C ASE R EPORT: Oral antioxidant therapy for the treatment of primary biliary cirrhosis: A pilot study

BACKGROUND: The symptoms of the chronic cholestatic liver disease primary biliary cirrhosis (PBC), in particular fatigue and chronic pruritus, adversely affect quality of life and respond only poorly to treatment. Recent studies have suggested that oxidative stress may play a role in tissue damage in cholestatic liver disease and may contribute to symptoms, such as fatigue. We have, therefore, examined, in an open-label pilot study, the therapeutic effects of antioxidant medication on the biochemistry and symptomatology of PBC. METHODS: Patients were randomized to 3 months treatment with a compound antioxidant vitamin preparation (Bio-Antox), four tablets daily (n = 11, group 1), or the combination of Bio-Quinone Q10 (100 mg) with Bio-Antox (n = 13, group 2). Biochemical and symptomatic responses were assessed at 3 months. RESULTS: Significant improvement in both pruritus and fatigue was seen in the patients in group 2. Mean itch visual analogue score improved from 2.4 +/- 3.0 to 0.4 +/- 0.7 post therapy (P < 0.05) while mean night itch severity score improved from 2.6 +/- 1.9 to 1.3 +/- 0.7 (P < 0.05). Nine of 13 of these patients reported less fatigue, while 10/13 showed an improvement in at least one domain of their Fisk Fatigue Severity Score. No significant improvement in itch and only limited improvement in fatigue were seen in the patients in group 1. No change in biochemical parameters was seen in either group. CONCLUSIONS: Antioxidant therapy, as a combination of Bio-Antox and Bio-Quinone Q10, may improve the pruritus and fatigue of PBC. This combination of therapy should be investigated further in a double-blind, placebo-controlled trial.     

祛风排毒止痒汤药浴联合氯雷他定片口服治疗慢性肾衰竭尿毒症透析皮肤瘙痒的效果

分析对尿毒症皮肤瘙痒患者应用祛风排毒止痒汤药浴治疗的效果。方法 选取2022年10月- 2023年10月于镇江市中医院接受透析治疗的80例尿毒症患者为研究对象，患者均于透析期间出现皮肤 瘙痒合并症，按入院时间先后将其分为对照组和观察组，每组40例。对照组予以氯雷他定片口服治 疗，观察组予以祛风排毒止痒汤药浴联合氯雷他定片口服治疗，比较两组症状评分、血清学指标及临 床疗效。结果 观察组治疗后瘙痒症状评分、继发皮损症状评分均低于对照组（P ＜0.05）；观察组治疗 后血清IL-2、TNF-α、IgE、P、Ca水平均低于对照组（P ＜0.05）；观察组治疗总有效率为90.00%，高 于对照组的70.00%（P ＜0.05）。结论 祛风排毒止痒汤药浴联合氯雷他定片口服治疗尿毒症皮肤瘙痒的 效果良好，能够有效改善患者的机体钙磷代谢，修复炎症反应，减轻透析相关皮肤瘙痒症状。     

血液灌流联合血液透析对尿毒症皮肤瘙痒患者的疗效观察及护理

目的探讨血液透析联合血液灌流治疗尿毒症皮肤瘙痒的效果。方法将尿毒症皮肤瘙痒患者48例随机分为治疗组和对照组各24例。治疗组实施血液透析联合血液灌流治疗,血液灌流联合血液透析治疗2h后,再继续行血液透析2h,总时间4h。1次/周。对照组患者实施血液透析加传统护理。比较2组患者皮肤瘙痒的治疗效果。结果治疗组和对照组皮肤瘙痒的治疗总有效率分别为94.7%和37.5%,二者比较差异有统计学意义,P〈0.01。结论血液灌流联合血液透析治疗尿毒症皮肤瘙痒疗效确切,提高了患者的生活质量。     

Addition of fexofenadine to a topical corticosteroid reduces the pruritus associated with atopic dermatitis in a 1-week randomized,multicentre, double-blind,placebo-controlled,parallel-group study

BACKGROUND: Fexofenadine, a nonsedating, H1-receptor selective antihistamine, exhibits consistent efficacy and safety in the treatment of allergic rhinitis and urticaria. The pruritus associated with atopic dermatitis is considered to be induced, in part, by histamine. Therefore, we thought that fexofenadine may be useful in the relief of pruritus associated with atopic dermatitis. OBJECTIVE: To compare the efficacy of twice-daily fexofenadine hydrochloride (HCl) 60 mg vs. placebo in reducing the pruritus associated with atopic dermatitis. METHODS: In this randomized, multicentre, double-blind, placebo-controlled study, patients (aged >or= 16 years) with atopic dermatitis underwent a 1-week placebo lead-in period, followed by randomization to fexofenadine HCl 60 mg twice daily or placebo for 1 week. All patients also received topical treatment with 0.1% hydrocortisone butyrate twice daily throughout the study. The primary efficacy endpoint was mean change in pruritus score from baseline. Patients reflectively recorded pruritus scores twice daily (day and night) using a five-point scale (0 = none; 4 = very severe). RESULTS: Fexofenadine (n = 201) significantly decreased the severity of pruritus compared with placebo (n = 199) (mean change in score -0.75 (unadjusted 95% confidence interval [-0.88, -0.62]) vs. -0.5 [-0.62, -0.38], respectively; P = 0.0005). This improvement was seen after just 1 day of treatment (P = 0.039) and was maintained throughout the treatment period (P = 0.019). Compared with placebo, fexofenadine significantly improved both diurnal (P = 0.0001) and nocturnal pruritus (P = 0.013). In addition, significantly more patients in the fexofenadine group experienced a reduction in the ratio of pruritus area to body surface area compared with those in the placebo group (P = 0.007). The incidence of adverse events was low and similar across all treatment groups. CONCLUSIONS: Fexofenadine HCl 60 mg twice daily demonstrated a rapid, significant improvement in the pruritus associated with atopic dermatitis, with a safety profile equivalent to that of placebo.     

Baseline serum levels of mast cell tryptase are raised in hemodialysis patients and associated with severity of pruritus

Background: The pathogenesis of pruritus in renal disease is not yet understood. Evidence suggests that mast cells play a role; for example, the number of dermal mast cells is increased in patients on hemodialysis. Patients and methods: To investigate a possible role of mast cell tryptase in pruritus of patients undergoing chronic hemodialysis, serum mast cell tryptase concentrations were measured in blood samples taken from 93 such patients, 53 of whom also recorded the severity of their pruritus on a visual analogue scale. Results: Serum mast cell tryptase levels were above 11.4 µg/l (95^th percentile) in 84 of 93 hemodialysis patients (90.3 %). The intensity of pruritus correlated significantly (p = 0.014) with the tryptase levels, an associated not yet shown for other mast cell‐related parameters. Conclusions: Mast cells or even tryptase itself may be involved in the pathogenesis of pruritus of hemodialysis patients.     

Die Pharmakotherapie bei Enddarmerkrankungen

Ohne Zusammenfassung

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Brachioradial pruritus and cervical spine manipulation

Brachioradial pruritus (BRP) causes significant morbidity in the majority of patients for whom no effective treatment is found. Chronic ultraviolet radiation exposure has usually been cited as the cause, but nerve damage from cervical spine disease has also been implicated. We report on a small retrospective exploratory study, conducted by questionnaire, of a group of patients who were treated with a specific cervical spine manipulation. Ten of 14 patients reported resolution of symptoms following manipulative treatment. All six patients who had had previous cervical spine disease responded to manipulation, as did half the remaining eight patients who had no previous history of neck symptoms. Although patients with BRP, by definition, share similar symptoms, the aetiology is almost certainly multifactorial. Prospective studies looking for cervical spine disease, as well as assessment of this particular method of cervical spine manipulation as a treatment modality for BRP, should be considered.     

Effect of topical vitamin D on chronic kidney disease‐associated pruritus: An open‐label pilot study

Chronic kidney disease‐associated pruritus (CKD‐aP) is a troublesome symptom in patients with end‐stage renal disease (ESRD). Recently, vitamin D deficiency has been known to be one of the possible etiologic factors in CKD‐aP. However, limited data is available on whether topical vitamin D treatment is effective for relieving CKD‐aP. Therefore, the purpose of this study is to evaluate the effectiveness of topically vitamin D for CKD‐aP. Twenty‐three patients with CKD‐aP were enrolled in a single center, open‐label study. Patients were instructed to apply a topical vitamin D (calcipotriol) agent (Daivonex solution; LEO Pharma) or vehicle solution twice daily for a month. We assessed the efficacy and safety of topical vitamin D on CKD‐aP using clinical and dermoscopic photographs, and questionnaires including the validated modified pruritus assessment score (VMPAS) and visual analog scale (VAS) every 2 weeks. Dry dermoscopic findings showed significant improvement of scale (dryness) on the skin of topical vitamin D‐treated patients compared with those of the vehicle group. Both VMPAS and VAS were significantly decreased after 2 and 4 weeks of the topical vitamin D treatment compared with the vehicle, respectively (P < 0.05). No significant side‐effects were observed. Topical vitamin D may be one of the safe and effective therapeutic candidates for CKD‐aP.