Nocturnal Itching Research Articles

Treatment With Topical Ivermectin 1% Once a Month to Control Demodex Blepharitis

Purpose: The study aimed to assess the effectiveness of a monthly application of topical 1% ivermectin cream, for 3 months, to the eyelids and eyelids margin, accompanied by gentle squeezing of meibomian glands and microexfoliation to the base of eyelashes, in the management of Demodex blepharitis. Methods: Thirty-eight patients diagnosed with Demodex blepharitis based on the presence of sleeves at the base of the eyelashes, telangiectasias, and signs of local inflammation with at least 4 Demodex mites observed at the lash roots were enrolled. Treatment involved applying 1% ivermectin topical cream using an eyelash brush in circular motion, gradually moving toward the eyelid margin. The procedure was repeated several times over 10 min by applying more cream. Each patient was evaluated before each treatment and 1 month after completion of the 3-month period. Results: Significant improvements in symptoms and signs were observed, with the disappearance of cylindrical sleeves on the base of the eyelashes, telangiectasias, signs of inflammation, and a significant decrease in night itching. The Schirmer test showed no changes, while the tear breakup time test exhibited slight yet statistically significant enhancement. No adverse events were reported during the study. Conclusions: The results of this investigation establish that Demodex blepharitis can be effectively managed by the application of 1% ivermectin cream once a month over a three-month period. This treatment approach, in conjunction with the gentle squeezing of meibomian glands and eyelid margin microexfoliation to the base of the eyelashes, resulted in the disappearance of objective indicators, such as cylindrical sleeves and telangiectasia, along with a significant reduction in nocturnal itching.

Frequent Misdiagnosis of Scabies as Eczema in China: A Descriptive Study of 23 Cases.

To outline the clinical manifestations observed in patients with scabies misdiagnosed as generalized eczema, analyse the factors contributing to these misdiagnoses and explore potential reasons for the resurgence of scabies. A retrospective analysis was performed to investigate the patients with scabies misdiagnosed as generalized eczema. We included 23 patients, with twelve (52.17%) being male and eleven (47.83%) female. The illness duration ranged from 0.5 to 7 months. Among all patients, 12 (52.17%) were residents of nursing homes, 5 (21.74%) were staff members of these facilities, 4 (17.39%) were caregivers of long-term hospitalized relatives, 1 (4.35%) was a construction worker, and 1 (4.35%) had a history of tourism. The rash predominantly affected the trunk and extremities, 12 patients (52.17%) are each involved the perineum and fingers webbings. The presentations included erythema, papules, and nodules. The main complaint of all patients was nocturnal itch. Under direct microscopy, 5 patients (21.74%) tested positive for scabies mites, and 3 (13.04%) showed histopathological features consistent with scabies. All patients were initially misdiagnosed with generalized eczema. Over half of all patients diagnosed with scabies either resided or worked in long-term care facilities. The lack of awareness of scabies among medical staff in long-term care facilities readily led to frequent misdiagnosis. Comprehensive measures should be implemented urgently to strengthen disease management.

Quality of life and burden of disease of vulvar lichen sclerosus: A single-center retrospective study in China.

This study examined the quality of life and burden of disease of vulvar lichen sclerosus (VLS) patients in three states of menstruation to better understand VLS. A total of 607 VLS patients were enrolled into this retrospective study. According to the ages of onset, menarche and menopause, the patients were divided into three groups: prepubertal group (n = 96), reproductive group (n = 400) and postmenopausal group (n = 111). Data were collected by direct interview and clinical examination. A total of 93% of patients had itching, with a median numerical rating scale score of five. In the prepubertal group, the median score was three. Nocturnal itching occurred in 49.6% patients. Nearly half of the patients (45.9%) thought the itching affected their sleep. However, this ratio was very different in the prepubertal group (20.7%). Some patients (12.8%) cleaned their vulva more than seven times per week. Only 17.2% of patients experienced no effect on their sex life. The median dermatology life quality index score in all patients was six, but it was only three in the prepubertal group. The median number of hospital visits was two times, and the number of clinic visits was three times. Previous expenses, in median, were 2000 RMB. For 84.3% patients, the gynecologic clinic was their first choice. VLS places great physical, mental and economic burdens on patients. Patients in the prepubertal group had milder symptoms and dermatology life quality index score. VLS should arouse the attention of patients and specialists.

Pruritic rash and nocturnal itching.

UV light illuminated the patient's diagnosis.

Association of pruritus with sleep in patients with psoriasis and chronic spontaneous urticaria: A cross-sectional study.

Pruritus is a frequent complaint associated with various inflammatory dermatoses. Sleep is often disturbed because of pruritus but the impact of severity and diurnal pattern of pruritus has not been studied so far. To estimate the prevalence of nocturnal itch (NI) and its association with itch severity, sleep disturbance and quality of life (QoL) compared with non-NI in chronic plaque psoriasis (CPP) and chronic spontaneous urticaria (CSU). We performed a cross-sectional study in patients aged ≥18 years with CPP or CSU for at least 6 weeks. A comprehensive in-house questionnaire designed for study formed the basis for categorizing patients into NI and non-NI. Validated instruments like visual analog scale, pruritus grading system, General Sleep Disturbance Scale, and Dermatology life quality index were used to assess itch severity, sleep, and QoL. A total of 255 patients (CPP: 131; CSU: 124) were included in this study. Prevalence of NI was 43.5% (95% confidence interval: 34.9%-52.4%) in CPP and 29% (95% confidence interval: 21.2%-37.9%) in CSU. NI was strongly associated with higher pruritus grading system scores in CSU and CPP (regression coefficient = 1.5, P =0.004 and regression coefficient = 1.3, P =0.004, respectively), with impaired sleep (OR = 2.97, P = 0.025) in CPP and with itch-affected sleep in CSU. Itch severity was associated with impaired sleep; however, the association was modified by the presence of NI in CSU patients. Nocturnal itch is prevalent in chronic dermatoses and significant for sleep deficit and impaired QoL. Early screening and management of sleep disturbance among patients presenting with nocturnal itch should be routinely undertaken.

A case series on bullous pemphigoid like scabies: A diagnostic challenge

Scabies is an ectoparasitic infection caused by Sarcoptes scabiei var. hominis in humans. Accurate figures of the prevalence of scabies are difficult to obtain, it seems to affect around 100–300 million people worldwide. Scabies is usually transmitted by close intimate physical contacts, such as the sharing of a bed or prolonged hand-holding. Scabies mites survive for 24–36 h outside of human bodies. Itching is the most obvious manifestation of scabies, which is usually sparing the face in adult classic scabies. The onset occurs 3–4 weeks after acquiring the infection. Bullous pemphigoid-like scabies is one of the atypical and rare forms of scabies that may be overlooked and mismanaged, where only 44 cases worldwide with this mode of presentation were reported. Here, we reported a series of three cases of bullous pemphigoid-like scabies, which presented with nocturnal itching and vesiculobullous lesions that are to the best of our knowledge the first cases reported in our country

Erythrodermic Manifestation due to Hyperinfestation of Scabies

Background: Scabies is a highly contagious skin disease with various skin clinical presentations. In consideration of its clinical presentations, proper early-onset diagnosis of scabies may not be met, leading to mistreatment and more severe scabies, Norwegian (crusted) scabies. Purpose: To report a case of Norwegian scabies misdiagnosed as eczema in a previously immunocompetent patient. Case: A 32-year-old man was admitted with generalized erythematous skin rash, pruritic, and hyperkeratotic scales of the body. He was previously diagnosed with eczema two months ago and was prescribed both topical and systemic steroid. Skin scales worsened and kept expanding after the treatment. There was a family history of nocturnal itch. Dermoscopic and microscopic examination from skin lesion and scraping with potassium hydroxide revealed the signs of scabies infection. Discussion: Norwegian scabies could be prevented by the correct diagnosis at the early-onset of the disease. Misdiagnosis due to various skin clinical presentations, leading to mistreatment of the infection. In this case, family history plays a role that could elucidate the presence of scabies infection. Conclusion: A correct diagnosis and treatment for the early-phase scabies-infected patient will be beneficial for the patient to prevent hyperinfestation of scabies mites. Specific examination for scabies decreases the possibility of misdiagnosis.

Effect of Vachadi Ointment in the Management of Scabies - A Case Report

Introduction: Skin disease has a high prevalence throughout the world. Scabies is contagious and canspread quickly through close physical contact so it is an acute communicable disease. It is highly prevalentin young children. The present study is aimed to show the effect of Vachadi ointment on scabies in children.Scabies is characterized by nocturnal itching, vesicular or pustule eruptions, with small red bumps andblisters. According to Ayurveda Scabies can be correlated to Pama. Pama is one of the eighteen types ofKushtha (Skin Disease) according to the Charak Samhita (Chikitsa-Sthana) which is caused by vitiation ofKapha and Pitta Dosha. Case Description: A 10 years old male patient brought with complaints of itchingin between the fingers of both the hands, wrists and forearms since 10-12 days. On local examination,vesiculopustular lesions were present along with dry scaly patches over both the hands, wrists and forearms.Effect of the treatment was assessed on the basis of clearance of lesion and relief from itching. Conclusion:After intervention of the Vachadi ointment for 14th day, there was a marked improvement in symptomslike itching, scaling, and discharge. So, it can be said that Ayurveda has a better remedy for skin relatedcomplaints.

Scabies-Renaissance of an ectoparasite infection : Diagnosis and therapy-How to proceed in practice

Scabies or mange is currently acommon dermatosis in Germany and other countries, and should be more important in health policy. It affects across-section of society, including all age groups, from infants to the aged. Locals and people with amigration background both suffer from this highly contagious ectoparasite infection with excessive, predominately nocturnal itching. Clinical diagnosis represents achallenge for the experienced dermatologist due to the variety of dermatosis to be considered in the differential diagnosis. It is still unclear whether treatment failure or the recurrences observed everywhere are due to in vitro and in vivo resistance of the pathogen agent Sarcoptes scabiei against permethrin or ivermectin. Therapeutic errors seem to play arole as often not all direct contact persons are recorded and treated with antiscabious treatment. They form the reservoir for reinfections. In the event of repeated nonresponse to topical (permethrin) and/or oral antiscabious treatment, alternative topical preparations-benzyl benzoate or crotamiton-should be used. Combination with ivermectin is mandatory.

Unusual microscopic appearance of Sarcoptes scabiei from skin scrapping sample and its epidemiology

<p>Scabies is still a global parasitic problem with an iceberg phenomenon. Vulnerable people including those with comorbidities and live in close contact to each other in a long time. Its causative agent is <em>Sarcoptes scabiei</em>, an Arthropod which live in the host by burrowing and making tunnel in the skin. The patient usually complaint suffer from nocturnal itching, beside the skin derangement of the affected areas. Here we reported an unusual appearance of <em>S. scabiei </em>from a skin scrapping sample sent to the laboratory of parasitology, Faculty of Medicine, Universitas Kristen Indonesia, Jakarta Indonesia and also discuss its epidemiology.</p>

Itching at night: A review on reducing nocturnal pruritus in children.

The most common causes of chronic nocturnal itching in children are atopic dermatitis and psoriasis, with lichen simplex chronicus and prurigo nodularis contributing to lesser degrees. Despite the prevalence of nocturnal itching, its pathophysiology remains poorly understood. The most troubling consequence of itching at night is poor quality of sleep. Poor sleep quality in children with nocturnal itching has been linked to adverse neurocognitive, behavioral, and physiologic outcomes, including poor performance in school, attention deficit hyperactivity disorder, short stature, hypertension, obesity, and impaired immune function. There is no consensus on the best management of nocturnal itching in children. We conducted a review of the literature evaluating the efficacy of various treatment options for children with chronic nocturnal pruritus. Our review found three recently conducted randomized controlled trials and one case report demonstrating the efficacy of topical corticosteroids, oral melatonin, and clonidine in reducing nocturnal itching or improving sleep quality in children with nocturnal pruritus. Future research is needed to elucidate the pathophysiology of nocturnal itching to best develop targeted, effective treatment strategies.

Direct Microscopy of Stool Samples for Determining the Prevalence of Soil-Transmitted Helminthic Infections among Primary School Children in Kaduwela MOH Area of Sri Lanka following Floods in 2016

A descriptive cross-sectional school based study was carried out to investigate the prevalence of soil-transmitted intestinal helminths and the associated factors among school children in Kaduwela Medical Officer of Health (MOH) area in the Colombo district, which was affected by floods in 2016. The study was conducted in 9 selected schools in Kaduwela MOH area from September 2016 to March 2017. Permission was obtained from the relevant authorities. Grade 1 students were enrolled in the study after obtaining informed written consent from their parents/guardian. Interviewer based questionnaire was administered to gather demographic data and other relevant information. Stool samples were collected and examined by direct wet saline smear. Study population comprised 53.4% male students. None of stool samples were positive for soil-transmitted helminths but 17.4% of students complained of nocturnal itching and parents of 23% of them had seen worms passing out from their children's anus at night. Fourteen stool samples were found to be positive for cyst of Entamoeba coli. Majority of parents (69%) stated that their children always wash their hands with soap and water before meals, whereas 26% stated that their children practice this sometimes. Majority of students (88%) washed their hands after going to the toilet. Almost all students (86%) used water sealed toilets and very few used pit latrines (14%). In this study, 67% of students had received anti-helminthic drugs after the floods. These findings suggest that zero prevalence of helminthic infections could be due to anti-helminthic prophylaxis and good health practices. Further studies should be done in this area with a large sample size to investigate the true prevalence of helminthic infections. Students and parents should be educated on Enterobius vermicularis infection. The source of water supply should be tested for fecal contamination.

European guideline for the management of scabies.

Scabies is caused by Sarcoptes scabiei var. hominis. The disease can be sexually transmitted. Patients' main complaint is nocturnal itch. Disseminated, excoriated, erythematous papules are usually seen on the anterior trunk and limbs. Crusted scabies occurs in immunocompromised hosts and may be associated with reduced or absent pruritus. Recommended treatments are permethrin 5% cream, oral ivermectin and benzyl benzoate 25% lotion. Alternative treatments are malathion 0.5% aqueous lotion, ivermectin 1% lotion and sulphur 6-33% cream, ointment or lotion. Crusted scabies therapy requires a topical scabicide and oral ivermectin. Mass treatment of large populations with endemic disease can be performed with a single dose of ivermectin (200 micrograms/kg of bodyweight). Partner management needs a look-back period of 2 months. Screening for other STI is recommended. Patients and close contacts should avoid sexual contact until completion of treatment and should strictly observe personal hygiene rules when living in crowded spaces. Written information should be provided to suspected cases.

Nocturnal Pruritus: The Battle for a Peaceful Night's Sleep.

Chronic pruritus is a debilitating condition with numerous etiologies. Many patients suffer from nocturnal pruritus, which can decrease quality of life and affect mortality in hemodialysis patients. Nocturnal pruritus may occur in all sleep stages but is most prevalent in stages N1 and N2. Further research is needed to elucidate the pathophysiology of nocturnal itch, which will aid in the development of tailored management strategies.

Nodular Scabies of the Genitals

A 20 years-old-man, a native Indian of low socio-economic reckoning, had come to clinic with the complaints of severe nocturnal itching of the genitals for the past one month. A similar complaint was registered by other members of the household. The early diagnosis of the condition seemed to have been overlooked, because of conspicuous sparing of the usual sites namely the anterior axillary folds, elbows, wrists, webs of the fingers and around the umbilicus of the abdomen. Skin surface examination of the genitals, however, was remarkable, because it was studded by nodules of the size varying from 0.5 to 1cm.

Scabies as an occupational disease

Scabies is an infectious skin disease caused by the human itch mite (Sarcoptes scabiei var. hominis). It is mainly transmitted by direct skin-to-skin contact. The spread of scabies can cause major difficulties in healthcare institutions, particularly in residential homes for the elderly. The disease is characterized by intense nocturnal itching, erythematous papules arranged in a linear order, and scratching resulting in excoriations. The diagnosis is confirmed by identification of the mite or by finding one or more mite tunnels in the skin. An individually occurring case does not need to be reported. If two or more cases occur in the same institution, the company physician and the appropriate public health department are to be informed in Germany. In case of a suspected scabies infection in medical personnel due to exposure in their work setting, medical notification to the statutory occupational accidents' insurance(Nr. 3101) is to be issued in accordance with §202, VolumeVII of the German Social Code. First line treatment is topical therapy with 5 % permethrin. If scabies control is required in an institution, systemic treatment with ivermectin may be considered. In the case of a scabies outbreak, all patients, contact persons, and staff must be treated simultaneously.

Sleep-wake disorders and dermatology

Sleep is an active process that occupies about one-third of the lives of humans; however, there are relatively few studies of skin disorders during sleep. Sleep disruption in dermatologic disorders can significantly affect the quality of life and mental health of the patient and in some situations may even lead to exacerbations of the dermatologic condition. Sleep and skin disorders interface at several levels: (1) the role of the skin in normal sleep physiology, such as thermoregulation, core body temperature control, and sleep onset; (2) the effect of endogenous circadian rhythms and peripheral circadian “oscillators” on cutaneous symptoms, such as the natural trough in cortisol levels during the evening in patients with inflammatory dermatoses, which most likely results in increased pruritus during the evening and night; (3) the effect of symptoms such as pruritus, hyperhidrosis, and problems with thermoregulation, on sleep and sleep-related quality of life of the patients and their families; (4) the possible effect of primary sleep disorders, such as insomnia, sleep apnea, sleep deprivation, and circadian rhythm disorders, on dermatologic disorders; for example, central nervous system arousals from sleep in sleep apnea can result in increased sympathetic neural activity and increased inflammation; and (5) comorbidity of some dermatologic disorders with stress and psychiatric disorders, for example, major depressive disorder and attention deficit hyperactivity disorder (ADHD) that are also associated with sleep-related complaints. Sleep loss in atopic dermatitis (AD) is likely involved in the pathogenesis of ADHD-like symptoms in AD. Scratching during sleep, which may be proportional to the overall level of sympathetic nervous activity during the respective stages of sleep, usually occurs most frequently during non-rapid eye movement (NREM) stages 1 and 2 (vs stages 3 and 4 which are the deeper stages of sleep), and in rapid eye movement (REM) sleep, where the severity of scratching is similar to stage 2 sleep. Patient and parental reports of nocturnal itch and scratching in AD typically do not correlate with objective measures of scratching.

A study of serum concentrations and dermal levels of NGF in atopic dermatitis and healthy subjects

Nerve growth factor (NGF) was reported to be increased in the serum and skin of atopic dermatitis (AD) patients, to the extent that serum nerve growth factor levels were proposed to serve as a marker of disease severity. We studied NGF levels in the serum and dermis using skin microdialysis and attempted to correlate them with disease severity. We also examined if potential differences between morning and evening levels of NGF can explain the phenomenon of nocturnal itch. In addition, neurogenic inflammation and itch were induced using histamine iontophoresis in lesional and non-lesional skin and the effect of experimental itch on dermal NGF concentration was examined. We found that systemic (serum) and eczematous skin levels of NGF in AD are significantly lower in comparison to healthy controls. Serum NGF decreases from morning to late afternoon in both groups. Interestingly, serum NGF levels were correlated to disease severity in the morning in AD, although the NGF concentration in AD were significantly lower than in the healthy group. The local itch and neurogenic inflammation induction via experimental histamine reduced local NGF levels in the eczema and non-lesional skin in atopics, but not in the healthy controls, where it was slightly increased. The higher the clinical severity of the eczema, a significantly less pronounced effect of neurogenic inflammation on the local levels of NGF was found. The availability of measurable NGF might be reduced by a higher expression of NGF receptors. The fluctuations of NGF levels during the day suggest a complex modulation of this neurotrophin, potentially linked to stress or to an altered neurophysiological mechanism.

Pathophysiology of Nocturnal Scratching in Childhood Atopic Dermatitis: The Role of Brain-Derived Neurotrophic Factor and Substance P

Hon KL, Lam MC, Wong KY, Leung TF, Ng PC. Br J Dermatol. 2007;157(5):922–925 PURPOSE OF THE STUDY. To determine if brain-derived neurotrophic factor (BDNF) and substance P are associated with disease severity, quality of life, and nocturnal scratching in atopic dermatitis (AD). STUDY POPULATION. This was a prospective study of 28 children with AD (mean age: 11.1 ± 3.3 years) recruited from a pediatric dermatology clinic at a university teaching hospital in Hong Kong. Eighty-nine percent had moderate-to-severe AD on the basis of Scoring Atopic Dermatitis (SCORAD) scores. METHODS. AD severity, as well as pruritus and sleep loss (in the preceding 3 days), was evaluated by using the SCORAD index. The Children's Dermatology Life Quality Index (CDLQI) was used to measure the quality of life over the preceding 7 days. Serum BDNF, substance P, AD-associated chemokine (cutaneous T-cell–attracting cytokine [CTACK] and thymus and activation-regulated chemokine [TARC]), total immunoglobulin E (IgE), and eosinophil counts were measured. Patients wore a DigiTrac monitor (IM Systems, Baltimore, MD) on their dominant wrist while sleeping to record limb motion from 10 pm to 8 am the following morning. On the basis of the group's previous work showing that the wrist activities between 1 and 3 Hz for the first 3 hours of sleep were indicators of AD severity of children, the same parameters were used for analyses of correlations. RESULTS. The mean SCORAD score was 48.1 ± 21.5, and mean CDLQI score was 8.7 ± 5.4. The mean plasma concentrations of BDNF, substance P, CTACK, and TARC were 1798 ± 935, 94 ± 42, 1424 ± 719, and 824 ± 1000 pg/mL, respectively. BDNF correlated significantly with both the SCORAD (P = .010) and CDLQI (P = .004) scores, whereas substance P had a significant correlation only with the CDLQI score (P = .019). Both BDNF and substance P were highly significantly correlated with average (P < .001) and frequency-specific (P < .001) wrist activities measured by the DigiTrac. In contrast, the chemokine (CTACK and TARC), serum total IgE, and eosinophil counts did not correlate with scratching. It is interesting to note that there was no correlation between BDNF or substance P level and pruritus or sleep-loss scores reported by the parents in the SCORAD. CONCLUSIONS. Serum levels of BDNF and substance P were significantly linked to disease activity, quality of life, and levels of nocturnal scratching. REVIEWER COMMENTS. Pruritus can be very distressing for children with AD. Unfortunately, the pathophysiology of nocturnal itching and the mediators involved have not been well elucidated. This article is the first to demonstrate that BDNF and substance P levels are significantly linked to nocturnal scratching. Certainly additional studies are needed to show that these neuropeptides are the causative factors in itching. Inclusion of control groups and those with other dermatologic conditions that also cause pruritus would be helpful. However, this article also suggests that perceived symptoms of itch, especially by parents of those with AD, may not be precise and that perhaps the extent of nocturnal itching has been underappreciated.

Nocturnal Itch: Why Do We Itch At Night?

Pruritus is exacerbated at night in many systemic and dermatological diseases, resulting in reports of significantly diminished quality of life and sleep disturbances. At present, the underlying mechanisms responsible for night-time itching are not well understood. Nocturnal pruritus may be related to the circadian rhythm of itch mediators and possibly the disruption of such patterns. Diurnal changes in skin physiology, such as temperature and barrier function, may also play a role. Currently, the paucity of specific treatment options for nocturnal pruritus is alarming and needs to be addressed by future research. This review describes the scale of the problem associated with nocturnal pruritus, the impact it has on patients, possible underlying mechanisms and, lastly, treatment options.