Moderate Pruritus Research Articles

Validity of a Single Worst Itch Numeric Rating Scale (WI-NRS) Measurement to Identify Patients with Moderate or Severe CKD-Associated Pruritus

Validity of a Single Worst Itch Numeric Rating Scale (WI-NRS) Measurement to Identify Patients with Moderate or Severe CKD-Associated Pruritus

#802 CENSUS-EU: a cross-sectional, study to assess the prevalence and burden of chronic kidney disease-associated pruritus in Europe

Abstract Background and Aims Chronic kidney disease-associated pruritus (CKD-aP) is a common condition that can negatively affect patients’ health-related quality of life (HRQoL). Despite this, there has been a lack of clarity on its prevalence and impact, leading to increasing interest in and need for an accurate overview of its epidemiology. Here we present the interim analyses of the real-world study CENSUS-EU to estimate the prevalence of CKD-aP and its impact on patients’ HRQoL. Method CENSUS-EU is a retrospective, cross-sectional, multicentre study across seven countries in Europe. Eligible patients (aged ≥18 years and on dialysis for ≥3 months) consenting to participate were asked to complete five patient-reported outcome questionnaires, one on CKD-aP severity (the Worst Itching Intensity Numerical Rating Scale) and four on HRQoL, including the 5-D itch scale and the integrated palliative care outcome scale symptom list for end-stage renal disease (IPOS-Renal). Patients also completed a survey on the communication and management of their pruritus, including current anti-pruritic medication use. In addition, the medical records of patients were assessed to gather retrospective information on clinical dialysis characteristics, treatment patterns and healthcare resource utilisation. In this presentation of the interim data, we report the prevalence of pruritus and the distribution of severity subgroups, how pruritus severity affects the disability score from the 5-D itch (impact on sleep, leisure, errands, and work/school), and the sleep and depression scores from the IPOS-Renal questionnaire. Results The interim analysis included 1,482 patients, of which 59.9% were ≥65 years of age and 61.2% were male. Patient characteristics were balanced across severity subgroups. Overall prevalence of CKD-aP was 52.6% (95% confidence interval 50.02, 55.10); 21.5% of patients experienced mild pruritus, 17.5% moderate pruritus, and 13.5% severe pruritus (Fig. 1). As pruritus severity increased from no pruritus to severe pruritus, patients reported greater difficulty sleeping, as shown by increasing scores for question 2 of the IPOS-Renal questionnaire (Fig. 2A). Patients with more severe pruritus also reported feeling depressed more often than those with less severe or no pruritus (Fig. 2B). There were also increasing scores for the 5-D itch disability subscale (Fig. 2C). Patients with moderate or severe pruritus were also hospitalised more often than patients with mild or no pruritus (mean 1.7 and 1.9 hospitalisations per year, respectively). Overall, 17.9% of patients were receiving at least one ongoing anti-pruritic treatment, and the proportion of patients using at least one anti-pruritic treatment became greater with increasing itch intensity. Despite the impact of pruritus on HRQoL, 40.6% of patients with severe pruritus who had ever suffered from itch while on dialysis were not receiving anti-itch treatment. Conclusion The interim results of this cross-sectional study suggest that approximately 50% of patients on haemodialysis experience CKD-aP. The data reveal that as pruritus severity increases, the effect on sleep and depression scores becomes greater, potentially impacting more deeply on patients’ HRQoL.

A Comprehensive Analysis of Immunoglobulin E Levels, Allergen-Specific Sensitivities, and Clinical Manifestations in Allergic Dermatological Conditions: A Multicenter Retrospective Study in China.

To assess the correlations between Immunoglobulin E (IgE) levels, pruritus, and lesion severity in patients with eczema, atopic dermatitis, or urticaria. A retrospective study was conducted and data of 814 patients who visited the dermatology or allergy clinics of multiple hospitals, from December 2019 to December 2021, were collected. Patients were divided into children group (<18 years, 325 cases), adult group (18-60 years, 435 cases), and older population group (>60 years, 54 cases) based on the age. Baseline information, pruritus severity, severity of skin lesions, total IgE level, and specific IgE level were recorded to analyze the complex relationship between them. The prevalence of allergic conjunctivitis and allergic rhinitis in the children group was significantly higher than that in the adult and older population group (P < 0.01 or P < 0.05). The positive rate of specific IgE in children group was significantly higher than that in the adult and older population group (P < 0.01). The IgE levels in children with moderate pruritus were significantly lower than those of severe pruritus (63.39vs 114.42 IU/mL, P < 0.05). The IgE levels in children with mild and moderate skin lesions were significantly lower than those in children with severe skin lesions (58.95 vs 72.88 vs 169.15 IU/mL, P < 0.001 or P < 0.01, respectively). Relationships among age, severity of skin pruritus and lesions, and allergen-specific IgE response are complex and subtle, displaying dynamic patterns.

Pigmented purpuric dermatoses: A review

Pigmented purpuric dermatosis (PPD) comprises a group of skin conditions characterized by flat, nonpalpable petechiae and purpura as a result of capillaritis. Although the precise cause of PPD is as yet unknown, increased vascular permeability and capillary fragility are key factors in its pathophysiology. PPD has diverse clinical presentations, but the histopathology of all these variants essentially remains the same. The initial purpuric lesions develop a golden-brown hue owing to hemosiderin absorption and eventually progress to chronic pigmentary changes. These lesions, which often affect the lower limbs, are either asymptomatic or accompanied by moderate pruritus, and can be difficult to diagnose and treat. There are several subtypes of clinical presentations that have been documented over the years. In order to accurately diagnose PPD, a thorough clinical evaluation and, occasionally, a biopsy may be required. It is essential to identify the condition and reassure patients of its benign nature. Treatment is usually necessary due to the chronic nature of the condition, its consequences on physical and mental well-being, and the presence of significant lesions or itching. In this review, we outline the various prevalent PPDs and discuss their etiopathogenesis, clinical features, and diagnostic and treatment modalities.

Higher-order sensorimotor circuit of the whole-brain functional network involved in pruritus regulation in atopic dermatitis.

Little is known about the neural mechanisms underlying pruritus regulation in Atopic dermatitis (AD). To investigate the functional changes of the resting-state whole brain network of AD participants and the mechanisms by which they were involved in pruritus regulation. Based on the functional magnetic resonance imaging data from 19 AD participants and 37 healthy controls (HC), a graph-theoretical measure of degree centrality (DC) conjoined with a voxel-level seed-based functional connectivity (FC) method was used to identify abnormal higher-order nodes and the functionally relevant circuit in AD participants compared to healthy controls (HC). Of 64 participants screened, 19 AD participants (12M/7F, median [IQR] age, 27 [14] years) and 36 HCs (13M/23F, median [IQR] age, 20 [1] years) were enrolled. DC values of the left superior frontal gyrus (LSFG) increased in AD participants and exhibited a negative correlation with the SCORAD score (r = -0.561, p = 0.012) compared with HC. In the FC analysis with LSFG as the seed, FC values of several sensory and motor regions increased in AD participants, highly overlapping with the anatomical distribution of the inferior fronto-occipital fascicle (IFOF). AD participants with severe pruritus exhibited lower levels of DC (T = -2.316, p = 0.033) and FC between the LSFG and left insula (T = -2.203, p = 0.042) than those with mild-to- moderate pruritus. LSFG was involved in pruritus regulation in AD by forming a high-order sensorimotor circuit through the IFOF, a white matter fascicle that proved to provide multimodal integration in motor control and sensory information processing. These results offer more mechanism-guided treatment targets for severe pruritus in AD.

The Association of Uremic Pruritus with Blood Lead Level in Prevalent Hemodialysis Patients through Systemic Inflammation

Abstract Back ground and objective Pruritus is a common and often distressing symptom in patients with chronic kidney disease. Though the pathogenesis of uremic pruritus remains poorly understood, however systemic inflammation is one of the possible pathogenesis of uremic pruritus, and blood lead level has been noted to be associated with inflammation and nutritional status in long-term hemodialysis patients. There might be an interaction or association, therefore, between blood lead level and uremic pruritus through systemic inflammation. Blood lead level in hemodialysis patients might increase the intensity or have an additive role of pruritus caused by other more common risk factors. This study aims to further verify or deny the relation between blood lead level and uremic pruritus. Design, setting, participants, &amp; measurements The present study is a cross sectional study that investigates the relation between blood lead levels and pruritus in patients with end stage renal disease receiving hemodialysis. 50 patients were enrolled in this study, all were on regular hemodialysis 3 times a week, patients with primary skin diseases (psoriasis, erythroderma, etc), HCV positive patients, patients with chronic liver disease and patients with malignancies were excluded. Patients with PTH levels over 300 pg/dl And those with corrected calcium and phosphorus levels over 10.2 and 5.5 mg/dl Were excluded from the study. We divided the patients into 2 groups, group 1 (n = 10) with no pruritus and group 2 (n = 40) with varying degrees of pruritus. Results There was a significant difference in serum lead levels and ferritin levels between group 1 and 2. Group 2 was further divided according to intensity of Pruritus by VAS score into mild (n = 10), moderate (n = 20) and severe pruritus (n = 10) There was also a statistically significant difference in serum lead levels in different groups of intensity of pruritus, having higher serum lead levels in patients who exhibited severe pruritus. And there was a significant correlation between blood lead and duration of dialysis Conclusion Uremic pruritus is a multi-factorial phenomenon, our study showed that Blood lead level in HD patients might increase the intensity and have an additive role in the pathogenesis of pruritus in dialysis patients hence Blood lead level is positively correlated with Uremic Pruritus. We were able to demonstrate that both blood lead and duration of dialysis together are the most sensitive predictors for pruritus, the best cut off value for blood lead is 6 together with duration above 10 with high sensitivity, specificity and efficacy.

Efficacy of polymethylmethacrylate membrane hemodiafilter Filtryzer® PMF™-21A in improving pruritus in hemodialysis patients: a prospective interventional study

BackgroundHemodialysis-associated pruritus (HAP) occurs in 60–80% of hemodialysis patients. This significant complication not only decreases quality of life through sleep disturbance and depression, but also leads to poor survival outcomes. The polymethylmethacrylate (PMMA) membrane was the first synthetic polymer membrane for the hollow-fiber artificial kidney created in 1977. PMMA membrane dialyzers have been reported to be effective for improving various complaints, including pruritus, and nutritional status. In Japan, a PMMA membrane hemodiafilter Filtryzer® PMF™-A (PMF-A) was launched in November 2021 and subsequently became available for online hemodiafiltration (OHDF). This study aimed to determine whether PMF-A effectively improves pruritus in hemodialysis patients.MethodsParticipants were 20 patients (median age 74.5 years) on predilution OHDF (pre-OHDF) or postdilution OHDF (post-OHDF) using an Asymmetric Triacetate Membrane® hemodiafilter (FIX-210E eco or FIX-210S eco), who were experiencing pruritus of “very mild” or higher severity based on the Shiratori severity score either during the daytime or nighttime. After switching to post-OHDF with PMF-21A (substitution flow rate: 10 L/session), the substitution flow rate was gradually increased according to results of pruritus evaluation every 2 weeks over 3 months. The primary endpoint was the severity of pruritus evaluated using visual analogue scale (VAS) and the Shiratori severity score. Secondary endpoints included white blood cell count (WBC), hemoglobin level (Hb), platelet count (Plt), serum albumin level (Alb), high-sensitivity C-reactive protein (hsCRP), IL-6, dry weight (DW), and solute removal performance.ResultsThe median VAS score was significantly decreased 2 weeks after switching compared with baseline (44 mm) and remained significantly decreased at Week 12 (22 mm; p < 0.01). From baseline to Week 12, 16 patients (80%) showed improvement in VAS score. The percentage of patients with mild to moderate daytime pruritus according to the Shiratori severity score decreased significantly from 80.0% to 45.0% (p < 0.05), whereas no significant change was observed for nighttime pruritus (p = 0.267). Pre-dialysis serum β2-MG levels were significantly higher at Week 12 compared with baseline. No significant changes were observed in WBC, Hb, Plt, serum Alb, hsCRP, IL-6, or DW.ConclusionsOHDF with PMF-21A may be more effective in improving HAP.

Prevalence, patient burden and physicians' perception of pruritus in haemodialysis patients.

Chronic kidney disease-associated pruritus (CKD-aP) is an underrated symptom in patients with impaired kidney function. The present study assessed the prevalence, impact on quality of life (QoL) and risk factors for CKD-aP in a contemporary national cohort of patients on haemodialysis. In addition, we evaluated attending physicians' awareness and approach to therapy. Validated patient's and physician's questionnaires on pruritus severity and QoL were used in combination with information obtained by the Austrian Dialysis and Transplant Registry. The prevalence of mild, moderate and severe pruritus in 962 observed patients was 34.4%, 11.4% and 4.3%. Physicians' estimated prevalence values were 25.0 (95% CI 16.8-33.2), 14.4 (11.3-17.6) and 6.3% (4.9-8.3), respectively. The estimated national prevalence estimate extrapolated from the observed patients was 45.0% (95% CI 39.5-51.2) for any, 13.9% (95% CI 10.6-17.2) for moderate and 4.2% (95% CI 2.1-6.2) for severe CKD-aP. CKD-aP severity was significantly associated with impaired QoL. Risk factors for moderate-severe pruritus were higher C-reactive protein [odds ratio (OR) 1.61 (95% CI 1.07-2.43)] and parathyroid hormone (PTH) values [OR 1.50 (95% CI 1.00-2.27)]. Therapy for CKD-aP included changes in the dialysis regimen, topical treatments, antihistamines, gabapentin and pregabalin and phototherapy in a majority of centres. While the overall prevalence of CKD-aP in our study is similar to that in previously published literature, the prevalence of moderate-severe pruritus is lower. CKD-aP was associated with reduced QoL and elevated markers of inflammation and PTH. The high awareness of CKD-aP in Austrian nephrologists may explain the lower prevalence of more severe pruritus.

Correlation Between Personal Hygiene Behavior During Menstruation and The Occurrence of Vulvar Pruritus at SMPN 1 Nassau

Vulvar Pruritus is a problem that often occurs during menstruation. This is a disorder of female external genitalia in the form of severe itching. This problem can be prevented through good personal hygiene behaviour. Personal hygiene is an action to maintain the health and hygiene of female organs during menstruation. This study aims to determine whether there is a relationship between personal hygiene behaviour during menstruation and vulvar pruritus in SMP Negeri 1 Nassau. This is correlation research with a cross-sectional design. Samples were female students at SMP Negeri 1 Nassau, with 102 respondents. The criteria of the sample are female students who have experienced menstruation. Female students who experience pruritus but not because of menstruation or are not in the vulvar pruritus category are excluded as a sample. The sample used a simple random sampling technique. Data were collected using a questionnaire and analyzed using the Pearson Product Moment test. The results showed that from 102 respondents, 86,3% had moderate behaviour doing personal hygiene. 51% of respondents had moderate vulvar pruritus, and only 11.8% had no problem. There was a weak correlation between female students' behaviour regarding personal hygiene during menstruation and pruritus vulva at SMP Negeri 1 Nassau with a result of p &lt;0.05 (p=0.038). But even though it has a weak correlation, keeping personal hygiene of genital organs is very influential in reducing the risk of vulvar pruritus.

A phase 1/2 study of the safety, tolerability, and preliminary efficacy of the anti-GITR monoclonal antibody, INCAGN01876, combined with immunotherapies (IO) in patients (Pts) with advanced cancers.

2541 Background: INCAGN01876 is a GITR agonist designed to induce antitumor immunity by promoting effector T cells while inhibiting Tregs. Recent clinical studies suggest that combining IO with immune agonists such as INCAGN01876 may extend clinical benefit in pts with cancer. Methods: This global open-label nonrandomized phase 1/2 study assessed the safety, tolerability, recommended phase 2 dose (RP2D), and efficacy of INCAGN01876 + nivolumab (NIVO) and/or ipilimumab (IPI) (NCT03126110). Eligible pts (≥18 y) had locally advanced/metastatic cancer. Phase 1 (dose escalation) consisted of 4 treatment groups: A, INCAGN01876 1, 3, 5, 10 mg/kg Q2W + NIVO 240 mg Q2W; B, INCAGN01876 1, 3, 5, 10 mg/kg for 2 doses then NIVO 240 mg Q2W; C, INCAGN01876 1, 3, 5 mg/kg Q2W + IPI 1 mg/kg Q6W; D, INCAGN01876 1 mg/kg Q2W + NIVO 3 mg/kg Q2W + IPI 1 mg/kg Q6W. INCAGN01876 RP2D was assessed via a 3+3+3 design. Phase 2 (dose expansion) evaluated INCAGN01876 RP2D in combination IO in select tumors; data will be presented elsewhere. Results: As of Nov 9, 2021, 51 pts (A, n=17; B, n=13; C, n=15; D, n=6) were enrolled (most common tumors: breast, gastric, and ovarian [each n=8]; prior PD-(L)1 therapy, n=12). One pt in D had DLTs (nonserious grade [gr] 3 pruritis and rash); MTD was not reached; INCAGN01876 300 mg Q2W was selected as RP2D. All pts in A, B, D, and 93.3% in C had TEAEs. Twenty-six pts had gr ≥3 TEAEs (A, n=10; B, n=5; C, n=7; D, n=4), most commonly, pneumothorax (A [5 mg/kg], n=2) and anemia (B [1, 5 mg/kg], n=2; C [1, 3, 5 mg/kg], n=3). INCAGN01876-related TEAEs occurred in 8, 6, 10, and 5 pts in A, B, C, and D, respectively. Most common immune-related AEs in A: pruritus (gr 1/2, n=2); in B: rash (gr 1, n=2), simultaneous rash and pruritus (gr 1, n=4); in C: pruritus (gr 1/2, n=2), rash (gr 1, n=2), simultaneous rash and pruritus (gr 1, n=2); in D: simultaneous pruritus and rash (gr 3, n=1); 3 pts (A [1 mg/kg], n=1; C [3 mg/kg], n=1; D, n=1) had infusion-related reactions. One pt in A (10 mg/kg Q2W) discontinued treatment due to a pneumonia TEAE. Best unconfirmed overall responses (per RECIST v1.1) were 1 complete response (CR; duration of response [DOR], 1065 days) in renal cancer and 1 partial response (PR; DOR, 573 days) in breast cancer in A; 1 CR (DOR, 876 days) in cervical cancer in B; 1 PR (DOR, 169 days) in ovarian cancer and 1 PR (DOR, 281 days) in lung cancer in C; none in D. The disease control rate was 35.3% in A, 23.1% in B, 33.3% in C, and 0% in D. Conclusions: INCAGN01876 plus NIVO and/or IPI was generally well tolerated in pts with advanced tumors; most common toxicities were mild to moderate pruritus and rash. No novel safety signals were seen. INCAGN01876 300 mg Q2W was selected as RP2D based on safety and preliminary PK/PD data and used for expansion in combination with NIVO or IPI. Clinical trial information: NCT03126110 .

Clinical Aspect of Pruritus in Pediatric Atopic Dermatitis: A Study from Western India

Introduction: Atopic dermatitis (AD) is one of the most common dermatoses in the pediatric population and pruritus is its leading symptom; however, the clinical aspect of pruritus has not been studied much. The aim of the study was to explore clinical aspect of pruritus in pediatric AD and to analyze correlation of intensity of pruritus to the severity of AD. Methods: A hospital-based cross-sectional study of 106 pediatric patients of AD, between the age group of 6 months and 16 years was conducted. Diagnosis was made using the UK Working Party’s Diagnostic Criteria for AD. The severity of pruritus and sleep disturbances were assessed using the Numerical Rating Scale, and the severity of AD was assessed using SCORing of AD index. Results: Mean age at onset was 4.73 years and the mean duration of disease was 1.07 years. Pruritus was localized in 66.03%, intermittent in 89.7%, and continuous in 10.3%. Winter aggravation was observed in 36.8% and sleep disturbances were observed in 39.62%. “Pruritus intensity” was moderate or severe in 92% of patients and had significant correlation to the duration and severity of the disease, sleep disturbances, and coexistence of other atopic diseases. Conclusion: A pediatric patient with AD usually presents with localized or generalized, moderate or severe pruritus, and with sleep disturbances. Exacerbation of pruritus was the most common in winter and due to woolen garments and sweating. The intensity of pruritus was in direct proportion with the duration and severity of AD and coexistence of other atopic diseases.

Moderate-to-severe pruritus in untreated or non-responsive hemodialysis patients: results of the French prospective multicenter observational study Pruripreva.

Chronic kidney disease-associated pruritus (CKD-aP) is a common condition in patients treated with hemodialysis, and has a negative impact on quality of life (QoL). Due to the lack of standardized diagnostic tools and frequent underreporting, pruritus prevalence remains poorly documented. Pruripreva was a prospective multicenter observational study that aimed to evaluate the prevalence of moderate to severe pruritus in a cohort of French hemodialysis patients. The primary endpoint was the rate of patients with mean Worst Itch Numerical Rating Scale (WI-NRS) score ≥4 calculated over 7 days (moderate pruritus, 4-6; severe, 7-8; very severe, 9-10). Impact of CKD-aP on QoL was analyzed according to its severity (WI-NRS), using 5-D Itch scale, EQ-5D and Short Form (SF)-12. Mean WI-NRS was ≥4 in 306 patients (mean age, 66.6 years; male, 57.6%) out of 1304 and prevalence of moderate to very severe pruritus was 23.5% (95% confidence interval 21.2-25.9). Pruritus was unknown prior to the systematic screening in 37.6% of patients, and 56.4% of those affected were treated for this condition. The more severe the pruritus, the poorer the QoL according to the 5-D Itch scale, EQ-5D and SF-12. Moderate to very severe pruritus was reported in 23.5% of hemodialysis patients. CKD-aP was underrated although it is associated with a negative impact on QoL. These data confirm that pruritus in this setting is an underdiagnosed and underreported condition. There is an urgent demand for new therapies to treat chronic pruritus associated with CKD in hemodialysis patients.

Psoriasis and Vitiligo Co-Occurrence: When Inflammatory Disease Meets Autoimmune Pathology

Vitiligo and psoriasis are common inflammatory skin diseases, although, their association in the same patient is rare. We report the cases of two diabetic women (59 and 61-year-old). The first patient had extensive vitiligo evolving since infancy; she consulted for a moderate pruritus in the vitiligo lesions followed by erythematosquamous lesions at the same sites. The second patient consulted for the same lesions but in this case psoriasis appeared first followed by achromic lesions in the same sites and beyond. A medical atopic history was reported in the two cases. Few publications reported the association of vitiligo-psoriasis in the literature. The majority of case reports illustrated patients diagnosed with vitiligo who developed psoriasis later. Current data on the pathophysiology of these two conditions are still unclear; however, the two diseases share a common locus in the major histocompatibility complex. Dendritic cells may also participate in the genesis of both skin diseases via autoimmune inflammation mediated by the Th1 and Th17 pathways. In addition, pro-inflammatory cytokines IFNα has been recognised as a potential inducer of both psoriasis and vitiligo. The presence of atopic medical history in our cases can be explained by the high activity of IL- 2 witch is raised in psoriasis, atopic dermatitis and vitiligo, furthermore, locus PSORS4 and atopic dermatitis locus ATOD2 are co-localizated on chromosome 1q21, it leads to suggest that, probably, a vitiligo locus overlaps on the same chromosome1q21. The role of psychological stress and Koebner’s phenomenon is often emphasized in the genesis of the two diseases.

A spectrum of dermatological manifestations associated with hypothyroid condition – A pilot study

BACKGROUND: Hypothyroidism, a major health problem, is associated with a wide range of diseases. One of the organs affected by hypothyroidism, which shows a wide range of clinical signs, is the skin. OBJECTIVES: The objective of this study was to determine various cutaneous manifestations of hypothyroidism that can be used as a diagnostic marker and may help in the early diagnosis and treatment of hypothyroidism. METHODOLOGY: A cross-sectional observational study was carried out on 100 consecutive diagnosed cases of hypothyroidism patients in the dermatology department of a tertiary care hospital in Bengaluru during June 2021–September 2021. A pretested standard pro forma was used to collect and maintain the details of the patients. The study was ethically approved by the institution. RESULTS: The majority were female (84%) and patients' age ranged from 16 to 65 years, covering all groups with 31% having comorbidities. Seventy-one percent had pruritus and 14% with urticaria, 13% with palmar and sole hyperkeratosis, 3% with burning skin symptoms, and 5% with cold skin symptoms. The majority (38%) had pruritus as an early symptom. Pruritus symptom patients were categorized into mild pruritus (25%) and moderate pruritus (75%). A significant number of patients presented with hair changes in the form of dry brittle hair in 50 patients and with other associated skin conditions which included 20 patients with melasma, 10 patients with seborrheic dermatitis, eight patients had acrochordons, four patients had vitiligo, five had polymorphic light eruptions like lesions, three patients had lichen planus, and two each had psoriasis and acne vulgaris. CONCLUSION: The present study was undertaken to know the spectrum of dermatological manifestations associated with a hypothyroid condition. It was observed the female sex, pruritis, and hair changes were common in these patients. Recognition of hypothyroidism is important to ensure that appropriate treatment is provided at the earliest, thus preventing complications.

Hepatic and renal improvements with FXR agonist vonafexor in individuals with suspected fibrotic NASH

The LIVIFY trial investigated the safety, tolerability, and efficacy of vonafexor, a second-generation, non-bile acid farnesoid X receptor agonist in patients with suspected fibrotic non-alcoholic steatohepatitis (NASH). This double-blind phase IIa study was conducted in two parts. Patients were randomised (1:1:1:1) to receive placebo, vonafexor 100mg twice daily (VONA-100BID), vonafexor 200mg once daily (VONA-200QD), or 400mg vonafexor QD (VONA-400QD) in Part A (safety run-in, pharmacokinetics/pharmacodynamics) or placebo, vonafexor 100mg QD (VONA-100QD), or VONA-200QD (1:1:1) in Part B. The primary efficacy endpoint was a reduction in liver fat content (LFC) by MRI-proton density fat fraction, while secondary endpoints included reduced corrected T1 values and liver enzymes, from baseline to Week 12. One hundred and twenty patients were randomised (Part A, n= 24; Part B, n= 96). In Part B, there was a significant reduction in least-square mean (SE) absolute change in LFC from baseline to Week 12 for VONA-100QD (-6.3% [0.9]) and VONA-200QD (-5.4% [0.9]), vs. placebo (-2.3% [0.9], p=0.002 and 0.012, respectively). A >30% relative LFC reduction was achieved by 50.0% and 39.3% of patients in the VONA-100QD and VONA-200QD arms, respectively, but only in 12.5% in the placebo arm. Reductions in body weight, liver enzymes, and corrected T1 were also observed with vonafexor. Creatinine-based glomerular filtration rate improved in the active arms but not the placebo arm. Mild to moderate generalised pruritus was reported in 6.3%, 9.7%, and 18.2% of participants in the placebo, VONA-100QD, and VONA-200QD arms, respectively. In patients with suspected fibrotic NASH, vonafexor was safe and induced potent liver fat reduction, improvement in liver enzymes, weight loss, and a possible renal benefit. 2018-003119-22. NCT03812029. Non-alcoholic steatohepatitis (NASH) has become a leading cause of chronic liver disease worldwide. Affected patients are also at higher risk of developing chronic kidney disease. There are no approved therapies and only few options to treat this population. The phase IIa LIVIFY trial results show that single daily administration of oral vonafexor, an FXR agonist, leads in the short term to a reduction in liver fat, liver enzymes, fibrosis biomarkers, body weight and abdominal circumference, and a possible improvement in kidney function, while possible mild moderate pruritus (a peripheral FXR class effect) and an LDL-cholesterol increase are manageable with lower doses and statins. These results support exploration in longer and larger trials, with the aim of addressing the unmet medical need in NASH.

Frequency and Severity of Pruritus and Its Related Factors among Patients under Hemodialysis at Ali Ibn Abitaleb Hospital in Zahedan

Background: End stage renal disease (ESRD) due to the inability of the kidneys to excrete toxins is clearly associated with many physical complications, such as skin disorders, itching and etc. The severity of pruritus varies and has varied in different societies. Considering the different statistics observed in various researches on the high prevalence of pruritus in hemodialysis patients and its adverse effects on their health, we intend to investigate the prevalence of uremic pruritus and its related factors in patients under hemodialysis at Ali Ibn Abi Talib Hospitalin Zahedan in 2019.&#x0D; Methods: A descriptive cross-sectional study was performed on 100 patients who underwent dialysis in Ali Ibn Abitaleb Hospital in 1398. Tools used for data collection was a questionnaire for demographic details and Jusipovich questionnaire. Laboratory information from patient records were entered in the information form.&#x0D; Results: The mean age of patients was 46.17 years. 56% of patients were female and 44% were male. 46% of patients had pruritus, of which 50% (23 cases) had mild pruritus, 28.26% (13 cases) moderate and 21.7% (10 cases) had severe pruritus. The average age of patients with mild pruritus was 45 years (31-67 years), in patients with moderate pruritus was 51 years (range 26 to 66 years) and in patients with severe pruritus was 49.5 (27-67years).&#x0D; Conclusion: In the present study, none of the factors such as dialysis adequacy, sex, serum phosphorus level, calcium, number of dialysis sessions, age, parathyroid hormone were significantly associated with the severity of pruritus in hemodialysis patients.

Prevalence of Pruritus and Association with Anxiety and Depression in Patients with Nonalcoholic Fatty Liver Disease.

Patient-reported outcomes are important in nonalcoholic fatty liver disease (NAFLD). Pruritus is of special interest for evolving therapies with farnesoid X receptor (FXR) agonists. The aim of this study was to investigate the prevalence of pruritus in a real-life NAFLD cohort and analyze associations with anxiety and depression. Pruritus was assessed using a visual analogue- (VAS) and 5-D itch-scale (5-D). Anxiety and depression were evaluated by Beck’s-Depression-Inventory (BDI) and the Hospital Anxiety and Depression Scale (HADS-A, HADS-D). An optimal logistic regression model was found with a stepwise procedure to investigate variables associated with pruritus. In total, 123 NAFLD patients were recruited. VAS and 5-D were highly correlated (Spearman’s correlation coefficient 0.89). Moderate/severe pruritus was reported in 19% (VAS) and 21% (5-D) of patients. Anxiety and depression were present in 12% and 4% (HADS-A and HADS-D, respectively) and 12% (BDI) of cases. There was a significant association between VAS and BDI (p = 0.019). The final multivariate model for 5-D included diabetes mellitus (OR 4.51; p = 0.01), BDI (OR 5.98; p = 0.024), and HADS-A (OR 7.75; p = 0.011). One-fifth of NAFLD patients reported moderate or severe pruritus. 5-D was significantly associated with diabetes mellitus, depression, and anxiety. These findings should be tested in larger populations and considered in candidates for treatment with FXR agonists.

The correlation between uremic pruritus and blood lead levels in prevalent hemodialysis patients and its relation to the severity of pruritus using visual analog score

BackgroundPruritus is a common and often distressing symptom in patients with chronic kidney disease. Though the pathogenesis of uremic pruritus remains poorly understood, systemic inflammation has presented itself as one of the possible explanations. High blood lead levels (BLLs) have been noted to be associated with inflammation and poor nutritional status in hemodialysis patients. Our aim is to study the relation between blood lead levels and uremic pruritus. This is a cross-sectional study that enrolled 50 patients; all were on regular hemodialysis 3 times per week for at least 6 months. Patients were divided into 2 groups, group 1 (n =10) with no pruritus and group 2 (n=40) with varying degrees of pruritus. Group 2 was further divided according to intensity of pruritus by visual analog score (VAS) into mild (n=10), moderate (n=20), and severe pruritus (n=10).ResultsThere was a significant difference in serum lead levels and ferritin levels between groups 1 and 2 (p value < 0.01 and < 0.05, respectively). There was a statistically significant difference in serum lead levels in the groups with varying intensity of pruritus, having higher serum lead levels in patients who exhibited severe pruritus (p value < 0.005) Moreover, a statistically significant relation between elevated blood lead levels and the duration of dialysis was observed in this study.ConclusionUremic pruritus is a multi-factorial phenomenon, and our study showed that blood lead levels in hemodialysis patients might be associated with increased intensity of pruritus.

Hubungan antara intensitas Pruritus Nokturna dengan Kualitas Tidur pada Penderita Skabies

Objectiv e: To analyze the relationship between the intensity of nocturnal pruritus and the sleep quality of scabies patients. Method: This was an analytic study with cross-sectional design. The subject was recruited by total sampling. Data was analysed using the Spearman correlation test. Result: As many as 160 out of 302 students (53%) were suffering from scabies. Majority of patients were 13 years old, at the 7th grade of school, had a normal Body Mass Index (BMI), had an onset of scabies ≤ 3 months and not in the scabies treatment period in the last 1 month. There were 22 scabies patients matched the inclusion and exclusion criteria. As many as 5 out of 22 patients had mild nocturnal pruritus,10 patients had moderate nocturnal pruritus and 7 patients had severe nocturnal pruritus. There were 13.6% had good sleep quality and 86.4% had poor sleep quality. Analysis using Spearman test showed the value of p=0.65 implicated that there was no significant correlation between the intensity of nocturnal pruritus and the sleep quality of scabies patients. Conclusion : There was no relationship between the intensity of nocturnal pruritus and the sleep quality of scabies patients at the Pesantren male dormitory.

Clinical characteristics of itch in cutaneous lupus erythematosus: A prospective, multicenter, multinational, cross-sectional study.

Pruritus is an important symptom frequently accompanying various inflammatory skin conditions and some recent data indicated that it may be associated with autoimmune connective tissue diseases. The aim of this study was to assess the frequency and clinical presentation of itch in CLE. A multinational, prospective, cross-sectional study was performed to assess the prevalence, intensity and clinical characteristic of pruritus in various subtypes of CLE. A total of 153 patients with active CLE lesions were included. Their age ranged between 17 and 82 years (mean 49.8 ± 15.4 years), and 115 patients (75.2%) were women. The disease activity and damage were assessed according to the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI). Pruritus severity was assessed with Numeric Rating Scale (NRS) and the 12-Item Pruritus Severity Scale. Dermatology Life Quality Index and EQ-5D questionnaire were used to measure quality of life. Pruritus was present in 116 (76.8%) of patients of whom half had NRS scoring equal or above 4 points indicating moderate or severe pruritus. Most commonly itch was localized on the scalp, face (excluding ears and nose) and arms (40.5%, 36.2%, 31.9%, respectively). Sensations connected with pruritus were most frequently described as burning, tingling and like ants crawling feeling, but 31.9% patients described it as "pure itch". More than half of patients reported that pruritus was present every day, and it was most frequent during the evenings. The pruritus scoring and the CLASI activity score were significantly correlated (r = 0.42, p = 0.0001), while no correlation was found with the CLASI damage score (p = 0.16). Both the maximum and average itch intensity were correlated with systemic lupus erythematosus (SLE) activity measured with the Systemic Lupus Erythematosus Disease Activity Index. Pruritus is a common, but frequently overlooked symptom of CLE. Its intensity correlates with the activity of CLE, but not with the skin damage. In more than a half of patients it occurs on a daily basis. The correlation between the intensity of pruritus and the activity of the skin lesions and the systemic involvement indicate that pruritus could be an individual indicator of both SLE and CLE activity.