine the therapeutic impact on quality of life (QoL). Utilizing the Dermatology Life Quality Index (DLQI) for QoL assessments, the study evaluated the effectiveness of the topical product over 15 days. Data collection was conducted via an eCRF and analyzed with statistical methods to provide reliable insights into the management of scalp pruritus. RESULTS: The prevalence of scalp pruritus in Spain was found to be 6.9%, predominantly among women with a mean age of 52.5 years. The leading causes identified were seborrheic dermatitis and pruritus of undetermined etiology or sensitive scalp. Stress was noted as a key factor, with corticosteroids and hygienic measures being common therapies. The topical product demonstrated significant reductions in pruritus and scratching in more than 90% of patients after 15 days. Improvements were also seen in dermatological quality of life, with 87.1% of patients showing enhancements in DLQI scores. The product was well-received thanksto its cosmetic properties, with high ratings in texture, ease of application, and fragrance. CONCLUSION: The topical product studied is a safe, effective, and cosmetically appealing treatment, improving scalp pruritus in various etiologies for most patients. The results highlight the need for patient-center treatments in dermatology, providing important insights for clinical practice and future research.

Pruritus in burn victims: relationship with anxiety, depression, and post-traumatic stress / Prurido em vítimas de queimaduras: relaçãocom ansiedade, depressão e estresse pós-traumático

Objetivos: Avaliar a relação entre a intensidade do prurido e os escores de ansiedade, depressão, estresse pós-traumático e a qualidade de vida relacionada à saúde em pacientes vítimas de queimaduras. Método: Estudo transversal, realizado em dois ambulatórios de hospitais de queimados localizados em municípios do interior paulista. A amostra foi constituída por 60 pacientes que responderam aos instrumentos de caracterização sociodemográfica e clínica, Escala Visual Numérica para avaliação da intensidade do prurido, Escala Hospitalar de Ansiedade e Depressão, Escala de Impacto de Eventos para avaliação do estresse pós-traumático e a versão brasileira da Freiburg Life Quality Assessment Wound. Resultados: A amostra caracterizou-se pelo predomínio do sexo masculino (73%). Correlações positivas significativas foram encontradas entre a intensidade de prurido e ansiedade (r=0,33), depressão (r=0,53), estresse pós-traumático (r=0,43) e escore total da Freiburg Life Quality Assessment Wound (r=0,63). Conclusão: Esses achados reforçam a importância da avaliação do prurido na atenção integral à vítima de queimadura visando à redução do impacto psicológico e melhora na qualidade de vida relacionada à saúde. (AU)

Objective: To assess the relationship between pruritus intensity and anxiety, depression, post-traumatic stress, and health-related quality of life scores in burn victims. Methods: A cross-sectional study, carried out in two outpatient clinics of burn hospitals located in municipalities in the countryside of São Paulo. The sample consisted of 60 patients who answered sociodemographic and clinical characterization instruments: the Visual Numerical Scale, to assess pruritus intensity, the Hospital Anxiety and Depression Scale, the Impact of Events Scale, to assess post-traumatic stress, and the Freiburg Life Quality Assessment Wound Module to Brazilian Portuguese. Results: The sample was characterized by a predominance of males (73%). Significant positive correlations were found between pruritus intensity and anxiety (r=0.33), depression (r=0.53), post-traumatic stress (r=0.43), and total Freiburg Life Quality Assessment Wound score (r=0.63). Conclusions: These findings reinforce the importance of assessing pruritus in comprehensive care for burn victims, aiming to reduce the psychological impact and improve health-related quality of life. (AU)

Objetivo: Evaluar la relación entre la intensidad del prurito y las puntuaciones de ansiedad, depresión, estrés postraumático y la calidad de vida relacionada a la salud en pacientes víctimas de quemaduras. Método: Estudio transversal, realizado en dos ambulatorios de hospitales de quemados ubicados en municipios del interior de São Paulo. La muestra se constituyó por 60 pacientes que respondieron a los instrumentos de caracterización sociodemográfica y clínica, Escala Visual Numérica para evaluación de la intensidad del prurito, Escala Hospitalaria de Ansiedad y Depresión, Escala de Impacto de Eventos para evaluación del estrés postraumático y la versión brasileña de la Freiburg Life Quality Assessment Wound. Resultados: La muestra se caracterizó por el sexo masculino (el 73%). Correlaciones positivas significativas se encontraron entre la intensidad de prurito y ansiedad (r=0,33), depresión (r=0,53), estrés postraumático (r=0,43) y puntuación total de la Freiburg Life Quality Assessment Wound(r=0,63). Conclusión: Esos hallazgos refuerzan la importancia de la evaluación del prurito en la atención integral a víctimas de quemadura, buscando la reducción del impacto psicológico y la mejora en la calidad de vida relacionada a la salud. (AU)

Real-World Clinical, Psychosocial and Financial Burden of Atopic Dermatitis: Results from the Spanish Cohort of the MEASURE-AD Trial. / Carga clínica, psicosocial y económica de la dermatitis atópica en vida real: resultados de la cohorte española del estudio MEASURE-AD.

BACKGROUND: Atopic dermatitis (AD) is one of the most prevalent skin diseases, but there are numerous knowledge gaps surrounding the impact this disease has on quality of life (QoL), mental health, and out-of-pocket expenses involved in the management of AD. The available scientific evidence on the multidimensional burden of AD is usually based on studies with measures reported by patients themselves. METHODS: In this context, the MEASURE-AD trial was developed as a cross-sectional, multicenter, multinational trial using patient- and physician-reported measures to characterize the multidimensional burden of AD in adults with moderate-to-severe AD. RESULTS: This paper presents the results of the Spanish cohort. We found that Spanish adults with moderate-to-severe AD and high EASI score (21.1-72) had a significantly increased disease burden, high severity of symptoms such as itch and sleep disturbances, impaired mental health and QoL, higher use of health care resources, and more out-of-pocket expenses than patients with low EASI scores (0-7 or 7.1-21). CONCLUSIONS: This study provides information to better understand disease burden, and identify aspects to be improved in the management of AD.

Consensus on the diagnostic algorithm for chronic nodular prurigo. / Consenso sobre el algoritmo diagnóstico del prurigo crónico nodular.

Chronic nodular prurigo (CNP) is a chronic dermatological disease characterized by the presence of chronic pruritus and pruritic nodular lesions. The aim of this study was to reach consensus among a group of experts based on a non-systematic literature review and an algorithm for the clinical diagnosis of CNP. The resulting algorithm is structured in 3 blocks: 1) early identification of the patient with a possible diagnosis of CNP; 2) diagnosis and assessment of CNP; and 3) categorization of CNP (identification of the underlying causes or associated comorbidities). We believe that this clinical algorithm can facilitate the correct diagnosis of patients with CNP. Additionally, it raises awareness on the need for a multidisciplinary approach and specific treatment of CNP, steps of paramount importance to make better therapeutic decisions.

Manifestaciones dermatológicas de la cirrosis hepática: revisión de la literatura / Dermatological manifestations of liver cirrhosis: review of the literature

La piel y sus anexos tienen amplia relación con todos los órganos y sistemas. Los cambios presentes en estos pueden ser el primer hallazgo en un paciente con enfermedad hepática, encontrándose hasta en el 20 % de los casos, por lo que las manifestaciones extrahepáticas adquieren importancia, y aunque muchas de estas no son específicas, algunos marcadores dermatológicos pueden ayudar al diagnóstico de la enfermedad y se pueden correlacionar con su severidad. El desarrollo de las lesiones cutáneas en los pacientes con cirrosis hepática se genera principalmente por hipertensión portal y exceso de estrógenos circulantes, por lo tanto, su tratamiento se basa en el manejo de la patología hepática subyacente. En el presente artículo se hace una revisión de la literatura y se describe un amplio espectro de manifestaciones dermatológicas asociadas a cirrosis hepática, con sus características y etiopatogénesis, siendo las más frecuentes la ictericia, el prurito, los nevus en araña, el eritema palmar, las venas en cabeza de Medusa, y los cambios de uñas y del vello, entre otras.

The skin and its annexes have a broad relationship with all organs and systems. Changes present in these can be the initial finding in a patient with liver disease, occurring in up to 20% of cases, therefore the extrahepatic manifestations become important, and although many of these are not specific, some dermatological markers can help in the diagnosis of the disease and may correlate with its severity. The development of cutaneous lesions in patients with liver cirrhosis is mainly generated by portal hypertension and excess of circulating estrogens, therefore their treatment is based on managing the underlying liver pathology. This article reviews the literature and describes a wide range of dermatological manifestations associated with liver cirrhosis, with their characteristics and etiopathogenesis, being the most frequent jaundice, pruritus, spider nevus, palmar erythema, caput Medusae veins, nail and hair changes, among others.

Manifestaciones cutáneas comunes de las principales enfermedades hepáticas / Common cutaneous manifestations of major liver diseases

Las enfermedades hepáticas presentan múltiples manifestaciones sistémicas, entre las cuales se destacan los hallazgos en piel, siendo los más comunes el prurito y la ictericia; así mismo, se pueden encontrar angiomas en araña, eritema palmar, xantomas, vasculitis y cambios en anexos. Este artículo tiene como objetivo describir los principales signos y síntomas cutáneos en las enfermedades hepáticas para brindar herramientas semiológicas al clínico en su práctica diaria

Liver disease present multiple systemic manifestations, among which skin findings stand out, being the most common pruritus and jaundice. Other findings can also be manifested like spider angiomas, palmar erythema, xanthomas, vasculitis and changes in skin appendages. The objective of this article is to describe the main skin signs and symptoms of liver diseases to provide semiological tools to the physician in his daily practice.

Pruritus and Cutaneous Lesions: Granuloma Annulare vs. Mycosis Fungoides in a Pa-tient with Comorbidities. Case Report

Introduction: Pruritus is a common symptom in dermatological practice. Affecting patients with a wide range of cutaneous and systemic diseases. It can be caused by cutaneous disorders, systemic diseases, neurological disorders, psychological disorders, medications, among others. When assessing individuals with pruritus and cutaneous lesions, it is essential to consider mycosis fungoides and granuloma annulare as noteworthy differential diagnoses. Case presentation: A 51-year-old female patient exhibited symptoms of pruritus and two occurrences of pruritic skin lesions. Accompanied by a low-grade fever measuring 37.7 ºC, as well as asthenia and myalgia. Physical examination revealed two rounded plaques with erythematous borders and multiple non-confluent papular lesions. Discussion: Differentiating between mycosis fungoides and granuloma annulare can be challenging due to the similarities in their clinical presentations. However, performing a biopsy is essential to reach a definitive diagnosis.Conclusions: A biopsy is being suggested for the front part of the left lower limb. The application of mometasone furoate twice a day for two weeks was prescribed. Subsequently, a meeting has been arranged to conduct a review and to carefully analyze the biopsy findings within thirty days.

Introducción: El prurito es un síntoma frecuente en la práctica dermatológica, que afecta a pacientes con una amplia gama de enfermedades cutáneas y sistémicas. Puede estar causado por trastornos cutáneos, enfermedades sistémicas, trastornos neurológicos, trastornos psicológicos y medicamentos, entre otros. En la evaluación de personas con prurito y lesiones cutáneas, es fundamental tener en cuenta la micosis fungoide y el granuloma anular como diagnósticos diferenciales destacables. Presentación del caso clínico: Una paciente de 51 años de edad presentaba síntomas de prurito y dos apariciones de lesiones cutáneas pruriginosas, acompañadas de fiebre baja de 37.7 ºC, así como astenia y mialgias. El examen físico reveló dos placas redondeadas con bordes eritematosos y múltiples lesiones papulares no confluentes. Discusión: Diferenciar entre micosis fungoide y granuloma anular puede ser un reto debido a las similitudes en sus presentaciones clínicas. Sin embargo, la realización de una biopsia es esencial para llegar a un diagnóstico definitivo. Conclusiones:Se sugiere la realización de una biopsia en la parte anterior del miembro inferior izquierdo. Se prescribe la aplicación de furoato de mometasona dos veces al día durante dos semanas. Posteriormente, se ha concertado una reunión para realizar una revisión y deliberar sobre los resultados de la biopsia en un plazo de treinta días

Prevalence of Demodex spp. in patients with chronic blepharitis.

Blepharitis is a very common disease in ophthalmology, dermatology and allergy practice. It generally follows a chronic course and is frequently associated with objective and/or subjective symptoms such as epiphora, red eye, dandruff, gritty sensation, itching, burning, photophobia, and blurred vision. The purpose of this study is to analyze the prevalence of Demodex spp. in patients with symptoms of chronic blepharitis. An analytical cross-sectional study was conducted in the period between 2016 and 2020. All patients with symptoms of chronic blepharitis who underwent a parasitological test of eyelashes (Rapitest) in the Dermatology Department of the Hospital Italiano de Buenos Aires were included. Those with previously established blepharitis due to another infectious cause were excluded. We analyzed 972 patients. Sixty percent (n=585) underwent a positive Rapitest for the presence of Demodex spp. Seventy five percent (n=728) were women. There were no significant differences in the prevalence associated with sex (p=0.38). Among the patients positive for Demodex spp., 65% (n=628) were older than 60 years old. The most frequently associated symptom was itching, present in 35% (n=342). A statistically significant decrease in the number of consultations was observed during the cold months of the year (May-June-July-August). Our results show a high prevalence of Demodex spp. in patients with chronic blepharitis. As its presence reveals a direct association with age, we recommend looking for this parasite in this age group.

Lo que esconde un prurito de larga evolución / What is hidden by extended course itching

Se presenta el caso de una mujer de 74 años que refiere prurito leve generalizado de 3 meses de evolución con aumento progresivo del mismo. Tras un seguimiento por parte de su médico de familia por la gran sintomatología referida, a pesar de seguir tratamiento con antihistamínicos y pauta corticoidea, y habiendo descartado analíticamente patología orgánica, se decide derivar a dermatología, donde finalmente se diagnostica penfigoide ampolloso autoinmune.(AU)

We report a 74-year-old woman with a gradual increase in generalized itching over three months. After her doctor’s monitoring because of her major symptoms and despite having been treated with antihistamines and corticosteroids, organic pathology was ruled out analytically. The patient was referred to dermatology where she was diagnosed with autoimmune bullous pemphigoid.(AU)

Prurito en dermatología. Enfermedades y su tratamiento. Parte 2 / Pruritus in Dermatology: Part 2 — Diseases and Their Treatment

El prurito es el síntoma principal en múltiples enfermedades dermatológicas y sistémicas. La dermatitis atópica, la psoriasis, la dermatitis de contacto, la urticaria, el liquen simple crónico, la micosis fungoides, las cicatrices, las enfermedades autoinmunes, la enfermedad renal o hepática crónica, entre otras, asocian prurito que puede requerir un manejo terapéutico distinto. Aunque los antihistamínicos parecen ser la primera línea de tratamiento, en realidad su papel queda limitado a la urticaria y reacciones por fármacos, ya que los mecanismos fisiopatológicos de cada una de las entidades tratadas a lo largo de este manuscrito serán distintas. En estos últimos años han aparecido nuevas moléculas para el tratamiento del prurito, con perfiles de eficacia y seguridad muy atractivos para su uso en práctica clínica. Sin duda, es un momento crucial para el desarrollo de la dermatología en el campo del prurito, y una oportunidad para ser más exigentes con los objetivos a alcanzar en estos pacientes (AU)

Pruritus is the main symptom of many dermatologic and systemic diseases. Atopic dermatitis, psoriasis, contact dermatitis, urticaria, lichen simplex chronicus, mycosis fungoides, scars, autoimmune diseases, kidney or liver diseases among others are all associated with itch that may require different approaches to management. Although antihistamines seem to be the first line of therapy, in reality their role is limited to urticaria and drug-induced reactions. In fact, the pathophysiologic mechanisms of each of the conditions covered in this review will differ. Recent years have seen the emergence of new drugs whose efficacy and safety profiles are very attractive for the management of pruritus in clinical practice. Clearly we are at a critical moment in dermatology, in which we have the chance to be more ambitious in our goals when treating patients with pruritus (AU)

[Translated article] Pruritus in Dermatology: Part 2—Diseases and Their Treatment / Prurito en dermatología. Enfermedades y su tratamiento. Parte 2

Pruritus is the main symptom of many dermatologic and systemic diseases. Atopic dermatitis, psoriasis, contact dermatitis, urticaria, lichen simplex chronicus, mycosis fungoides, scars, autoimmune diseases, kidney or liver diseases among others are all associated with itch that may require different approaches to management. Although antihistamines seem to be the first line of therapy, in reality their role is limited to urticaria and drug-induced reactions. In fact, the pathophysiologic mechanisms of each of the conditions covered in this review will differ. Recent years have seen the emergence of new drugs whose efficacy and safety profiles are very attractive for the management of pruritus in clinical practice. Clearly we are at a critical moment in dermatology, in which we have the chance to be more ambitious in our goals when treating patients with pruritus (AU)

El prurito es el síntoma principal en múltiples enfermedades dermatológicas y sistémicas. La dermatitis atópica, la psoriasis, la dermatitis de contacto, la urticaria, el liquen simple crónico, la micosis fungoides, las cicatrices, las enfermedades autoinmunes, la enfermedad renal o hepática crónica, entre otras, asocian prurito que puede requerir un manejo terapéutico distinto. Aunque los antihistamínicos parecen ser la primera línea de tratamiento, en realidad su papel queda limitado a la urticaria y reacciones por fármacos, ya que los mecanismos fisiopatológicos de cada una de las entidades tratadas a lo largo de este manuscrito serán distintas. En estos últimos años han aparecido nuevas moléculas para el tratamiento del prurito, con perfiles de eficacia y seguridad muy atractivos para su uso en práctica clínica. Sin duda, es un momento crucial para el desarrollo de la dermatología en el campo del prurito, y una oportunidad para ser más exigentes con los objetivos a alcanzar en estos pacientes (AU)

Manejo Clínico ­ Quirúrgico de pacientes con Fisura Anal en la Unidad de Coloproctología del HECAM / Clinical-Surgical Management of patients with Anal Fissure in the Unit HECAM Coloproctology

La fisura anal es una de las enfermedades más antiguamente descritas, la misma que, ha tenido hasta el momento múltiples tratamientos tanto médicos como quirúrgicos, existiendo controversias en su algoritmo terapéutico. Constituye una de las patologías cuyo diagnóstico y tratamiento corresponde a la Especialidad de Coloproctología, afecta a ambos sexos y a cualquier edad y puede ser aguda o crónica. Proponemos el presente Protocolo para un adecuado manejo de la patología, de manera que sirva de guía en la toma correcta de decisiones basadas en la evidencia y el consenso de quienes integramos la Unidad Técnica de Coloproctología del Hospital de Especialidades Carlos Andrade Marín.

Anal fissure is one of the oldest described diseases, which has so far had multiple medical and surgical treatments, with controversies in its therapeutic algorithm. It is one of the pathologies whose diagnosis and treatment corresponds to the Coloproctology Specialty, it affects both sexes and any age and can be acute or chronic. We propose the present Protocol for an adequate management of the pathology, so that it serves as a guide in the correct decision making based on evidence and consensus of those who integrate the Technical Unit of Coloproctology of the Hospital de Especialidades Carlos Andrade Marín.

Prurito en dermatología. Generalidades y pruritógenos. Parte 1 / Pruritus in Dermatology: Part 1 — General Concepts and Pruritogens

El prurito es el síntoma más frecuente asociado a enfermedades dermatológicas y sistémicas. Su diagnóstico es clínico, aunque en ocasiones será necesario realizar pruebas complementarias para identificar o confirmar el origen. La medicina traslacional ha permitido descubrir nuevos mediadores pruritógenos y nuevos receptores. Saber reconocer adecuadamente la principal vía por la que media el prurito en cada paciente será clave para el éxito terapéutico. La vía histaminérgica predomina en enfermedades como la urticaria o las reacciones a fármacos, mientras que la vía no histaminérgica predomina prácticamente en la mayoría de las otras dermatosis incluidas en esta revisión. La clasificación del prurito, las pruebas complementarias, la fisiopatología y los pruritógenos implicados, incluyendo citoquinas y otras moléculas, así como la sensibilización central al prurito que sufren estos pacientes formarán parte de este primer manuscrito sobre el prurito (AU)

Pruritus is the most common symptom of dermatologic and systemic diseases. The diagnosis of pruritus is clinical, although additional tests may be necessary to identify or confirm the cause. Translational medicine has led to the discovery of new mediators of itch, or pruritogens, as well as new receptors. Knowing how to properly recognize the main pathway that mediates itch in each patient is the key to successful treatment. Although the histaminergic pathway predominates in conditions like urticaria or drug-induced pruritus, it is the nonhistaminergic pathway that predominates in nearly all other skin diseases covered in this review. Part 1 of this 2-part review discusses the classification of pruritus, additional testing, the pathophysiology of itch and the pruritogens implicated (including cytokines and other molecules), and central sensitization to itch (AU)

[Translated article] Pruritus in Dermatology: Part 1-General Concepts and Pruritogens / Prurito en dermatología. Generalidades y pruritógenos. Parte 1

Pruritus is the most common symptom of dermatologic and systemic diseases. The diagnosis of pruritus is clinical, although additional tests may be necessary to identify or confirm the cause. Translational medicine has led to the discovery of new mediators of itch, or pruritogens, as well as new receptors. Knowing how to properly recognize the main pathway that mediates itch in each patient is the key to successful treatment. Although the histaminergic pathway predominates in conditions like urticaria or drug-induced pruritus, it is the nonhistaminergic pathway that predominates in nearly all other skin diseases covered in this review. Part 1 of this 2-part review discusses the classification of pruritus, additional testing, the pathophysiology of itch and the pruritogens implicated (including cytokines and other molecules), and central sensitization to itch (AU)

El prurito es el síntoma más frecuente asociado a enfermedades dermatológicas y sistémicas. Su diagnóstico es clínico, aunque en ocasiones será necesario realizar pruebas complementarias para identificar o confirmar el origen. La medicina traslacional ha permitido descubrir nuevos mediadores pruritógenos y nuevos receptores. Saber reconocer adecuadamente la principal vía por la que media el prurito en cada paciente será clave para el éxito terapéutico. La vía histaminérgica predomina en enfermedades como la urticaria o las reacciones a fármacos, mientras que la vía no histaminérgica predomina prácticamente en la mayoría de las otras dermatosis incluidas en esta revisión. La clasificación del prurito, las pruebas complementarias, la fisiopatología y los pruritógenos implicados, incluyendo citoquinas y otras moléculas, así como la sensibilización central al prurito que sufren estos pacientes formarán parte de este primer manuscrito sobre el prurito (AU)

Etiopathogenesis of chronic kidney disease-associated pruritus: putting the pieces of the puzzle together.

Defined as the unpleasant sensation that causes the desire to scratch, pruritus is the most common skin symptom associated with uremia and appears in almost half of patients with advanced chronic kidney disease (CKD). Beyond its direct impact on quality of life, CKD-associated pruritus (CKD-aP) is an independent predictor of mortality that also has a synergistic effect with other quality of life-related symptoms, such as insomnia, depression, and anxiety. Although different mechanisms have been proposed to explain the origin of Pa-ERC, its etiopathogenesis is still not fully understood. Since new therapeutic targets have been identified and several clinical trials have recently shown promising results, our current understanding of the interrelationships has expanded significantly and the pathophysiological mechanisms underlying CKD-aP are now considered to be multifactorial. The potential triggers of pruritus in patients with CKD are discussed in this review, including hypotheses about skin xerosis, accumulation of uremic toxins, dysregulation of the immune system and systemic inflammation, uremic neuropathy, and imbalances in the endogenous opioid system. Other non-uremic causes of pruritus are also discussed, with the aim of guiding the physicians to apply an adequate aetiopathogenic approach to CKD-aP in their day-to-day clinical practice.

Perception of Spanish nephrologists on an old unsolved problem: Pruritus associated with chronic kidney disease (CKD-aP).

INTRODUCTION: Pruritus associated with chronic kidney disease is defined as the sensation of itching, in people with chronic kidney disease, in a one area or all over the body that causes the need to scratch, after having ruled out other dermatological or systemic causes. It is an old and known problem whose prevalence has been able to decrease with the improvement of dialytic techniques but which still persists and is underdiagnosed. OBJECTIVES: The objective of this study was to analyse the current perception of nephrologists about this problem that influences the quality of life of people with chronic kidney disease through a survey. RESULTS: 135 nephrologists, most of them engaged in haemodialysis, participated. 86% considered that pruritus associated with chronic kidney disease is still a problem today that affects the quality of life. Most nephrologists believe that the main pathophysiological cause is uremic toxins (60%) and only 16% believe that it is due to the dysregulation of the opioid system/endorphins-dynorphins. Only 16% comment that the prevalence of pruritus in their centre is greater than 20%. 40% believe that the diagnosis is made because it is manifested by the patient and only 27% because it is asked by the doctor. Moreover, it is not usual to use scales to measure it or the codification in the medical records. The main treatment used is antihistamines (96%), followed by moisturizers/anaesthetics (93%) and modification of the dialysis regimen (70%). CONCLUSIONS: Pruritus associated with chronic kidney disease is still a current problem, it is underdiagnosed, not codified and with a lack of indicated, effective and safe treatments. Nephrologists do not know its real prevalence and the different pathophysiological mechanisms involved in its development. Many therapeutic options are used with very variable results, ignoring their efficacy and applicability at the present time. The new emerging kappa-opioid-receptor agonist agents offer us an opportunity to reevaluate this age-old problem and improve the quality of life for our patients with chronic kidney disease.

Pruritus in Dermatology: Part 2 - Diseases and Their Treatment. / Prurito en dermatología. Enfermedades y su tratamiento. Parte 2.

Pruritus is the main symptom of many dermatologic and systemic diseases. Atopic dermatitis, psoriasis, contact dermatitis, urticaria, lichen simplex chronicus, mycosis fungoides, scars, autoimmune diseases, kidney or liver diseases among others are all associated with itch that may require different approaches to management. Although antihistamines seem to be the first line of therapy, in reality their role is limited to urticaria and drug-induced reactions. In fact, the pathophysiologic mechanisms of each of the conditions covered in this review will differ. Recent years have seen the emergence of new drugs whose efficacy and safety profiles are very attractive for the management of pruritus in clinical practice. Clearly we are at a critical moment in dermatology, in which we have the chance to be more ambitious in our goals when treating patients with pruritus.

Pruritus in Dermatology: Part 1 - General Concepts and Pruritogens. / Prurito en dermatología. Generalidades y pruritógenos. Parte 1.

Pruritus is the most common symptom of dermatologic and systemic diseases. The diagnosis of pruritus is clinical, although additional tests may be necessary to identify or confirm the cause. Translational medicine has led to the discovery of new mediators of itch, or pruritogens, as well as new receptors. Knowing how to properly recognize the main pathway that mediates itch in each patient is the key to successful treatment. Although the histaminergic pathway predominates in conditions like urticaria or drug-induced pruritus, it is the nonhistaminergic pathway that predominates in nearly all other skin diseases covered in this review. Part 1 of this 2-part review discusses the classification of pruritus, additional testing, the pathophysiology of itch and the pruritogens implicated (including cytokines and other molecules), and central sensitization to itch.

Etiopatogenia del prurito asociado a la enfermedad renal crónica: recomponiendo las piezas del puzle / Etiopathogenesis of chronic kidney disease-associated pruritus: Putting the pieces of the puzzle together

Definido como la sensación desagradable que provoca el deseo de rascarse, el prurito es el síntoma cutáneo más frecuente asociado a la uremia, pudiendo aparecer en casi la mitad de los pacientes con enfermedad renal crónica (ERC) avanzada. Más allá de su repercusión directa sobre la calidad de vida, el prurito asociado a la ERC (Pa-ERC) es un predictor independiente de mortalidad que además ejerce un efecto sinérgico con otros síntomas también relacionados con la calidad de vida, como la depresión y el insomnio. Aunque se han propuesto diferentes mecanismos para explicar su origen, la etiopatogenia del Pa-ERC sigue sin conocerse por completo. Dado que se han identificado nuevas dianas terapéuticas y recientemente varios ensayos clínicos han mostrado resultados prometedores, nuestra comprensión actual de las interrelaciones se ha ampliado significativamente, considerando multifactoriales los mecanismos fisiopatológicos subyacentes al Pa-ERC. En la presente revisión se discuten los potenciales factores desencadenantes de prurito en el paciente con ERC, incluyendo las hipótesis sobre la xerosis cutánea, el acúmulo de toxinas urémicas, la desregulación del sistema inmune y la inflamación sistémica, la neuropatía urémica y los desequilibrios en el sistema opioide endógeno, así como otras causas no urémicas de prurito, con el objetivo de orientar al clínico para realizar un adecuado abordaje etiopatogénico del Pa-ERC en su día a día. (AU)

Defined as the unpleasant sensation that causes the desire to scratch, pruritus is the most common skin symptom associated with uremia and appears in almost half of patients with advanced chronic kidney disease (CKD). Beyond its direct impact on quality of life, CKD-associated pruritus (CKD-aP) is an independent predictor of mortality that also has a synergistic effect with other quality of life-related symptoms, such as insomnia, depression, and anxiety. Although different mechanisms have been proposed to explain the origin of Pa-ERC, its etiopathogenesis is still not fully understood. Since new therapeutic targets have been identified and several clinical trials have recently shown promising results, our current understanding of the interrelationships has expanded significantly and the pathophysiological mechanisms underlying CKD-aP are now considered to be multifactorial. The potential triggers of pruritus in patients with CKD are discussed in this review, including hypotheses about skin xerosis, accumulation of uremic toxins, dysregulation of the immune system and systemic inflammation, uremic neuropathy, and imbalances in the endogenous opioid system. Other non-uremic causes of pruritus are also discussed, with the aim of guiding the physicians to apply an adequate etiopathogenic approach to CKD-aP in their day-to-day clinical practice. (AU)