Management Of Pruritus Research Articles

Pharmacological Therapy of Pruritus in Primary Biliary Cholangitis

We aim to summarize the current management of pruritus in primary biliary cholangitis (PBC) by evaluating the efficacy and safety of pharmacological therapies. Pruritus is a common symptom of PBC, and evidence regarding the most effective antipruritic agents available is lacking. New pharmacotherapy for PBC has shown promising antipruritic effects. We performed a systematic literature review and meta-analysis including all available double-blind, randomized, placebo-controlled clinical trials that evaluated the efficacy of pharmacotherapy for the symptomatic management of pruritus in PBC. Pruritus was assessed as either a change from baseline or a postintervention score. We included 33 studies and 20 medications. Using the visual analog scale, cholestyramine did not significantly improve pruritus compared with placebo [standardized mean differences (SMD): -0.94, 95% CI: -2.05 to 0.17], whereas rifampin and nalfurafine hydrochloride both significantly improved pruritus (SMD: -3.29, 95% CI: -5.78 to -0.80; n=23 and SMD: -0.58, 95% CI: -1.04 to -0.12). In addition, Bezafibrate and linerixibat significantly improved pruritus (SMD: -1.05, 95% CI: -1.41 to -0.68; n=110 and SMD: -0.31, 95% CI: -0.62 to -0.04, respectively). This effect was also present within the subgroup analysis by pruritus scale, where both bezafibrate and linerixibat significantly improved pruritus compared with placebo (SMD: -1.09, 95% CI: -1.54 to -0.65; P <0.001; visual analog scale; as postintervention score and SMD: -0.31, 95% CI: -0.62 to -0.01; P =0.04; numeric rating scale; as a change from baseline score, respectively). Bezafibrate and Linerixibat are potential second-line antipruritic medications for PBC, particularly those with moderate to severe pruritus.

The efficacy of adding oral sodium cromoglycate to stable treatment for controlling bullous pemphigoid-related pruritus: A retrospective study.

Bullous pemphigoid (BP) is the most common autoimmune subepidermal blistering disease which mainly affects the elderly. It manifests as severe pruritus, urticarial plaques, and tense bullae and is associated with significant mortality. Therapy options for itch in BP patients are limited, mainly because the pathogenesis of itch in BP remains unclear. Sodium cromoglycate was commonly used in the past as an inhaled drug for the management of bronchial asthma and as an oral treatment for children with urticaria pigmentosa. In this study we sought to assess its efficacy in reducing BP associated itch. Assessing the efficacy of oral sodium cromoglycate in reducing BP-related pruritus after stabilization of disease activity. We retrospectively reviewed the medical records of patients with a confirmed diagnosis of BP who were treated with sodium cromoglycate. Patient reported outcome measures (PROM) including: BPDAI pruritus, ABQOL and TABQOL, and BPDAI activity score were compared at two points in time: before commencing treatment with sodium cromoglycate or before commencing maximal dose of this treatment, and at least 4 weeks after treatment commencement. A total of 21 patients met the inclusion criteria. After at least 4 weeks of treatment with oral sodium cromoglycate BPDAI pruritus, ABQOL and TABQOL scores were statistically significantly decreased compared to the scores prior to treatment commencement, P < 0.000, P < 0.008, and P < 0.004, respectively. Oral treatment with sodium cromoglycate for the management of pruritus in BP patients may be beneficial, however, further prospective studies are required to better assess its efficacy.

Improvement of Quality of Life in Dialysis and Diabetic Patients by Skin Dryness and Pruritus Management with an Ecobiological Dermo-Cosmetic Product.

PurposeXerosis and pruritus are common chronic dermatological disorders among dialysis and diabetic patients that are frequently underdiagnosed or neglected, which can impact the quality of life of these patients. This study aimed to evaluate the efficacy and safety of a specific dermo-cosmetic product in the treatment of dry skin and pruritus associated with dialysis and diabetes.Patients and MethodsTwenty-nine dialysis patients (mean age 62 years) and 40 diabetic patients (mean age 57 years, 88% type 2) were included in two different single-center open-label uncontrolled clinical trials. All patients presented skin dryness according to the Scaling Roughness Redness and Cracks (SRRC) scale, and pruritus and/or insomnia. They applied the dermo-cosmetic product Medi-Secure Atoderm Xereane (NAOS, Laboratoire Bioderma) once or twice a day. The clinical efficacy (SRRC, pruritus, and insomnia), the skin-related quality of life (Dermatological Life Quality Index, DLQI), and the subjective efficacy were assessed at the inclusion visit and after 28 days of product application, as well as the safety.ResultsAfter 28 days of application, the product significantly reduced the SRRC global score of 83% (0.9±0.8 vs 5.1±1.2) and 66% (1.4±1.2 vs 4.2±0.5), pruritus intensity of 76% (1.1±1.3 vs 4.6±2.1) and 78% (0.9±1.7 vs 4.2±2.6), and insomnia intensity of 61% (0.9±1.3 vs 2.4±2.3) and 82% (0.9±1.7 vs 4.8±2.7) in dialysis and diabetic patients, respectively. Furthermore, the product’s application led to an improvement of the skin-related quality of life of 50% (5.4 vs 2.7; p<0.0001) in dialysis patients and 71% (6.6 vs 1.9; p<0.0001) in diabetic patients at D28. In addition, the product was greatly appreciated by all patients for its soothing, comforting, repairing, nourishing, and hydrating effects and was very well tolerated by the entire panels.ConclusionThis specific dermo-cosmetic product significantly reduces skin dryness, pruritus, and insomnia in dialysis and diabetic patients, thereby greatly improves their skin-related quality of life. By managing and avoiding bothersome symptoms associated with their disease or treatment, this ecobiological dermo-cosmetic can prevent serious complications that constitute a substantial burden on their daily life.

0602 Rapid Eye Movement (REM) Sleep Duration Is Inversely Related To Daytime Pruritus Severity: Preliminary Findings in Posttraumatic Stress Disorder (PTSD) Patients

Abstract Introduction Pruritus (itching) is one of the most distressing symptoms of dermatologic disease. There can be a bidirectional relationship between pruritus severity and sleep. Pruritus during sleep is most frequently encountered during stages N1 and N2 and sleep fragmentation can exacerbate pruritus. Often there are limited effective treatments available for pruritus. In this study we examined REM sleep data obtained from PTSD patients who reported somatic complaints including daytime pruritus. To our knowledge there are no studies of REM sleep and pruritus during wakefulness. Methods Seventy-five consenting patients with mild-to-moderate PTSD (all female; mean ±SD age 48.89 ±13.50 years) completed a battery of psychiatric and sleep ratings and underwent ≥ 1 home sleep apnea test (Watch PAT200; Itamar) which provided measures of %REM and REM duration. Exclusion criteria were use of benzodiazepines or narcotics. Pruritus was measured using Item 2 of the Pennebaker Inventory of Limbic Languidness (PILL), which assesses the frequency of common physical symptoms. For PILL Item 2 patients self-rated the frequency with which they experienced “Itchy eyes or skin” with a rating of “1” = “”never or almost never”, “2”=”less than 3 or 4 times per year”, “3”=”every month or so”, “4”=”every week or so’, and”5”=”more than once every week”. Results The mean±SD % REM was 21.78 ±7.64 (range 1.76% to 40.69%); and overall duration of REM sleep (mean ±SD) was 91.37±38.20 minutes (range 5.01 to 194.47 minutes). The frequency of pruritus ratings were as follows:: 39.5% endorsed a rating of “5” . The remainder self-endorsed the following frequencies: “4” (15.8%), “3” (21.1%), “2” (15.8%), and “1” (7.9%).. Pearson product moment correlation between the pruritus rating (item 2 of PILL) and REM sleep parameters were as follows: % REM (Pearson r= -0.172; p=0.144) and REM duration (Pearson r= -0.247; p=0.035). Conclusion Daytime pruritus was inversely related to the duration of REM sleep in a sample of PTSD patients. Pruritus can be a difficult condition to manage. Optimization of REM sleep may have a role in the management of pruritus. Support (If Any) None

Low dose naloxone for pruritus in systemic sclerosis: Case series and literature review.

Rationale:Pruritus is a common symptom in patients with systemic sclerosis and has a tremendous effect on the quality of life. Nevertheless, current therapeutic options are limited. The pathogenesis of pruritus in systemic sclerosis is not completely understood; however, opiate-mediated neurotransmission has been postulated to be involved.Patient concerns and diagnosis:We describe 4 female patients with systemic sclerosis suffering from severe pruritus, with an average 5D-itch score of 22.75.Intervention and outcomes:Low-dose oral naloxone was initiated, followed by a significant improvement in the level of pruritus, reaching an average 5D-itch score of 7.5, after 6 and 12 months of treatment. None of the patients experienced side effects.Lessons:Low-dose naloxone plays an important role in the management of pruritus in systemic sclerosis.

Nasobiliary drainage: an effective treatment for pruritus in cholestatic liver disease

IntroductionNasobiliary drains (NBDs) have been successfully used to manage intrahepatic cholestasis, bile leaks and obstructive cholangitis. It allows external drainage of bile, bypassing the ileum where bile salts are reabsorbed....

Knowledge, Attitude and Practice for Pruritus Management in Physicians and Patients with Diabetes.

Pruritus is a common dermatological condition observed in patients with diabetes, making it a dermatometabolic condition. Being multiaethiological, pruritis is caused by autoimmune, genetic, infectious and various systemic diseases. The present survey aimed to understand the knowledge, attitude and practice toward pruritus among Indian physicians and patients with diabetes presenting with pruritus. A telephonic, cross-sectional, qualitative survey was conducted among physicians and patients across five cities in India from July–August 2020. An open-ended discussion guide was used for the interview; the data were analyzed to check for common themes and trends. A majority of the consulting physicians (CPs) believed that uncontrolled diabetes is the main causal factor for pruritus in patients with diabetes and reported that currently there are no standard tests or treatment guidelines for its management. CPs emphasized proper monitoring and counseling to overcome current challenges. Patients reported a negative impact of pruritus on their daily activities and quality of life. The survey concluded that poor management of diabetes is one of the main causal factors for patients with diabetes presenting with pruritus in India. CPs emphasized controlling diabetes along with symptomatic treatment. For patients, pruritus has multifaceted effects on their health, overall well-being, and quality of life.

Management of Psychiatric Disorders with HIV and Dermatological Disorders.

Management of Psychiatric Disorders with HIV and Dermatological Disorders.

Knowledge, Attitude and Practice toward Pruritus Management among Physicians and Patients Living With Diabetes Mellitus: A Quantitative Survey in India

Pruritus is a common dermatological condition which may have systemic etiology. Diabetes is one such condition; pruritus is commonly seen in patients with diabetes thus making it a dermatometabolic condition. The present survey aimed to understand the knowledge, attitude, and practice toward pruritus among Indian physicians and patients living with diabetes presenting with pruritus.

Psychometric validation and meaningful change thresholds of the Worst Itching Intensity Numerical Rating Scale for assessing itch in patients with chronic kidney disease-associated pruritus

BackgroundChronic kidney disease-associated pruritus (CKD-aP) is characterized by persistent itch that often leads to substantially impaired quality of life. The Worst Itching Intensity Numerical Rating Scale (WI-NRS) is a single-item patient-reported outcome measure in which patients indicate the intensity of the worst itching they experienced over the past 24 h. Here, we evaluated the content validity and psychometric properties of the WI-NRS and confirmed the threshold of meaningful change in hemodialysis patients with moderate-to-severe CKD-aP.MethodsContent validity interviews were conducted in 23 patients. Psychometric properties of the WI-NRS were assessed using data from one phase 2 (N = 174) and two phase 3 (N = 848) clinical trials investigating an anti-pruritic treatment. Anchor-based methods were used to confirm meaningful within-patient change score thresholds in the phase 3 trial patients and mixed-method exit interviews (N = 70) contributed further insight.ResultsContent validity interviews indicated patients considered the WI-NRS to be straightforward, comprehensive, and relevant. Test–retest reliability was strong in both trial cohorts (intraclass correlation coefficients > 0.75). Construct validity analyses indicated high correlation between the WI-NRS and other measures of itch. Anchor-based analyses showed a reduction of ≥ 3 points from baseline score represented an appropriate clinically meaningful within-patient change on the WI-NRS. In the exit interviews, all patients with a reduction ≥ 3 points considered the change meaningful.ConclusionsThe WI-NRS is a reliable, valid, and responsive measure of itch intensity for patients with moderate-to-severe CKD-aP. These results support its use to assess treatment efficacy and in clinical evaluation and management of pruritus in hemodialysis patients.

Non-Pharmacological Management of Pruritus in Chronic Kidney Disease Patients at Panti Waluya Sawahan Hospital

Patients of chronic kidney disease require long-term hemodialysis therapy. However, this therapy has various complications, one of which is pruritus. Pruritus can interfere with individual activities, cause sleep disturbances, lesions and hyperpigmentation on the skin, to impact the patient's quality of life. So that non-pharmacological management is needed to treat pruritus. The design was cross sectional. The population in this community service was chronic kidney failure patients undergoing hemodialysis therapy in the hemodialysis room. The sample was patients who experience pruritus and undergo hemodialysis therapy at least 1x / week as many as 45 people. The variables were health education related to non-pharmacological management and pruritus. The instruments used leaflets and counseling program units for health education, while for pruritus used the Numeric Rating Scale. The average patient experienced pruritus on a scale of 5, which was a moderate category where itching was felt by frequent scratching. After health education, patients understand how to deal with pruritus with non-pharmacological methods so that the patient's quality of life becomes better

New Topical Therapies for Psoriasis.

Psoriasis is a chronic immune-mediated skin disease with a significant impact on patients' quality of life. Mild-to-moderate forms of the disease usually require long-term topical treatment, but prolonged use of corticosteroids and vitamin D analogues is limited by adverse effects. With further understanding of psoriasis pathogenesis, new molecules are emerging aiming to fulfil these clinical needs. Tapinarof, an aryl hydrocarbon receptor modulator, has completed a phase III study and demonstrated good efficacy results, even in long treatment courses, with a favourable safety profile. It additionally appears to have a promising remitting effect as patients presented with an average relapsing time of over 3 months. Roflumilast, a phosphodiesterase type 4 inhibitor, also underwent a phase III study with significant lesion improvement and notable pruritus management, and with no reported side effects. Roflumilast was evaluated as an option for intertriginous areas with good outcomes in a small sample, but larger trials are required. The Janus kinase-signal transducer and activator of transcription pathway has been targeted in recent clinical investigations with promising options, currently with brepocitinib pending phase IIb results. Ongoing preclinical studies involving interleukin-2 inhibition, RNA modulators and amygdalin analogues may lead to forthcoming clinical trials. New topical drugs are successfully emerging and future research comparing them to classical options will dictate their clinical role in the treatment of psoriasis.

Neuropathic agents in the management of pruritus in burn injuries: a systematic review and meta-analysis

ObjectivesPruritus is a common and often distressing complication after a burn injury. The purpose of this review is to explore the efficacy of drugs classically used to treat neuropathic pain...

A review on atopic dermatits

(AD) is common, chronic skin disorders that can significantly quality of life of affected individuals as well as their families. Although the pathogenesis of the disorder is not completely understood, it appears to result from the complex interplay between defects in skin barrier function, environmental &amp; infectious agents, &amp; immune deregulation. There are no diagnostic tests for AD; therefore, the diagnosis is based on specific clinical criteria that corticosteroids, Topical calcineurin inhibitors Atopic dermatitis(AD) is a chronic, highly pruritic(itchy) inflammatory skin disease, &amp; is one of the most common skin disorders in children. The disorder results in significant morbidity &amp; adversely affects quality of life.Not only are patients affected by the social stigma of a visible skin condition, but the intense itching characteristic of the disease often leads to skin trauma &amp; significant sleep disturbances. In addition, management of the condition necessitates the frequent application of emollients (agents that soothe, moisturize take into account the patient’s history &amp; clinical manifestations. Successful management of the disorder requires a multifaceted approach that involves education, optimal skin care practices, anti-inflammatory treatment with topical corticosteroids and/or topical calcineurin inhibitors, the management of pruritus, &amp; the treatment of skin infections. Systemic immunosuppressive agents may also be used, but are generally reserved for severe flare-ups or more difficult-to-control disease. Topical corticosteroids are the first-line pharmacologic treatments for AD, &amp; evidence suggests that these agents may also be beneficial for the prophylaxis of disease flare-ups. Although the prognosis for patients with AD is generally favourable, those patients with severe, widespread disease &amp; concomitant atopic conditions, such as asthma &amp; allergic rhinitis, are likely to experience poorer outcomes. Keywords: Atopic dermatitis, Diagnosis &amp; management, Emollients, Skin care practices, Topical &amp; soften the skin) &amp; topical medications, as well as physician visits. AD also poses a significant economic burden with an estimated annual cost in Canada of $1.4 billion. Current evidence suggests that AD is a primary skin barrier defect that facilitates the development of other atopic conditions., In fact, AD is often the initial step in the “atopic march” (the sequential development of allergic disease manifestations during early childhood), which leads to asthma and/or allergic rhinitis in the majority of afflicted patients.Early AD may also be a causative factor in the development of food allergy. Newer insights into AD suggest that both structural abnormalities of the skin &amp; immune dyregulation play important roles in the pathophysiology of the disease. Therefore, optimal management of AD requires a multifaceted approach aimed at healing &amp; protecting the skin barrier &amp; addressing the complex immune pathogenesis of the disease., This article provides an overview of current literature related to the epidemiology, pathophysiology, diagnosis, &amp; appropriate management of AD

HUBUNGAN LAMA TERAPI HEMODIALISA DENGAN SKALA PRURITUS PASIEN GAGAL GINJAL KRONIS

Patients with end-stage chronic renal failure required hemodialysis to survive for a long time. One of the complications of hemodialysis therapy is pruritus. Pruritus interfered with the patient's activities and sleep quality so that it has an impact on the quality of life. The purpose of this study was to determine the relationship between the length of hemodialysis therapy and pruritus in patients with chronic kidney failure. The research design is cross sectional. The population of all chronic kidney failure patients at Panti Waluya Hospital Malang during November 2020 who underwent hemodialysis was 56 people. Simple random sampling was used as the sampling technique, so that a sample of 45 people met the inclusion criteria. Analysis test with Mann Whitney, the result of the mean length of time patients undergoing hemodialysis is 2 years 5 months. The median score for patients with pruritus was 5 (moderate category – itching indicated frequent scratching). The results of the analysis test showed that there was a relationship between duration of hemodialysis and pruritus (p value = 0.033). Nurses in the hemodialysis room need to provide health education related to non-pharmacological management of pruritus as a result of hemodialysis therapy for patients with chronic renal failure. This is an effort to minimize the severity of pruritus that causes sleep disturbances so that it indirectly reduces the activity and quality of life of patients with chronic kidney failure. Keywords : Chronic renal failure, Hemodialysis, Pruritus

Chronic itch in African Americans: an unmet need.

Chronic pruritus carries a significant burden of disease and is associated with a negative impact on quality of life. African Americans are disproportionately burdened by chronic pruritic disorders, including but not limited to atopic dermatitis, prurigo nodularis, inflammatory scalp dermatoses, pathologic scarring, and HIV-related dermatoses. Racial differences in skin structure and function may contribute to the pathogenesis of itch in African Americans. Itch perception and response to treatment in African Americans remain understudied and not well understood. As such, there is a large unmet need with regard to the knowledge and management of pruritus in African Americans. This review highlights notable differences in the epidemiology, pathophysiology, genetic predisposition, clinical presentation, and response to treatment for select pruritic skin conditions. By addressing itch as an unmet need in African Americans, we hope to improve patient outcomes and lessen disparities in dermatologic care.

Evaluation of Therapies for Peripheral and Neuraxial Opioid-induced Pruritus based on Molecular and Cellular Discoveries.

Opioids are a mainstay of treatment for pain worldwide. Pruritus, a common side effect of opioids, is a patient dissatisfier that limits their use in many clinical settings. Both parenteral and neuraxial administration of opioids frequently evoke pruritus. The ability of opioids to suppress pain while causing itch continues to perplex clinicians and researchers alike. Several mechanisms have been proposed to explain how opioids can give rise to pruritus, but specific knowledge gaps perpetuate debate. This review summarizes the clinical burden of opioid-induced pruritus and emphasizes recent discoveries of peripheral and central mechanisms for opioid-induced pruritus, particularly with respect to scientific and conceptual advances in spinal cord circuitry and mast cell biology. The mechanisms and effectiveness of existing medications used for clinical management of pruritus will be evaluated, and we will highlight the emerging preclinical utility of selective κ-opioid receptor agonists, such as nalfurafine, for the management of opioid-induced pruritus.

Management of pruritus in primary biliary cholangitis

Primary biliary cholangitis (PBC) is a progressive intrahepatic cholestatic autoimmune disease, and pruritus can be seen in 60%-70% of PBC patients and seriously affects patients' quality of life. Improving the symptoms of pruritus in PBC patients is of great significance for improving their quality of life. This article mainly summarizes the advances in the pathogenesis of PBC and the treatment of PBC-related pruritus.

A systematic review on the management of pruritus in patients with cutaneous T-cell lymphoma

Introduction: Cutaneous T-cell lymphomas (CTCLs) represent a rare group of primary cutaneous lymphomas. Pruritus is common in patients with CTCL and is severe and intractable in the subtypes Sézary syndrome (SS) and folliculotropic mycosis fungoides (MF). Materials and methods: We conducted a systematic review on interventions demonstrating efficacy in reducing pruritus in patients with CTCL. The primary aim of our study was to identify disease-directed and itch-directed therapies effective in reducing CTCL-associated pruritus. Our secondary aim was to outline various tools used to quantify itch in clinical studies. Results: Our study identified multiple disease-directed therapies effective in reducing CTCL-associated pruritus. Most evidence supported the use of histone deacetylase inhibitors. For the agents romidepsin, vorinostat, and quisinostat, reduction in pruritus was achieved in both disease responders and nonresponders. Various therapies were effective in managing pruritus associated with SS and folliculotropic MF. Vorinostat is effective in reducing pruritus in patients with SS. Extracorporeal photophoresis, total skin electron beam therapy, and romidepsin are effective in reducing pruritus in patients with folliculotropic MF. The antiemetic aprepitant is an effective targeted treatment of CTCL-associated pruritus. Aprepitant demonstrated efficacy in reducing pruritus in patients with all stages of MF, including patients with SS. Lignocaine administered via continuous subcutaneous infusion is effective in reducing pruritus in patients with advanced-stage MF, including patients with SS. The most frequently used tools to quantify itch were the Visual Analogue Scale and Numerical Rating Scale. Definitions of a significant reduction in pruritus were extremely varied between studies. Discussion: To our knowledge, this is the first systematic review specifically addressing the management of itch in patients with CTCL. Patients with all stages of CTCL were represented across included studies, including patients with folliculotropic MF and SS. A wide range of treatment options were identified, including options appropriate for patients with end-stage disease.

Topical application of sebacoyl dinalbuphine ester-loaded nanostructured lipid carriers alleviate pruritus in scratching mouse model

Sebacoyl dinalbuphine ester (SDE) is a nalbuphine (NA) prodrug capable of biotransformation in vivo and prolong the duration of NA, maximize its effect in pain and pruritus management. However, the large molecular weight, low skin penetration, and stability concerns of SDE make it difficult to be used in local skin delivery. Nanostructured lipid carrier (NLC) is a lipid-based nanoparticulate system that has the potential for formulating SDE in order to promote drug delivery through the skin. The aim of this study was to develop SDE-loaded NLC formulations (SDE-NLC) with good stability, sustained release characteristics, and sufficient antipruritic effect. SDE was successfully encapsulated into NLC and the formulation increased the stability of SDE, enhanced skin penetration through hair follicles, and sustained SDE release during pruritus management. We also demonstrated that topical application of SDE-NLCs significantly reduced the number of scratches in pruritus-induced mice. Both NA and SDE were found in the skin strata, but only NA was detectable in the plasma, indicating rapid conversion of SDE into NA. All results demonstrated that SDE-NLC formulation protected SDE from degradation in vitro, while the released prodrug was converted into NA in vivo and extended antipruritic effect. The formulation has the potential of improving the life quality of patients with chronic pruritus.