Chloroquine-induced pruritus among patients with malaria

A questionnaire survey was performed among 550 acutely febrile patients with malaria to determine whether pruritus accompanied chloroquine therapy when the drug was employed to suppress paroxysmal febrile attacks. Eighty-one (74.3%) of the 109 respondents, including two Asian and one white patients, recalled the past occurrence of regular (60%) or occasional (40%) pruritus under those conditions, and 15 black patients (13.8%) under active treatment were currently experiencing itching. The typical pruritic reaction following chloroquine administration was generalized, began after a latency of 11 +/- 9 hours (mean +/- SD of 15 acute reactions), increased to a moderately severe peak of intensity within 25 +/- 12 hours, remained maximal for about 12 hours, and then gradually subsided completely 55 +/- 21 hours after onset. Antihistamines were largely ineffective for the relief of pruritus. These results suggest that certain undetermined factors, present in febrile patients with malaria, predispose to 4-aminoquinoline-induced pruritus. Black patients may have an increased susceptibility to this symptomatic drug reaction.     

Plasma neuropeptides and perception of pruritus in psoriasis

The aim of this study was to evaluate the influence of selected neuropeptides on itching in psoriatic individuals. Fifty-nine patients (43 pruritic and 16 non-pruritic) with psoriasis were included in the study. The severity of psoriasis, measured using the Psoriasis Area and Severity Index scale, ranged between 2 and 43.7 points. The intensity of pruritus was evaluated using a Visual Analogue Scale. The plasma levels of substance P, vasoactive intestinal peptide, calcitonin gene-related peptide and neuropeptide Y were measured radioimmunologically. The plasma level of neuropeptide Y was significantly decreased in patients with pruritus compared with those without pruritus (21.6 +/- 39.6 pg/ml and 144.3 +/- 385.7 pg/ml, respectively; p=0.03). Levels of other neuropeptides did not differ significantly between pruritic and non-pruritic patients; however, a tendency to lower plasma levels of substance P and vasoactive intestinal peptide in patients with itching was noted. Moreover, a significant negative correlation was observed between pruritus severity and levels of substance P (r = -0.36; p=0.02), as well as between pruritus severity and plasma levels of vasoactive intestinal peptide (r = -0.34; p=0.03). The imbalance of neuropeptide activity in the sera of pruritic subjects may suggest a role for neuropeptides in perception of itching in psoriatic individuals.     

Pimecrolimus cream 1% is effective in asteatotic eczema: results of a randomized, double-blind, vehicle-controlled study in 40 patients

BACKGROUND AND OBJECTIVE: Pimecrolimus cream 1% is an effective treatment for atopic eczema. The aim was to investigate its efficacy in asteatotic eczema, a skin disease similar to atopic eczema and its associated dry skin and itching. METHODS: Single-centre, randomized, double-blind, vehicle controlled study in 40 patients with asteatotic eczema. Efficacy was assessed by eczema area and severity index (EASI), investigators global assessment (IGA), patient's self-assessment, and pruritus severity. RESULTS: After 4 weeks of treatment, EASI, the primary efficacy variable, was reduced by 62+/-7% from baseline in patients on pimecrolimus, compared to 21+/-14% in patients on vehicle (P=0.013). With pimecrolimus there was also a better control of pruritus (P=0.042) at week 4 whereas a better control of disease according to self-assessment could only be observed at weeks 2 (P=0.01) and week 3 (P=0.08). CONCLUSION: Pimecrolimus cream 1% is effective in patients with asteatotic eczema.     

Drugs against chloroquine antimalarial itch

Background Limb activity meters are useful in correlation with subjective measurements for studying the antipruritic effects of drugs against current chloroquine itch among patients with malarial fever, in a tropical environment. Objective To prospectively monitor the palliative effects of drugs, without any presumptively significant antipuritic effects known, against moderate to severe chloroquine-related pruritus among patients with malaria. Methods Using a standard ordinal (0–10) scale questionnaire and limb activity meters on all limbs, 60 subjects (50 malarial patients plus 10 healthy controls; both sexes; aged 16–32 years) were recruited for study. Forty patients and the 10 healthy unmedicated controls completed the study and were used for data analysis. Results Dapsone (50 mg tablets, 8 hourly, orally) significantly reduced pruritus ordinal scores (below 2.5) and limb activity recordings to levels comparable with unmedicated controls by the second or third night of nocturnal monitoring the chloroquine itch among the patients. Clemastine or ketotifen (1 mg tablets, 8 hourly, orally) or prednisolone (5 mg tablets, 12 hourly, for 3 days, then tapered to 5 mg daily for another 2 days, orally), did not significantly exceed the placebo responsiveness to vitamin B-comple.x tablets (one 8 hourly, orally, for 3 days). Conclusion Dapsone. or sulphapyridine (500 mg tablets, 6 hourly, orally daily for 5 days in another recent investigation) have now emerged as potent symptomatic palliatives against chloroquine pruritus.     

Scratching and fasting: a study of pruritus and anorexia nervosa

An association between pruritus and eating disorders has been suggested. This study examined changes in pruritus during weight restoration in a homogeneous group of women with severe anorexia nervosa (n = 19), using a structured questionnaire, visual analogue scale, clinical examination and a range of serological markers. We demonstrated that itching is a clinical feature of anorexia nervosa, associated with low weight and resolving on weight restoration. Some 58% of the sample suffered pruritus at low weight in a stable hospital environment. There was a significant association between changes in body mass index and severity of pruritus (P = 0.033), with reduced itching on weight restoration. Pruritus occurred in the absence of abnormalities in thyroid, renal and hepatic function, serum androgens, oedema, dermatoses or compulsive washing. Scratching was manifest as 'scratch prurigo' in five cases. Where itching was present, it was experienced as severe. We discuss a variety of possible explanations, including psychopathology, endocrine factors, regional blood flow variation, eczema and the role of central opioid and serotonergic activity. We argue that anorexia nervosa should be considered in all patients at low weight presenting with pruritus, and pruritus should be considered to be a physical symptom of anorexia nervosa.     

成人寻常型银屑病瘙痒特征及对生活质量的影响调查

【摘要】 目的 调查成人寻常型银屑病患者瘙痒的流行程度及临床特征,评估瘙痒对睡眠和生活质量的影响。方法 2020年1 - 12月在兰州大学第二医院采用医师评估和问卷调查相结合的方式,评估291例寻常型银屑病患者的瘙痒特征、睡眠及生活质量。运用二元Logistic回归分析影响瘙痒的危险因素,多元线性回归分析影响睡眠及生活质量的相关因素。结果 291例寻常型银屑病患者,男184例（63.23%）,女107例（36.77%）,年龄M（Q1,Q3）为37.00（28.00,50.00）岁。258例（88.64%）有瘙痒症状,瘙痒程度以中度多见。皮损严重程度（OR = 1.252,95% CI 1.114 ~ 1.407,P＜0.001）是患者瘙痒的主要危险因素。银屑病面积和严重程度指数与瘙痒数字评价量表（NRS）评分（r = 0.65,P＜0.001）、5-D′S评分（r = 0.65,P＜0.001）、匹兹堡睡眠质量指数量表（PSQI）评分（r = 0.48,P＜0.001）及皮肤病生活质量指数量表（DLQI）评分（r = 0.63,P＜0.001）均存在正相关,瘙痒严重程度NRS评分与DLQI评分（r = 0.61,P＜0.001）和PSQI评分（r = 0.55,P＜0.001）存在正相关,5-D′S评分与DLQI评分（r = 0.62,P＜0.001）和PSQI评分（r = 0.64,P＜0.001）均存在正相关。结论 大部分成人寻常型银屑病患者存在中等程度瘙痒;疾病严重程度显著影响患者的瘙痒严重程度,瘙痒对睡眠和生活质量有较大影响。     

Successful Treatment of Refractory Aquagenic Pruritus with Naltrexone

Background

Aquagenic pruritus is an intense prickling sensation that develops in affected individuals immediately after contact with water at any temperature. It is most commonly associated with polycythemia rubra vera. Common but often ineffective treatments include anticholinergics and antihistamines. Other moderately successful treatments include capsaicin cream, UVB phototherapy, and sodium bicarbonate bath water.

Objective

In this case report we describe a 55-year-old female with severe itching following showers. Underlying causes were ruled out with a series of blood tests, a chest X-ray, and serum protein electrophoresis. After multiple treatment failures, her itching was relieved with naltrexone.

Conclusion

Endogenous opiates, like naltrexone, can modify pruritus by influencing the peripheral and central sensation of itch. It has been found to be successful in suppressing the perception of pruritus from many diverse origins including aquagenic pruritus.

Antécédents

Aquagenic pruritus est une sensation intense de picotement qui apparaît immédiatement après le contact avec 1’eau, peu importe sa température. Elle est fréquemment associée à la polycythémie vraie. Les traitements courants, mais souvent inefficaces, comprennent les anticholinergiques et les antihistaminiques. D’autres traitements à succès modéré comprennent les crèmes de capsicine, la photothérapie aux rayons UV et les bains au bicarbonate de soude.

Objectifs

Le présent rapport de cas décrit la situation d’une femme âgée de 55 ans qui souffre de démangeaison aiguë après les douches. Une série de prélèvements sanguins, des radiographies pulmonaires et des électrophorèses des protéines sériques ont permis d’éliminer les causes sous-jacentes possibles. Après l’échec de multiples traitements, sa démangeaison a été soignée grâce au naltrexone.

Conclusion

Les agents endogènes opiacés, tels que naltrexone, peuvent modifier le prurit en agissant sur la sensation centrale et périphérique de démangeaison. Ce traitement semble efficace sur toute sorte de prurit, y compris le prurit lié à 1’eau.     

Efficacy of gabapentin in the improvement of pruritus and quality of life of patients with notalgia paresthetica

BACKGROUND

notalgia paresthetica is a subdiagnosed sensory neuropathy presenting as a condition of intense itching and hyperchromic macule on the back that interferes with daily habits.

OBJECTIVES

To determine the efficacy of treatment of notalgia paresthetica using oral gabapentin, assessing the degree of improvement in itching and influence on quality of life. Moreover, to evaluate the signs and symptoms associated with notalgia paresthetica.

METHODS

We conducted an experimental, non-randomized, parallel, non-blinded study including 20 patients with clinical and histopathological diagnosis of notalgia paresthetica. After application of the visual analogue scale of pain adapted for pruritus and of the questionnaire of dermatology life quality index (DLQI), ten patients with visual analogue scale > 5 were given treatment with gabapentin at the dose of 300 mg/day for four weeks. The other ten were treated with topical capsaicin 0.025% daily for four weeks. After the treatment period, patients answered again the scale of itching.

RESULTS

The use of gabapentin was responsible for a significant improvement in pruritus (p=0.0020). Besides itching and hyperchromic stain on the back, patients reported paresthesia and back pain. It was observed that the main factor in the worsening of the rash is heat.

CONCLUSION

Gabapentin is a good option for the treatment of severe itching caused by nostalgia paresthetica.     

A comparative study on the effects of naltrexone and loratadine on uremic pruritus

BACKGROUND: Two recent studies have provided opposite results on the efficacy of naltrexone on uremic pruritus. We have performed a third study. OBJECTIVE: To compare the efficacy and tolerance of naltrexone and loratadine in uremic pruritus. PATIENTS/METHODS: Among 296 hemodialyzed patients, 65 suffered from uremic pruritus. Fifty-two patients participated in the study. The patients were treated for 2 weeks with naltrexone (50 mg/day; 26 patients) or loratadine (10 mg/day; 26 patients), after a washout of 48 h. Pruritus intensity was scored by a visual analogue scale (VAS). Adverse events were carefully searched for. The two groups were statistically equivalent. RESULTS: There was no significant difference in the mean VAS scores after treatment, but naltrexone allowed a dramatic decrease in VAS scores (Delta >3/10) in 7 patients. Adverse events (mainly nausea and sleep disturbances) were observed in 10/26 patients. CONCLUSIONS: Naltrexone is effective only in a subset of patients. Adverse events are very frequent. The differences of efficacy and tolerance between patients might be due to metabolism. Naltrexone might be considered as a second-line treatment.     

Impact of pruritus on quality of life in sulfur mustard-exposed Iranian veterans

Background  Sulfur mustard, a chemical warfare agent, has various verified chronic effects on the skin. One of the foremost negative impacts of this agent is chronic pruritus, which plagues chemically injured veterans for life and can downgrade their quality of life.
Aim  To assess the association between the quality of life and pruritus severity in chemically injured veterans.
Methods  One hundred and twenty-five consecutive chemically injured veterans suffering from pruritus were assessed via the Dermatology Life Quality Index (DLQI) and pruritus score. Pruritus scores less than 15, between 16 and 30, and more than 30 were considered as mild, moderate, and severe pruritus, respectively. Patients with different levels of pruritus were compared with respect to their DLQI and its subscores.
Results  All subjects were male with a mean age of 44.3 ± 8.0 years; 11.2% had mild, 35.2% moderate, and 53.6% severe itching. The DLQI median scores in the mild, moderate, and severe cases were 16, 20, and 21, respectively ( P  = 0.014). The DLQI subscores of symptoms and feelings ( P  = 0.015), personal relationships ( P  = 0.002), and daily activities ( P  = 0.036) were worst in patients with severe itching.
Conclusion  Chemically injured veterans suffering from severe itching have a significantly poorer quality of life than do patients with milder symptoms.     

Efficacy of oral naltrexone on pruritus in atopic eczema: a double-blind, placebo-controlled study

Aim  The intent of our study was to determine the efficacy of oral naltrexone, an opiod antagonist, in the treatment of pruritus in patients with chronic eczema.
Methods  This double-blind, placebo-controlled study recruited 38 patients with eczema complaining from pruritus. Pruritus scores were evaluated. Patients were given placebo ( n  = 20) or naltrexone 50 mg ( n  = 18) for 2 weeks period. During the study, pruritus scores based on visual analogue scale system (VAS) were assessed three times: at the start of study, after 1 week, and after 2 weeks.
Results  In both groups, decreased VAS scores were observed, but naltrexone showed to be significantly more effective than placebo in decreasing VAS score after 1 week ( P <  0.005) and 2 weeks ( P <  0.001).
Conclusion  Naltrexone is more effective than placebo in the treatment of pruritus in patient with eczema. Naltrexone might be considered as an adjunct treatment in the treatment of pruritus. However, further studies in this aspect are highly fostered.

Conflicts of interest

This study and the authors were not supported by any company with a vested interest in the product being studied and the project was funded by Skin Research Center.     

Elevated Plasma Histamine in Chronic Uremia Effects of Ketotifen on Pruritus

A role for histamine in the pathogenesis of uremic pruritus was investigated in maintenance hemodialysis patients. Venous plasma histamine levels, as determined by radioenzymatic assay, were significantly higher (p less than 0.05) in hemodialysis patients with pruritus (368 +/- 103 pg/ml [mean +/- SEM], n = 6) than in those without pruritus (146 +/- 22 pg/ml, n = 5) and in normal controls (142 +/- 16, n = 5). Arteriovenous fistula histamine levels (202 +/- 52 pg/ml, n = 6) were significantly lower (p less than 0.05) than simultaneously drawn venous samples. Markedly elevated histamine-degrading enzyme (histaminase) activities were found in both hemodialysis patients with (2.95 +/- 0.18 pg histamine degraded/minute) and without (2.44 +/- 0.28) pruritus, but was undetectable in normal controls. Histaminase activities did not significantly differ in simultaneously drawn venous and fistula samples. With hemodialysis, histaminase activities fell significantly (p less than 0.01), whereas plasma histamine did not change. We further examined the effects of ketotifen, a putative mast cell stabilizer, on severe uremic pruritus. Five of five patients had significant (p less than 0.01) reductions in pruritus, as judged on a six-point pruritus index, after 8 weeks of drug (x = 2.3), as compared to conventional therapy (x = 5.9). Despite these improvements, no significant differences were noted in pre- versus post-drug plasma histamine levels, histaminase activities, or the histamine content per gram of skin biopsy specimen. These data support prior hypotheses that mast cell activation contributes to the pruritus of uremia.     

银屑病患者瘙痒特征及其对生活质量的影响

目的:确定银屑病患者的瘙痒特征并评价其生活质量。方法:采用问卷调查的方法,评价银屑病患者的瘙痒特征和生活质量。结果:131例银屑病患者中有89.31%伴有不同程度的瘙痒,其中87.18%的患者因瘙痒影响心情,62.39%因瘙痒影响睡眠;相关分析显示,瘙痒强度、频率、持续时间与银屑病严重程度和皮损红斑、浸润、脱屑呈正相关(P0.05)。结论:大多数银屑病患者有不同程度的瘙痒,且对患者的生活质量产生的负面影响。     

Sensitivity of human scalp skin to pruritic stimuli investigated by intradermal microdialysis in vivo

BACKGROUND: Although pruritus is common in scalp skin, the forearm has been the main site for investigation in previous experimental studies. OBJECTIVE: Our purpose was to compare the sensitivity to pruritic stimuli in human scalp and forearm skin. METHODS: Four microdialysis fibers were inserted intradermally into scalp (n = 10) or forearm skin (n = 10) of healthy male subjects and were perfused with histamine (0.01%) or compound 48/80 (C48/80; 0.05%) for 20 minutes. Total protein content in the dialysate was assessed at 10-minute intervals. Intensity of itching and pain sensation were measured psychophysically. RESULTS: Histamine- and C48/80-induced protein extravasation was significantly lower in scalp skin. Histamine and C48/80 invariably provoked an itching sensation in the forearm but only in 4 of 10 applications in the scalp. CONCLUSION: Despite the high prevalence of pruritus, scalp skin is less sensitive to histamine-induced experimental itching. A lower innervation density of pruritic nociceptors and/or different central processing of itching might account for this difference.     

Possible contribution of stem cell factor in psoriasis vulgaris

It is suggested that mast cell is implicated to play a role in the pathogenesis of psoriasis. In this study, to determine the role of stem cell factor (SCF), which is a growth factor of mast cells, we have examined the immunohistochemical localization and serum level of SCF in patients with psoriasis vulgaris. Immunohistochemical analysis revealed diffuse staining for SCF on keratinocytes in acanthotic epidermis in psoriasis, along with endothelial cells and fibroblasts. Serum SCF level, which was measured by enzyme-linked immunosorbent assay (ELISA), was significantly increased in patients with psoriasis vulgaris (1033+/-334 pg/ml) (n=24) than that of normal subjects (666+/-196 pg/ml) (n=15) (P<0.05). However, serum SCF did not show a correlation with the disease severity assessed by psoriasis activity and severity index (PASI) score. As patients with psoriasis vulgaris occasionally complain itching, next we divided 20 patients into two groups, those with itching (Group I) (n=8) and those without (Group II) (n=12), and compared the mast cell number located in the papillary dermis between thickened psoriatic epidermis, serum SCF and plasma histamine levels. Results showed that mast cell numbers (56.3+/-22.3/mm(2) in Group I vs 31.5+/-10. 3/mm(2) in Group II, P<0.05) and plasma histamine level (1.5+/-0.59 ng/ml vs 0.39+/-0.15 ng/ml, P<0.01) were significantly higher in patients of Group I than those of patients of Group II, however, the difference of serum SCF level (1132+/-368 pg/ml vs 890+/-373 pg/ml) did not reach a statistical significance. Finally, in a separate experiment, we examined whether exogenous SCF is capable of inducing psoriatic architecture on the transplanted uninvolved psoriatic skin onto severe combined immunodeficient (SCID) mice. SCF injection for 2 weeks could not induce a psoriasiform architecture such as acanthosis on the transplanted uninvolved psoriatic skin, although mast cells were increased in number. These results raised a possibility that keratinocyte-derived SCF plays a role, in part, in the increased number of mast cells in the papillary dermis of psoriasis, which may lead pruritus associated with psoriasis. Elevated serum SCF level may also be responsible for increment of mast cells in psoriasis vulgaris. Mast cell-derived factor stimulated by exogenous SCF could not induce psoriatic epidermis, suggesting that other factors such as activated lymphocytes or macrophages are further required for the development of psoriatic lesions.     

Recent studies of cutaneous nociception in atopic and non-atopic subjects

Itching reflects a distinct quality of cutaneous nociception elicited by chemical or other stimuli to neuronal receptors at the superficial layers of the skin and muco-cutaneous orifices. Although recent experimental studies of the conduction and perception of itch have yielded deeper insight into the physiology of this sensory quality, little is known about the neuromechanisms involved in pruritus accompanying many inflammatory skin diseases, in particular, in atopic eczema. Previous case-control studies of our research group with patients suffering from atopic eczema (AE) revealed significantly diminished itch perception after iontophoretic application of different doses of histamine as well as substance P (i.c. injected). Further experiments using acetylcholine (ACh, i.c.) clearly demonstrated that ACh elicits pruritus instead of pain in patients with AE. The first part of the present review deals with the results of our most recent case-control studies on histamine-induced itch perception in atopics devoid of eczema as well as in patients with urticaria or psoriasis compared to atopics with or without manifest eczema. We demonstrated that both focal itch and perifocal alloknesis (i.e., itch elicited by a slight mechanical, otherwise non-itching stimulus) were significantly reduced in eczema-free atopics yet were normal in non-atopics suffering from urticaria or psoriasis. In further studies using ACh i.c. injected into the uninvolved skin of patients with AE, lichen ruber, psoriasis, type IV contact eczema, or non-specific nummular eczema (n = 10/each group), all the atopics and 6/10 psoriatics felt itch instead of burning pain, but none of the others did. Different doses of vasoactive intestinal peptide (VIP) i.c. applied to the controls and the atopics with or without eczema did not markedly increase the intensity of nociceptive sensations. However, ACh induced pain in the controls, pure pruritus in the atopics with acute eczema, and a 'mixture' of pain and itch in the atopics just free from eczema. Obviously, the quality of sensations evoked by ACh and VIP depends on the inflammatory or non-inflammatory state of the atopic skin. In a placebo-controlled, double blind study on histamine-induced focal itch and alloknesis with healthy subjects (n = 15) using naltrexone (opioid receptor antagonist) and cetirizine (H1-blocking agent), naltrexone was found to significantly reduce both itching and alloknesis. Cetirizine reduced focal itch but failed to influence the alloknesis phenomenon. The wheal and flare reaction was suppressed only by cetirizine. These different effects point to a mainly CNS-based activity of naltrexone but a peripheral level effect of cetirizine. Due to long-lasting experience with group sport as a supporting adjuvant for inpatients with AE, we evaluated, by clinical, psychometric, and physiological studies, the therapeutic efficacy of controlled physical exercise in addition to otherwise equal anti-eczematous therapy for both voluntary participants and non-participants in sports by performing several case-control studies, one followed-up to 6 months after the patients' discharge from the hospital. Regular moderate exercises neither deteriorated nor impeded the recovery from AE, ameliorated the participants' scratch controlling ability and significantly their depressed emotional mood. The non-participants failed to achieve these aims. Sweating-induced itch was inhibited in almost all participants if simple skin care (clearing by warm shower, ointment) and short-term rest were used by informed patients. In conclusion, there are several indications that itching is elicited in individuals inclined to cutaneous atopy, regardless of their eczematous or just eczema-free state, by a different physiological pathway from that in non-atopic individuals. Therefore, antipruritic agents influencing the centrally altered nociception of atopics are needed and may be expected in near future. (ABSTRACT TRUNCATED)     

Hemodialysis-related pruritus and associated cutaneous manifestations

BACKGROUND: Uremic pruritus is one of the most common disabling problems in patients with chronic renal failure. Few studies have evaluated itching and cutaneous manifestations in hemodialysis-dependent patients. OBJECTIVES: The aim of this prospective study was to identify the prevalence of pruritus and cutaneous changes affecting patients undergoing hemodialysis. METHODS: The degree of itching in 70 patients treated at the Haemek Medical Center Hemodialysis Unit, in northern Israel, was scored according to presence and severity. We examined the relationship between the quality of dialysis and the frequency of pruritus, and identified concurrent cutaneous disorders. RESULTS: Pruritus was a common problem in the study cohort and affected 74.3% of hemodialysis patients at some point. The main characteristics of pruritus were a general pattern in 65.7% and mild intensity in 78.3% of observed patients. Duration of hemodialysis varied between 3 months and 13 years. There was no correlation between occurrence of pruritus and demographic or medical parameters (sex, type of kidney disease, regular medications or duration of hemodialysis) of the patients. Higher dialysis efficacy, as expressed by dialyser clearance, volume distribution of area, dialysis duration (Kt/v), may reduce the prevalence of pruritus (P < 0.02). None of the blood and chemical values considered (hemoglobin, creatinine, urea, phosphorus, calcium, albumin, parathormone and alkaline phosphatase) revealed any statistically relevant differences between pruritus groups. The appearance of foot ulcers was different between diabetic and nondiabetic individuals undergoing hemodialysis (P < 0.001). CONCLUSIONS: Pruritus is still a common problem in hemodialysis-dependent patients. The prevalence of xerosis and excoriations was high in patients undergoing replacement therapy. Efficient replacement hemodialysis may provide a clinical benefit.     

Clinical Characteristics of Pruritus in Patients with Scalp Psoriasis and Their Relation with Intraepidermal Nerve Fiber Density

Background

The scalp is frequently affected in psoriasis patients, and pruritus can adversely affect the quality of life of affected patients. Few studies have assessed pruritus in scalp psoriasis.

Objective

To determine the correlation among the clinical characteristics of pruritus, psoriasis scalp severity index (PSSI), and intraepidermal nerve fiber (IENF) density in psoriatic scalp lesions.

Methods

Eighty patients (53 men, 27 women; mean age, 46.4 years; mean PSSI, 19.9) with scalp psoriasis were evaluated by using the PSSI and the Leuven itch scale. Biopsies were obtained from the lesional and nonlesional skin of 19 patients (10 men, 9 women; mean age, 37.8 years; mean PSSI, 25.8). Immunofluorescence staining of protein gene product 9.5 was performed to determine the IENF density.

Results

Sixty-four patients (80%) complained of pruritus associated with scalp psoriasis, which negatively affected their quality of life to varying degrees. A moderate positive relation between PSSI score and pruritus intensity was identified (r=0.225 and p=0.044). The IENF density in psoriatic lesions was significantly higher than that in the nonlesional scalp (6.2±1.2 vs. 4.2±1.6, p<0.001). However, the correlations between IENF density and PSSI score, and IENF density and pruritus intensity were insignificant.

Conclusion

These results indicate that pruritus prevalence is high in patients with scalp psoriasis, and pruritus considerably influences the patients'' daily lives and quality of life. In addition, high IENF density in psoriatic scalp lesions may play a role in the development of pruritus in scalp psoriasis.     

Generalized pruritus treated with narrowband UVB

BACKGROUND: Narrowband UVB phototherapy has been increasingly used in a variety of dermatological diseases. We planned to evaluate its efficacy in generalized pruritus in this prospective study. METHODS: Forty-six patients were included and then divided into two groups: group 1 and group 2 consisted of patients with uremic pruritus and "idiopathic pruritus", respectively. Phototherapy was given three times a week. Efficacy assessments were made by means of visual analog scale (VAS) and pruritus grading score. RESULTS: Thirty-five patients completed the treatment. Mean VAS decreased from 8.2 +/- 1.5 to 3.6 +/- 3 in group 1 and from 7.1 +/- 2.3 to 2.3 +/- 2.8 in group 2 (P < 0.0001). Mean percentage of change in VAS was 54.2% (95% CI 32.6-75.9) and 67.9% (95% CI 53.8-81.9) in group 1 and group 2, respectively. Mean number of treatments was 22 in both groups. Mean cumulative UVB dose was 24,540 mJ/cm(2) and 20,801 mJ/cm(2) in group 1 and group 2, respectively. CONCLUSION: Narrowband UVB is an effective and well-tolerated treatment option for patients with generalized pruritus.