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1.
Clin Infect Dis ; 73(9): 1733-1734, 2021 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-34732015
2.
Orphanet J Rare Dis ; 16(1): 473, 2021 11 08.
Artigo em Inglês | MEDLINE | ID: mdl-34749770

RESUMO

BACKGROUND: Wound management is a critical factor when treating patients with the inherited skin fragility disease dystrophic epidermolysis bullosa (DEB). Due to genetic defects in structural proteins, skin and mucous epithelia are prone to blistering and chronic wounding upon minor trauma. Furthermore, these wounds are commonly associated with excessive pruritus and predispose to the development of life-threatening squamous cell carcinomas, underscoring the unmet need for new therapeutic options to improve wound healing in this patient cohort. Vitamin D3 is acknowledged to play an important role in wound healing by modulating different cellular processes that impact epidermal homeostasis and immune responses. In this study, we evaluate the safety and efficacy of low-dose calcipotriol, a vitamin D3 analogue, in promoting wound healing and reducing itch and pain in patients with DEB. METHODS: Eligible DEB patients, aged ≥ 6 years and with a known mutation in the COL7A1 gene, were recruited to a placebo-controlled, randomized, double blind, cross-over phase II monocentric clinical trial. Patients were required to have at least two wounds with a minimum size of 6 cm2 per wound. The primary objective was to evaluate efficacy of daily topical application of a 0.05 µg/g calcipotriol ointment in reducing wound size within a 4-week treatment regimen. Secondary objectives were to assess safety, as well as the impact of treatment on pruritus, pain, and bacterial wound colonization in these patients. RESULTS: Six patients completed the clinical trial and were included into the final analysis. Topical low-dose calcipotriol treatment led to a significant reduction in wound area at day 14 compared to placebo (88.4% vs. 65.5%, P < 0.05). Patients also reported a significant reduction of pruritus with calcipotriol ointment compared to placebo over the entire course of the treatment as shown by itch scores of 3.16 vs 4.83 (P < 0.05) and 1.83 vs 5.52 (P < 0.0001) at days 14 and 28, respectively. Treatment with low-dose calcipotriol did not affect serum calcium levels and improved the species richness of the wound microbiome, albeit with no statistical significance. CONCLUSIONS: Our results show that topical treatment with low-dose calcipotriol can accelerate wound closure and significantly reduces itch, and can be considered a safe and readily-available option to improve local wound care in DEB patients. Trial Registration EudraCT: 2016-001,967-35. Registered 28 June 2016, https://www.clinicaltrialsregister.eu/ctr-search/trial/2016-001967-35/AT.


Assuntos
Epidermólise Bolhosa Distrófica , Calcitriol/análogos & derivados , Colágeno Tipo VII , Método Duplo-Cego , Humanos , Pomadas , Dor/tratamento farmacológico , Dor/etiologia , Prurido/tratamento farmacológico , Prurido/etiologia , Cicatrização
3.
BMJ Case Rep ; 14(11)2021 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-34799388

RESUMO

A 53-year-old woman presented with a 25-year history of acne excoriée and prurigo excoriée. Her symptoms began in 1988 coinciding with her husband's death from a brain tumour when she was 27. The pruritus affected her quality of life and disturbed her sleep. She had scarring on her face and body resulting from persistent scratching. The pruritus proved refractory to treatment despite a multi-modal treatment approach including multiple topicals, phototherapy and systemic agents such as isotretinoin, antibiotics, anxiolytic agents and neuromodulators. She was extremely frustrated that various treatments had been ineffective at controlling the itch-scratch cycle. She was commenced on low dose naltrexone (LDN), 3 mg nocte, and she became itch free within a few weeks. She reports that the LDN has had a beneficial impact on her quality of life.


Assuntos
Naltrexona , Prurigo , Feminino , Humanos , Isotretinoína , Pessoa de Meia-Idade , Naltrexona/uso terapêutico , Prurigo/tratamento farmacológico , Prurido/tratamento farmacológico , Prurido/etiologia , Qualidade de Vida
5.
Arq Neuropsiquiatr ; 79(10): 900-903, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34706020

RESUMO

BACKGROUND: Pruritus is a common complaint in dermatology. Wartenberg, in 1943, associated pruritus with neuropathy, relating it to the "posterior antebrachial cutaneous nerve neuropathy". In 1968, Waisman described patients with frequent pruritus complaints in the upper limb during the summer, which he named "brachioradial summer pruritus". Currently, this pruritus is named brachioradial pruritus (BRP). BRP is characterized by a chronic pruritus, usually localized, with a long duration, and without apparent cutaneous abnormalities. Neurological disorders both from the central and peripheral nervous systems, including multiple sclerosis, are associated with pruritus. OBJECTIVE: To investigate correlations between symptomatic dermatomes and alterations in the myotomes, as evidenced by electroneuromyography (ENMG). METHODS: Forty-six patients with BRP dermatological diagnoses were subjected to upper limb ENMG. RESULTS: Among 46 patients with C5 to C8 dermatomal pruritus, we evaluated 113 symptomatic dermatomal areas. Overall, 39 (85%) patients had radicular involvement and 28 (60%) had agreement between complaint and the ENMG findings (p=0.015). A total of 80% of the patients with complaints at C7 and 47% at C6 had radicular involvement at the same level. CONCLUSIONS: Among the patients who presented complaints, 47 and 80%, respectively, had ENMG alterations in the C6 and C7 myotomes. We conclude that peripheral nervous system involvement is associated with BRP.


Assuntos
Doenças do Sistema Nervoso , Prurido , Antebraço , Humanos , Masculino , Neurofisiologia , Prurido/etiologia , Pele
6.
Acta Derm Venereol ; 101(10): adv00583, 2021 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-34642766

RESUMO

Pruritus can be defined as an unpleasant sensation that evokes a desire to scratch and significantly impairs patients' quality of life. Pruritus is widely observed in many dermatoses, including mastocytosis, a rare disease characterized by abnormal accumulation of mast cells, which can involve skin, bone marrow, and other organs. Increasing evidence highlights the role of mast cells in neurogenic inflammation and itching. Mast cells release various pruritogenic mediators, initiating subsequent mutual communication with specific nociceptors on sensory nerve fibres. Among important mediators released by mast cells that induce pruritus, one can distinguish histamine, serotonin, proteases, as well as various cytokines. During neuronal-induced inflammation, mast cells may respond to numerous mediators, including neuropeptides, such as substance P, neurokinin A, calcitonin gene-related peptide, endothelin 1, and nerve growth factor. Currently, treatment of pruritus in mastocytosis is focused on alleviating the effects of mediators secreted by mast cells. However, a deeper understanding of the intricacies of the neurobiology of this disease could help to provide better treatment options for patients.


Assuntos
Mastócitos , Mastocitose , Humanos , Mastocitose/diagnóstico , Prurido/diagnóstico , Prurido/etiologia , Qualidade de Vida , Pele
7.
Intern Med ; 60(20): 3195-3203, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34657905

RESUMO

Objective This study evaluated cases of pruritus, which is known to be associated with sleep disorder, in chronic liver disease (CLD) patients. Methods Questionnaires were given to 339 enrolled CLD outpatients in winter (November 2019 to March 2020) and again in summer (April to October 2020) (median interval: 104 days). Relative changes in symptoms shown by a visual analogue scale (VAS) and Kawashima's pruritus score between winter and summer were evaluated in Study 1 (n=199), while Study 2 examined the clinical features of patients with sleep disorder based on the results of the second questionnaire (n=235, median age 70 years old; 141 men, liver cirrhosis 37%). Results Study 1. There was a significant relationship in VAS between daytime and nighttime for each season, as well as between winter and summer for each time period (p<0.001). A comparison of Kawashima's pruritus scores for the daytime and nighttime showed no significant seasonal differences (p=0.436 and 0.828, respectively). When Kawashima's score increased, so did the average VAS for both daytime (0:1:2:3:4=0.4±0.2:1.4±0.9:3.0±1.8:5.9±2.1:6.2±2.3) and nighttime (0:1:2:3:4=0.3±0.1:1.4±1.5:3.5±2.3:6.7±2.6:6.9±1.8) (p<0.001 for both). Study 2. Twenty subjects (8.5%) complained of sleep disorder. An elevated FIB-4 index (≥3.07) showed a good predictive value for sleep disorder (p<0.01). The cut-off for the daytime and nighttime VAS values for existing sleep disorder were 1.6 [area under the curve (AUC) 0.901] and 3.4 (AUC 0.931). The respective sensitivity, specificity, and positive and negative predictive values for sleep disorder based on Kawashima's score (≥2) were 0.85, 0.28, 0.10, and 0.95 for the daytime and 1.00, 0.29, 0.12, and 1.00 for the nighttime. Conclusion Intervention against pruritus is recommended in CLD patients with a high Kawashima's score (≥2) in any season, especially with an elevated FIB-4 index.


Assuntos
Hepatopatias , Transtornos do Sono-Vigília , Idoso , Humanos , Hepatopatias/complicações , Hepatopatias/epidemiologia , Masculino , Medição da Dor , Prurido/diagnóstico , Prurido/epidemiologia , Prurido/etiologia , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/etiologia , Inquéritos e Questionários
8.
Acta Derm Venereol ; 101(9): adv00562, 2021 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-34515798

RESUMO

Human hands are complex structures essential for a variety of functions in everyday life. This study prospectively investigated the clinical features of hand pruritus and the resulting functional impairment and disease-related burden in 395 patients with chronic pruritus (210 females, median age 59 years). Moderate to very severe hand pruritus was reported by 91.2% of patients, while 79% perceived additional sensory symptoms, such as burning, pain or tingling. A long duration of pruritus occurred in most cases (>6 months: 71.4%). A considerable proportion of patients showed moderate to severe impairment in the use of their hands (40.2%), performance of daily activities (65.0%) and quality of life (45.2%). Disease severity and burden is particularly high when both the palms and the backs of the hands are affected, and when pain is present simultaneously. Pruritus located on the hands is impairing and burdensome due to the functional relevance of the hands in everyday life.


Assuntos
Prurido , Qualidade de Vida , Efeitos Psicossociais da Doença , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Prurido/diagnóstico , Prurido/epidemiologia , Prurido/etiologia , Índice de Gravidade de Doença
9.
Acta Derm Venereol ; 101(10): adv00582, 2021 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-34518894

RESUMO

Keloids are scars that extend beyond the margins of an insulting cutaneous injury. Keloids are often thought to be primarily a cosmetic issue, as they are typically quite raised and pigmented. However, these scars also present with functional symptoms of pruritus and pain that significantly impact quality of life. The symptom of pruritus is frequently overlooked by dermatologists, and treatments are often primarily focused on the gross appearance of the scar. This review describes the prevalence and importance of pruritus in keloids. In addition, the putative mechanisms underlying the development of keloid pruritus, which include neuronal and immunological mechanisms, are discussed. Furthermore, this review describes keloid treatments that have been shown to reduce pruritus, treatments that specifically target the itch, and emerging therapies.


Assuntos
Cicatriz Hipertrófica , Queloide , Terapia Combinada , Humanos , Queloide/diagnóstico , Queloide/patologia , Queloide/terapia , Dor , Prurido/diagnóstico , Prurido/epidemiologia , Prurido/etiologia , Qualidade de Vida
11.
Neurol India ; 69(4): 1034-1036, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34507438

RESUMO

Brachioradial pruritus (BRP) is an enigmatic condition often encountered by dermatologists and passed off as a benign itch. It is an "idiopathic" pruritus, presenting as severe itching on the radial aspect of the elbow. The physical examination may be unremarkable except for mild pruritic lesions. Hence, the patient is treated with local applications of sunscreens, anti-inflammatory agents, anti-histamines and steroids, most of which prove to be ineffective. Dermatomal localization of localization of pruritis has suggested cervical myeloradiculopathy as a novel aetiology and this has been elucidated in recent studies. Here we report a young man, who presented with brachioradial pruritus and was diagnosed to have a C6-7 intramedullary cervical cord lesion.


Assuntos
Exantema , Doenças do Sistema Nervoso , Neurologia , Vértebras Cervicais/diagnóstico por imagem , Humanos , Masculino , Prurido/tratamento farmacológico , Prurido/etiologia
12.
Pediatr Dermatol ; 38(5): 1051-1060, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34515372

RESUMO

Chronic pruritus associated with systemic diseases in the pediatric population has been infrequently addressed in the literature. This review focuses on chronic pruritus presenting without cutaneous manifestations. Common systemic etiologies include diseases with hepatic, renal, and hematologic origins. This encompasses several congenital liver disorders, end-stage renal disease (ESRD), and lymphoproliferative disorders such as Hodgkin's lymphoma. In this paper, an expert panel describes the clinical characteristics, pathophysiology, and therapeutic treatment ladders for chronic pruritus associated with the aforementioned systemic etiologies. Novel therapies are also reviewed. Our aim is to shed light on this unexplored area of pediatric dermatology and instigate further research.


Assuntos
Dermatologia , Transtornos Linfoproliferativos , Criança , Humanos , Prurido/etiologia , Prurido/terapia
14.
J Postgrad Med ; 67(3): 174-176, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34380804

RESUMO

Scleredema adultorum of Buschke is a rare disorder of the connective tissue, involving the skin. Here, we present a 61-year-old male, who is a known case of compensated liver cirrhosis with a past history of being treated for autoimmune thyrotoxicosis, who presented with complaints of alopecia, skin tightening, dry skin, pruritus, and woody indurated plaques on the skin of the upper back, shoulder, and arms. Skin biopsy of the arm revealed the characteristic features of scleredema. He was extensively evaluated for known literature-cited causes of scleredema, and the work up revealed a negative result. He was also found to be hypothyroid on presentation. Hence, we present a case of scleredema occurring in a patient with hypothyroidism and chronic liver disease, which to our knowledge is being described for the first time in literature.


Assuntos
Hipotireoidismo/complicações , Cirrose Hepática/complicações , Escleredema do Adulto/diagnóstico , Alopecia/etiologia , Betametasona/uso terapêutico , COVID-19/tratamento farmacológico , Ácido Fusídico/uso terapêutico , Glucocorticoides/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Prurido/etiologia , Tireotoxicose/complicações
15.
Acta Derm Venereol ; 101(9): adv00550, 2021 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-34405244

RESUMO

Chronic pruritus of unknown origin is established when no underlying origin for pruritus can be determined. This retrospective cohort study aimed to determine the clinical profile and disease-related burden of chronic pruritus of unknown origin. A total of 263 patients (female/male: 154/109, median age 55 years) were included. Moderate to severe itch intensities were recorded (median average itch: 5.5/10, n = 200; median worst itch: 7.5/10, n = 199). In most cases pruritus lasted longer than 1 year (77.6%), occurred daily (68.2%), occurred in attacks (72.8%), and was often accompanied by dysaesthesias, such as burning, tingling and stinging. Quality of life was moderately impaired, while 22.2% and 12.4% of patients showed pathological anxiety and depression scores. Scratch lesions were associated with higher intensities of itch and greater impairment of quality of life, while women were more burdened by the disease than men. Chronic pruritus of unknown origin may occur at any age and the majority of patients endure severe itch with substantial disease-related burden.


Assuntos
Prurido , Qualidade de Vida , Doença Crônica , Efeitos Psicossociais da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prurido/diagnóstico , Prurido/epidemiologia , Prurido/etiologia , Estudos Retrospectivos
16.
Acta Derm Venereol ; 101(9): adv00539, 2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34436622

RESUMO

Prurigo simplex or "itchy red bump" disease is a controversial pruritic papular eruption. The objective of this study was to delineate the diagnostic criteria for this disease. A PubMed search was performed for: "prurigo simplex", "prurigo simplex subacuta", "subacute prurigo", "chronic papular dermatitis in adults" and "itchy red bump disease". Medical charts of patients with prurigo diagnoses in a university setting were analysed. The literature search revealed 32 relevant studies (431 patients) on different aspects of the disease. Out of 50 patients with prurigo diagnoses, 5 patients (4 women, mean age at onset 54 years) matched the description in literature. Small, severely itchy papules without secondary skin lesions continued to appear for years (mean 5.6 years). Skin biopsies revealed lymphocytic perivascular infiltrates, few eosinophils and occasionally spongiosis. Treatment with long-term metho-trexate or cyclosporine cleared the symptoms. Some major and minor diagnostic criteria for prurigo simplex are proposed and compared with chronic prurigo.


Assuntos
Dermatite , Prurigo , Dermatopatias Vesiculobolhosas , Urticária , Adulto , Feminino , Humanos , Prurigo/diagnóstico , Prurigo/tratamento farmacológico , Prurido/diagnóstico , Prurido/etiologia
17.
Ann Palliat Med ; 10(7): 7697-7705, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34353058

RESUMO

BACKGROUND: This meta-analysis aimed to evaluate the effectiveness of fibrates in the treatment of pruritus in patients with primary biliary cholangitis (PBC), so as to guide the clinical treatment of such cases. METHODS: Searches of the PubMed, Google Scholar, and Cochrane Library databases were performed to identify randomized controlled trials (RCTs) and prospective studies published up to December 2020 that used bezafibrate and fenofibrate as treatments for pruritus in patients with PBC. Data extraction and quality evaluation of the included literature were performed. Review Manager 5.3 software was employed for statistical analysis of the data. RESULTS: This meta-analysis included 7 studies, comprising 382 patients with PBC, which assessed the efficacy of bezafibrate and fenofibrate for treating pruritus. The results showed that treatment with fibrates significantly improved pruritus symptoms in patients with PBC [relative risk (RR) =6.52, 95% confidence interval (CI): 3.26-13.06, P<0.00001]. Subgroup analysis revealed that in comparison with fenofibrate (RR =5.34, 95% CI: 0.88-32.62, P=0.07), bezafibrate (RR =25.87, 95% CI: 7.93-84.42, P<0.00001) was more effective in improving pruritic symptoms in patients with PBC. Bezafibrate was also superior to fenofibrate in reducing the degree of pruritus in patients (mean difference =3.36, 95% CI: 2.62-4.09, P=0.05, I2=73%). CONCLUSIONS: Fibrates can significantly improve pruritus symptoms in patients with PBC but only in a subset of patients. Further studies are needed to elucidate the pathophysiological mechanisms underlying the effect of fibrates on pruritus in PBC, and thus guide future treatment regimens.


Assuntos
Cirrose Hepática Biliar , Bezafibrato/uso terapêutico , Ácidos Fíbricos/uso terapêutico , Humanos , Cirrose Hepática Biliar/complicações , Cirrose Hepática Biliar/tratamento farmacológico , Prurido/tratamento farmacológico , Prurido/etiologia , Ácido Ursodesoxicólico/uso terapêutico
18.
Expert Rev Clin Pharmacol ; 14(11): 1435-1444, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34410205

RESUMO

Introduction:Several novel biological agents and janus kinase (JAK) inhibitors are being investigated for efficacy in the management of atopic dermatitis (AD). However, there is a paucity of head-to-head trials comparing agents and their effect on quality of life (QoL).Methods:A systematic review of existing studies was performed, and data was pooled for meta-analysis from eligible studies of novel systemic agents for AD which reported QoL outcomes. Sixteen week least square means differences (LSM) were pooled and compared using network meta-analysis to synthesize direct and indirect comparisons, with 95% credible intervals (Crl) provided.Results:At 16 weeks, Dermatology Life Quality Index outcomes showed dupilumab 300 mg once weekly had the highest improvement versus placebo (LSM -4.63, 95% Crl -5.46,3.79). At 16 weeks, the improvement in Patient Oriented Eczema Measure scores ranked abrocitinib 200 mg daily the highest (LSM -7.62, 95% Crl -10.26; -4.98) and improvement in Hospital Anxiety and Depression Scale ranked dupilumab 300 mg once weekly highest (LSM -2.98, 95% Crl -4.48; -1.47) The improvement in peak pruritus scores ranked lebrikizumab 250 mg fortnightly (LSM -64.90, 95% Crl-84.58; -45.22) highest.Conclusion:The present study suggests that there are various systemic options for AD for which all seem to demonstrate a degree of QoL-related efficacy.


Assuntos
Fatores Biológicos/uso terapêutico , Dermatite Atópica/tratamento farmacológico , Inibidores de Janus Quinases/uso terapêutico , Dermatite Atópica/patologia , Humanos , Prurido/tratamento farmacológico , Prurido/etiologia , Qualidade de Vida , Índice de Gravidade de Doença , Resultado do Tratamento
19.
J Drugs Dermatol ; 20(8): 844-847, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34397204

RESUMO

Psoriasis is polygenic, interleukin (IL)-17 and IL-23 driven chronic relapsing inflammatory multisystem disease caused by a complex interplay of endogenous and environmental factors. The most common and distressing symptom in psoriasis is itch, adding significantly to the burden of disease. Although histamine has historically not been considered a key itch mediator in psoriasis, there is some evidence from the literature that antihistamines may be effective to reduce itch in psoriasis. This review focuses on the role of antihistamines in the management of itch in psoriasis. The literature search included peer-reviewed articles published in English language (clinical trials or scientific reviews). Studies were identified by searching electronic databases (MEDLINE and PubMed) until January 2021 and by reference lists of respective articles. J Drugs Dermatol. 2021;20(8):844-847. doi:10.36849/JDD.5966.


Assuntos
Psoríase , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Prurido/tratamento farmacológico , Prurido/etiologia , Psoríase/diagnóstico , Psoríase/tratamento farmacológico
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