Visual Analog Scale Pruritus Score Research Articles

More than a skin disease: stress, depression, anxiety levels, and serum neurotrophins in lichen simplex chronicus

BackgroundLichen simplex chronicus is a dermatological condition due to excessive scratching, with few studies on psychoneuroimmunology. ObjectiveWe aimed to estimate the levels of stress, depression, and anxiety, and to measure serum levels of neurotrophins in patients with lichen simplex chronicus, and to correlate these parameters with the severity of the disease and pruritus. MethodsThirty-six patients with lichen simplex chronicus and 36 age- and sex-matched healthy controls were included. Each participant was administered the Hospital Anxiety and Depression Scale and Perceived Stress Scale questionnaires, along with a visual analog scale for pruritus. Levels of neurotrophins (brain-derived neurotrophic factor, neurotrophin-3, nerve growth factor, glial cell line-derived neurotrophic factor) were determined by ELISA assays. ResultsThe scores of Perceived Stress Scale-10, Hospital Anxiety and Depression Scale were statistically higher in patients (p < 0.05 for all). The serum levels of all neurotrophins were significantly lower in patients compared to healthy controls (p < 0.05 for all). Disease severity showed no correlation with all four neurotrophins. In linear regression models applied for increased visual analog scale-pruritus scores and disease severity these two variables were statistically significant predictors (p = 0.043). Study limitationsA direct causal relationship was not addressed. ConclusionLichen simplex chronicus patients are at risk of increased levels of stress, anxiety, depression, and present decreased levels of neurotrophins, that may suggest a role in the pathophysiology of this disorder.

Ablative fractional CO2 laser surgery improving sleep quality, pain and pruritus in adult hypertrophic scar patients: a prospective cohort study.

BackgroundPoor sleep quality is associated with a decrease in quality of life in patients with major burn scars, combined with pruritus and pain. Few interventions have been reported to improve the sleep quality of patients with scars. In the current prospective cohort study, we investigated the efficacy of CO2-ablative fractional laser (AFL) surgery vs conventional surgery in post-burn patients with hypertrophic scars with sleep quality as the primary study outcome.MethodsIn total 68 consecutive patients undergoing scar surgical treatment were recruited, including a CO2-AFL surgery cohort (n = 35) and a conventional surgery cohort (n = 33). A subgroup from the AFL cohort was selected. Sleep quality, pain and pruritus were evaluated. Multiple linear regression analyses were performed to reveal the effect of CO2-AFL surgery.ResultsThe CO2-AFL surgery cohort had significantly lower Pittsburgh sleep quality index (PSQI) global scores than the conventional surgery cohort after the last surgical treatment. In the subgroup of patients receiving hardware sleep monitoring, CO2-AFL markedly increased deep sleep time, deep sleep efficiency and reduced initial sleep latency. Compared to the conventional surgery cohort, the CO2-AFL cohort presented significantly lower pain and pruritus scores. Correlation analysis showed pain and pruritus were significantly associated with PSQI scores, and there were also significant correlations between pain and pruritus scores. Multiple linear regression analysis showed that surgery method was negatively linearly correlated with visual analog scale (VAS) pain score, brief pain inventory (BPI) total, VAS pruritus score, 5-D itch scale total, four-item itch questionnaire (FIIQ) total and PSQI total.ConclusionsCO2-AFL surgery significantly improved sleep quality and reduced pain and pruritus of hypertrophic scar patients. The alleviation of sleep disorder was associated with improvement of deep sleep quality including deep sleep time and deep sleep deficiency.Trial registrationThe Chinese Clinical Trial Registry (ChiCTR200035268) approved retrospectively registration on 5 Aug 2020.

Efficacy and safety of topical OPA-15406, a new phosphodiesterase 4 inhibitor, in Japanese patients with atopic dermatitis for 8weeks: A phase 2, randomized, double-blind, placebo-controlled study.

The efficacy and safety of topical OPA‐15406, a new phosphodiesterase 4 inhibitor, were examined in Japanese patients aged 15–70 years with atopic dermatitis in a phase 2, randomized, double‐blind, vehicle‐controlled study. Two hundred patients were randomized to three treatment groups at a 1:1:1 ratio to receive OPA‐15406 0.3%, OPA‐15406 1% or vehicle ointment twice daily for 8 weeks. The OPA‐15406 1% group was superior to the vehicle group in terms of the incidence of success based on the Investigator Global Assessment score at week 4 (P = 0.0328), which was the primary end‐point, while the OPA‐15406 0.3% group showed a trend toward improvement in the primary end‐point. The mean Eczema Area and Severity Index total score and subscale (erythema, induration/papulation, excoriation and lichenification) scores, the Visual Analog Scale pruritus score and the Patient‐Oriented Eczema Measure score were significantly improved and the percentage of affected body surface area was significantly decreased in both OPA‐15406 groups relative to the vehicle group as early as week 1, and the improved scores and decreased percentages were generally maintained until week 8. No deaths or serious treatment‐emergent adverse events occurred in the OPA‐15406 treatment groups. Treatment‐emergent adverse events frequently observed across treatment groups were worsening of atopic dermatitis, viral upper respiratory tract infection and pruritus, all of which were mild or moderate in severity in the OPA‐15406 groups. OPA‐15406 1% ointment showed favorable efficacy and safety profiles, indicating a promising treatment option for patients with atopic dermatitis.

Therapeutic effect of ultra pulse carbon dioxide fractional laser on treating hypertrophic scar after burn

Objective To study the therapeutic effect of ultra pulsed carbon dioxide fractional laser on treating hypertrophic scar after burn. Methods Forty-five patients with hypertrophic scar after burn were selected. Each laser treatment included an ultra-pulse mode and a Scaar FX mode scan irradiation, and the treatment was conducted once a month for 4 to 6 times. In the ultra-pulse irradiation, the energy was 150~175 mJ, frequency was 40 Hz, hole spacing was about 4~5 mm, and irradiation time per hole was 2~3 s, and in Scaar FX mode energy was 60~150 mJ, frequency 250 Hz, and density 1% to 3%. Before the first treatment and 6 months after the end of the treatment, the Vancouver scar scale (VSS) was used to score the scar morphology, and the visual analog scale (VAS) was used to score the scar pain and itching. The effect of the treatment was classified as significant, effective and invalid. In addition, adverse reactions occurred during the treatment were recorded. Results After six months of the treatments, the VSS score, VAS pain score, and VAS pruritus score of the patients were 4.16±1.72, 1.58±0.62, and 1.24±0.74, respectively, while the pre-treatment values were 10.17±1.96, 2.98±0.89, and 2.31±0.97, respectively. The differences were statistically significant (all P<0.01). The treatment was effective in all patients, and the effect was significant in 35 cases, effective in 10 cases, and no recurrence occurred within 6 months after treatment. In 3 patients, blisters appeared on the scar after the first treatment, and the blister collapsed to form a wound. After the dressing change, the blisters healed after 7 to 10 days. Conclusion Ultra pulsed carbon dioxide fractional laser is effective in treating hypertrophic scar after burn, with mild adverse reactions and no relapse, which is worthy of clinical promotion. Key words: Burns; Scar; Ultra pulsed CO2 fractional laser; Laser therapy

Serlopitant for the treatment of chronic pruritus: Results of a randomized, multicenter, placebo-controlled phase 2 clinical trial

The substance P/neurokinin 1 receptor pathway is critical in chronic pruritus; anecdotal evidence suggests that antagonism of this pathway can reduce chronic itch. To assess the safety and efficacy of the substance P/neurokinin 1 receptor antagonist serlopitant in treating chronic pruritus. Eligible patients with severe chronic pruritus who were refractory to antihistamines or topical steroids were randomized to serlopitant, 0.25, 1, or 5mg, or to placebo, administered once daily for 6weeks as monotherapy or with midpotency steroids and emollients. The primary efficacy end point was percentage change in visual analog scale pruritus score from baseline. Serlopitant treatment resulted in a dose-dependent decrease in pruritus. The mean percentage decreases from baseline visual analog scale pruritus scores were statistically significantly larger with the 1-and 5-mg doses of serlopitant (P=.022 and P=.013, respectively) than with placebo at week 6. No significant safety or tolerability differences were detected among the groups. The sample size was insufficient for subgroup analyses of the efficacy of serlopitant for chronic pruritus on the basis of underlying conditions. Serlopitant, 1mg and 5mg daily, was associated with a statistically significant reduction in chronic pruritus and was well tolerated (NCT01951274).

OPA-15406, a novel, topical, nonsteroidal, selective phosphodiesterase-4 (PDE4) inhibitor, in the treatment of adult and adolescent patients with mild to moderate atopic dermatitis (AD): A phase-II randomized, double-blind, placebo-controlled study

Peripheral leukocytes in patients with atopic dermatitis (AD) have elevated phosphodiesterase-4 activity, which is associated with production of proinflammatory mediators. OPA-15406 is a phosphodiesterase-4 inhibitor with high selectivity for phosphodiesterase-4-B. We sought to assess effectiveness and tolerability of topical OPA-15406 in patients with AD. This was a randomized, double-blind, vehicle-controlled, phase-II study. Patients 10 to 70years of age with mild or moderate AD received topical OPA-15406 0.3% (n=41), OPA-15406 1% (n=43), or vehicle (n=37) twice daily for 8weeks. The primary end point, Investigator Global Assessment of Disease Severity score of 0 or 1 with greater than or equal to 2-grade reduction, was met at week 4 in the OPA-15406 1% group (P=.0165 vs vehicle). Mean percentage improvement from baseline Eczema Area and Severity Index score for OPA-15406 1% was notable in week 1 (31.4% vs 6.0% for vehicle; P=.0005), even larger in week 2 (39.0% vs 3.0%; P=.0001), and persisted for 8weeks. Visual analog scale pruritus scores improved from moderate to mild within the first week in the OPA-15406 1% group (36.4% mean change; P=.0011). OPA-15406 levels in blood were negligible. Incidence of adverse events was low, with most events mild in intensity. Further confirmatory phase-III studies are required. OPA-15406 ointment may provide an effective therapeutic modality for patients with mild to moderate AD.

Comparison of FEDESI and SCORFAD scoring systems for the evaluation of skin lesions in allergic cats.

Feline Dermatitis Extent and Severity Index (FeDESI) and Scoring Feline Allergic Dermatitis (SCORFAD) are two different scoring systems for the evaluation of feline allergic dermatitis. To evaluate the correlation between FeDESI and SCORFAD and pruritus. The dermatological lesions of 32 cats affected by feline allergic dermatitis were evaluated with both FeDESI and SCORFAD before treatment and once monthly during treatment where ciclosporin was administered at 7 mg/kg orally once daily for 1 month then tapered, when possible, in the subsequent 2 months. Pruritus was scored by pet owners with a Visual Analog Scale (VAS). Correlation between scores at Visit 1, and between absolute and percentage score improvements at visits 1, 2 and 3, were analysed statistically using a nonparametric Spearman's rank correlation test. Correlation between FeDESI, SCORFAD and VAS pruritus scores at baseline was low and nonsignificant for all combinations. The correlation of absolute score improvement was moderate and significant only between FeDESI and VAS pruritus at Visit 3. Correlation of improvement percentage was moderate and significant between FeDESI and SCORFAD and between FeDESI and VAS pruritus at Visit 2, whereas at visits 3 and 4 it was high and significant for each combination. Only improvement percentage of FeDESI and SCORFAD scores seem to correlate well. SCORFAD is the only scoring system to have been validated, although it seems to correlate less with pruritus and may be more difficult to use than FeDESI. The latter could thus be more appropriate for use, but further studies are needed especially in regard to its validation.

Oclacitinib in feline nonflea-, nonfood-induced hypersensitivity dermatitis: results of a small prospective pilot study of client-owned cats.

Oclacitinib is a Janus kinase inhibitor that decreases pruritus and lesions in allergic dogs. In cats, it is able to inhibit interleukin-31-induced pruritus; no information is available on its clinical effectiveness. To evaluate the efficacy, ease of administration and tolerability of oclacitinib in feline nonflea-, nonfood-induced hypersensitivity dermatitis. Cats >12 months of age and >3 kg body weight with a diagnosis of nonflea-, nonfood-induced hypersensitivity dermatitis were treated with oclacitinib, 0.4-0.6 mg/kg orally (p.o.) twice daily for 2 weeks, then once daily for an additional 14 days. Clinical lesions were evaluated with the Scoring Feline Allergic Dermatitis (SCORFAD) system and pruritus was evaluated with a 10-cm-long visual analog scale (VAS) before and at the end of the study. Owners assessed global efficacy, ease of administration and tolerability with a four-point scale. Twelve cats were treated with a mean initial oclacitinib dose of 0.47 mg/kg p.o. twice daily. There was good improvement in SCORFAD and VAS pruritus scores in five of 12 cases, while the other cats were unchanged, deteriorated or dropped out due to treatment failure. Owners scored global efficacy as good/excellent in four of 12 cases and ease of administration and tolerability as good/excellent in 10 of 12. Oclacitinib at 0.4-0.6 mg/kg p.o. may be an effective and safe drug for some cats with nonflea-, nonfood-induced hypersensitivity dermatitis. Further studies are needed to identify the most effective dose range for this species.

A prospective observational study evaluating hypothalamic-pituitary-adrenal axis alteration and efficacy of intramuscular triamcinolone acetonide for steroid-responsive dermatologic disease

The lack of recommendations regarding dosing and administration, an undetermined risk of hypothalamic-pituitary-adrenal axis alteration, and the unknown effectiveness of intramuscular (IM) corticosteroid injection to treat dermatologic disease may be deterrents to use. We sought to evaluate presence and duration of iatrogenic Cushing syndrome and secondary adrenal insufficiency in patients receiving IM triamcinolone acetonide (TAC), and to assess physician- and patient-reported outcomes. We conducted a prospective observational study of 14 patients given the diagnosis of steroid-responsive dermatologic disease who received either 1 or 2 doses 6 weeks apart of IM TAC. Baseline and follow-up cortisol, adrenocorticotropic hormone, Physician and Subject Global Assessments of Disease Activity Scale score, and the visual analog scale score of pruritus were evaluated at 6-week intervals. Although mean total cortisol was significantly decreased at 6 and 12 weeks compared with baseline, IM TAC did not result in iatrogenic Cushing syndrome or secondary adrenal insufficiency in any patient. Mean Physician and Subject Global Assessments of Disease Activity Scale scores were significantly improved at 6 and 12 weeks compared with baseline. Mean visual analog scale pruritus scores were significantly improved at 6 weeks compared with baseline. The study was limited by the cohort size and a lack of a comparator group. IM TAC appears safe when administered as 2 injections at 6-week intervals. Significant improvement was noted across a number of steroid-responsive dermatoses. These results may provide a guide to dosing, frequency, and administration for dermatologists considering the use of IM TAC in the appropriate clinical contexts.

Efficacy and safety of tacrolimus 0.03 ％ ointment for the treatment of 2-year-old patients with moderate to severe atopic dermatitis

Objective To evaluate the efficacy and safety of tacrolimus 0.03％ ointment for the treatment of 2-year-old patients with moderate to severe AD.Methods An open-labeled,non-comparative,multi-center study was carried out,which included 59 2-year-old children with moderate to severe AD.All the patients were given topical tacrolimus 0.03％ ointment twice daily for 3 weeks.The evaluation of patients was scheduled at the baseline,1,2,and 3 weeks after the start of treatment.Clinical outcome parameters included the total response rate,eczema area and severity index score (EASI score),the percentage of body surface area (BSA％) affected,physician's global evaluation (PGE),children's dermatology life quality index (CDLQI),visual analog scale (VAS) pruritus score.Safety was assessed based on adverse events reported by patients or observed by the physicians.Results At the end of the treatment,the total response rate was 65.85％ with an EASI score of 4.18,and BSA％ of 16.41％.Of these patients,85.10％ achieved a satisfactory outcome,2.13％ achieved a complete cure,and all achieved an improvement,with no exacerbation observed.The 3-week treatment also resulted in a significant decrease in VAS pruritus score (from 6.80 to 3.21) and CDLQI (frown 7.06 to 2.91).Side effects mainly manifested as temporary burning sensation at the application site,and no severe adverse events associated with tacrolimus were observed.Conclusion Tacrolimus 0.03％ ointment seems safe and effective for the treatment of 2-year-old patients with moderate to severe AD.

The use of concentrated heat after insect bites/stings as an alternative to reduce swelling, pain, and pruritus: an open cohort-study at German beaches and bathing-lakes

BackgroundSwelling, pain, and pruritus are the most relevant symptoms after insect bites/stings. Glucocorticoids and antihistamines are well established in insect sting treatment. Bite Away® is a CE-certified medical device of class 2A (noninvasive device intended for administration to the body, which exchanges energy with the patient in a therapeutic manner) to reduce swelling, pruritus, and pain after insect bites/stings via non-invasive administration of concentrated heat to the skin. We therefore performed a prospective, non-interventional, single-arm cohort study with 146 volunteers using the visual analog scale (VAS) for insect bites/stings to study the reduction of swelling, pruritus, and pain. Demographic data, time from insect sting to treatment, number and duration of administrations of concentrated heat, relevant symptoms, and the development of a VAS score of swelling, pruritus, and pain on baseline, after 2, 5, and 10 minutes after administration, were registered.ResultsIn total 146 subjects with a mean age of 29.4 ± 20.7 years (range 2–81) were enrolled in the study. Ninety-three (63.7%) of the subjects were stung by wasps, 33 (22.6%) of the subjects were bitten by mosquitoes, and eight suffered bee stings (5.3%). VAS score swelling decreased with statistical significance after the use of Bite Away® from 4 before treatment to 2 and 1 after 2–5 and 10 minutes, respectively. VAS pain score was 6 before treatment, 2 after 2 minutes, 1 after 5 minutes, and 0 after 10 minutes (median). VAS pruritus score was only available for 52 (35.2%) of the patients. The score decreased from 5 before treatment, to 2 after 2 minutes, and 0 after 5 and 10 minutes.ConclusionsLocally administrated concentrated heat leads to fast amelioration of symptoms. Usually an absence of symptoms is noticeable 10 minutes after administration. Pain reduction is the dominant effect. Compared with alternatives of pruritus and pain treatment after insect bites/stings, Bite Away® seems to be the fastest treatment option available.