Effect of omega-3 fatty acid supplementation in the treatment of Uremic Pruritus among dialytic chronic kidney disease patients: A meta-analysis

Background and Objectives@#Pruritus is a common and disabling symptom affecting as much as 50-90% of chronic kidney disease (CKD) patients undergoing dialysis. The pruritus experienced by these patients is often resistant to common anti-pruritic agents and has an overall negative impact on quality of life. With its antioxidant property and anti-inflammatory effects, omega-3 fatty acids have been used to alleviate pruritus. The objective of this study is to assess the effect of omega-3 fatty acid supplementation in reducing the severity of pruritus among dialytic CKD patients. @*Methods@#Various electronic databases were searched from inception to August 2022. Randomized controlled trials comparing the effect of omega-3 fatty acids versus placebo on the pruritus scores were included. The studies were independently assessed by three reviewers. Revman version 5.4 was used to analyze the data extracted from the studies while heterogeneity was evaluated using Chi2 and I2.@*Results@#A total of four studies with a population of 166 patients were included in the meta-analysis. The results show an overall beneficial effect of omega-3 fatty acids with a standardized mean difference of -1.40 (CI -1.74 to -1.05, Z=7.95, p value <0.00001). With a Chi2 of 2.91 (p=0.41) and I2 of 0%, there was no significant heterogeneity observed in the pooled analysis.@*Conclusion@#Overall, the results of the meta-analysis support the finding that omega-3 fatty acid supplementation may have a beneficial effect on reducing the severity of pruritus among CKD patients on dialysis.

Clinical and pathological analysis of 345 cases of vulvar lichen sclerosus and a preliminary study on the frequency of maintenance treatment / 中华妇产科杂志

Objective: To analyze and summarize the clinical and pathological characteristics, management, and efficacy of patients with vulvar lichen sclerosus (VLS) through a single center large sample study, and preliminarily to explore the frequency of maintenance treatment medication for VLS. Methods: The clinical data of VLS patients in Obstetrics and Gynecology Hospital of Fudan University from 2018 to 2021 were retrospectively collected. The clinicopathological characteristics (patients' age, course of disease, complicated disease history, family history, symptoms, signs and pathology), treatment and effects were retrospectively analyzed. The patients in the maintenance treatment stage were followed up regularly to explore the minimum frequency of individual medication to maintain the stability of the disease. Results: (1) General situation: a total of 345 patients with VLS were included in this study. The average age was (50.4±14.7) years (ranged from 8 to 84 years old), prevalence was highest in the 50-59 years group (30.1%, 104/345). Immune diseases occurred in 18.6% (33/177) of patients, 24.3% (43/177) of patients had allergic skin diseases, and 5.6% (10/177) of the patients' immediate family members had chronic vulvar pruritus or vulvar hypopigmentation. (2) Clinical features: the most common symptom was vulvar pruritus (96.1%, 196/204) among 204 patients with recorded symptoms. The most common sign was hypopigmentation of the vulva (96.3%, 206/214). The most common involved sites were labia minora (70.3%, 142/202), labia majora (67.8%, 137/202), and labial sulcus (59.4%, 120/202). The cumulative number of sites involved in 62 vulvar atrophy patients (2.7±1.1) was significantly higher than that in 152 non-atrophy patients (2.2±1.0; t=3.48, P=0.001). The course of vulvar atrophy was (9.3±8.5) years, which was significantly longer than that of non-atrophy patients [(6.6±5.6) years; t=2.04, P=0.046]. (3) Pathological features: among the 286 patients with electronic pathological sections, the most common pathological feature in the epidermis was epithelial nail process passivation (71.3%, 204/286). The common pathological features in the dermis were interstitial collagenization (84.6%, 242/286), and inflammatory cell infiltration (73.8%, 211/286). (4) Treatment: 177 patients received standardized treatment after diagnosis and were followed up regularly in our hospital. In the initial treatment stage, 26.0% (46/177) of the patients were treated with 0.05% clobetasol propionate cream, and 74.0% (131/177) of the patients were treated with 0.1% mometasone furoate ointment. The complete remission rates of the two methods were respectively 80.4% (37/46) and 74.0% (97/131), and there was no statistically significant difference (χ²=0.76, P=0.385). During maintenance treatment, 27.1% (48/177) of the patients took the medication twice a week, 35.0% (62/177) took the medication once a week, and 37.9% (67/177) took the medication once every 10 days. During follow-up after 6 months of maintenance treatment, there were no patients with recurrence of pruritus or progression of vulvar signs. Conclusions: The majority of VLS patients have itching, hypopigmentation, involvement of labia minora and labia majora, progressive atrophy, and inflammatory infiltration of dermis. Local treatments of mometasone furoate and clobetasol propionate have good initial therapeutic effects. The frequency exploration of individualized maintenance treatment could minimize the occurrence of adverse reactions when ensuring the stability of the patients' condition.

Nova ocorrência de lepidopterismo por Hylesia nigricans (Berg, 1875) (Lepidoptera: Saturniidae) no Rio Grande do Sul, Brasil / New occurrence of lepidopterism by Hylesia nigricans (Berg, 1875) (Lepidoptera: Saturniidae) in Rio Grande do Sul, Brazil

Adult forms of lepidopterans can cause health problems. This type of incident is known as Lepidopterism, which is caused by contact with urticating setae released by adults, such as those from the Hylesia Hübner (Saturniidae) genus. In this study, the objective is to document a new occurrence of lepidopterism caused by specimens of Hylesia nigricans(Berg, 1875) (Lepidoptera: Saturniidae). The outbreak took place in the summer of 2017 in the municipality of Três Coroas, Rio Grande do Sul, Brazil. During this period, approximately 300 people were affected by dermatitis in the municipality.The outbreak resulted from the release of two types of urticating setae by female moths in the area. We want to emphasize that in case of proliferation of this moth species, it is essential to instruct the population to avoid direct contact with these insects. Monitoring these groups of lepidopterans is fundamental in facilitating decision-making and ensuring public health. (AU)

Formas adultas de lepidópteros podem causar problemas de saúde. Esse tipo de acidente é conhecido como lepidopterismo, causado pelo contato com cerdas urticantes liberadas por adultos, como as do gênero Hylesia Hübner (Saturniidae). Neste estudo, o objetivo é registrar uma nova ocorrência de lepidopterismo causado por espécimes de Hylesia nigricans (Berg, 1875) (Lepidoptera: Saturniidae). O surto ocorreu no verão de 2017, no município de Três Coroas, Rio Grande do Sul, Brasil. No período, aproximadamente 300 pessoas foram acometidas por dermatite no município. O surto foi causado pela liberação de dois tipos de setas urticantes das mariposas fêmeas no ambiente. Ressaltamos que na ocorrência da proliferação dessa espécie de mariposa, é importante instruir a população a evitar o contato direto com esses insetos. O monitoramento desses grupos de lepidópteros é fundamental para facilitar a tomada de decisões e garantir a saúde pública. (AU)

Diagnóstico y manejo de la colestasis intrahepática en el embarazo / Diagnosis and management of intrahepatic cholestasis in pregnancy

La colestasis intrahepática del embarazo es producida por una disfunción de los hepatocitos, propia de la gestación. Las concentraciones elevadas de hormonas sexuales y la predisposición genética parecen ser factores importantes para su desarrollo. La incidencia depende de la composición étnica de la población y de los criterios diagnósticos utilizados. Está caracterizada por prurito creciente y persistente, aumento de las concentraciones de ácidos biliares, generalmente a finales del segundo o tercer trimestre del embarazo. Lleva a la aparición de hipoxia uteroplacentaria que aumenta el riesgo de líquido amniótico meconial, parto pretérmino, preeclampsia, hemorragia posparto, síndrome de dificultad respiratoria del neonato y muerte perinatal. El manejo terapéutico está dirigido a reducir los síntomas clínicos, normalizar los cambios bioquímicos maternos y prevenir complicaciones fetales. El tratamiento farmacológico principal consiste en la administración de ácido ursodesoxicólico. El objetivo de esta investigación es evaluar el diagnóstico y manejo de la colestasis intrahepática del embarazo(AU)

Intrahepatic cholestasis of pregnancy is caused by a dysfunction of the hepatocytes, typical of pregnancy. High concentrations of sex hormones and genetic predisposition appear to be important factors for their development. The incidence depends on the ethnic composition of the population and the diagnostic criteria used. It is characterized by increasing and persistent pruritus, increased concentrations of bile acids, usually in the late second or third trimester of pregnancy. It leads to the occurrence of uteroplacental hypoxia that increases the risk of meconium amniotic fluid, preterm delivery, preeclampsia, postpartum hemorrhage, neonatal respiratory distress syndrome, and perinatal death. Therapeutic management is aimed at reducing clinical symptoms, normalizing maternal biochemical changes, and preventing fetal complications. The main pharmacological treatment consists of the administration of ursodeoxycholic acid. The objective of this research is to evaluate the diagnosis and management of intrahepatic cholestasis of pregnancy(AU)

A case of duodenal ulcer as prominent manifestation of IgG4-related disease / 北京大学学报(医学版)

A case of IgG4-related disease presented with a duodenal ulcer to improve the understan-ding of IgG4-related diseases was reported. A 70-year-old male presented with cutaneous pruritus and abdominal pain for four years and blackened stools for two months. Four years ago, the patient went to hospital for cutaneous pruritus and abdominal pain. Serum IgG4 was 3.09 g/L (reference value 0-1.35 g/L), alanine aminotransferase 554 U/L (reference value 9-40 U/L), aspartate aminotransferase 288 U/L (reference value 5-40 U/L), total bilirubin 54.16 μmol/L (reference value 2-21 μmol/L), and direct bilirubin 29.64 μmol/L (reference value 1.7-8.1 μmol/L) were all elevated. The abdominal CT scan and magnetic resonance cholangiopancreatography indicated pancreatic swelling, common bile duct stenosis, and secondary obstructive dilation of the biliary system. The patient was diagnosed with IgG4-related disease and treated with prednisone at 40 mg daily. As jaundice and abdominal pain improved, prednisone was gradually reduced to medication discontinuation. Two months ago, the patient developed melena, whose blood routine test showed severe anemia, and gastrointestinal bleeding was diagnosed. The patient came to the emergency department of Beijing Hospital with no improvement after treatment in other hospitals. Gastroscopy revealed a 1.5 cm firm duodenal bulb ulcer. After treatment with omeprazole, the fecal occult blood was still positive. The PET-CT examination was performed, and it revealed no abnormality in the metabolic activity of the duodenal wall, and no neoplastic lesions were found. IgG4-related disease was considered, and the patient was admitted to the Department of Rheumatology and Immunology of Beijing Hospital for further diagnosis and treatment. The patient had a right submandibular gland mass resection history and diabetes mellitus. After the patient was admitted to the hospital, the blood test was reevaluated. The serum IgG4 was elevated at 5.44 g/L (reference value 0.03-2.01 g/L). Enhanced CT of the abdomen showed that the pancreas was mild swelling and was abnormally strengthened, with intrahepatic and extrahepatic bile duct dilation and soft tissue around the superior mesenteric vessels. We pathologically reevaluated and stained biopsy specimens of duodenal bulbs for IgG and IgG4. Immunohistochemical staining revealed remarkable infiltration of IgG4-positive plasma cells into duodenal tissue, the number of IgG4-positive cells was 20-30 cells per high-powered field, and the ratio of IgG4/IgG-positive plasma cells was more than 40%. The patient was treated with intravenous methylprednisolone at 40 mg daily dosage and cyclophosphamide, and then the duodenal ulcer was healed. IgG4 related disease is an immune-medicated rare disease characterized by chronic inflammation and fibrosis. It is a systemic disease that affects nearly every anatomic site of the body, usually involving multiple organs and diverse clinical manifestations. The digestive system manifestations of IgG4-related disease are mostly acute pancreatitis and cholangitis and rarely manifest as gastrointestinal ulcers. This case confirms that IgG4-related disease can present as a duodenal ulcer and is one of the rare causes of duodenal ulcers.

Research progress on clinical and mechanisms of chronic pruritus with anxiety and depression / 中华预防医学杂志

Chronic pruritus seriously affects the quality of life of patients, which is closely related to stress, anxiety and depression. Prolonged and repeated pruritus can induce negative emotions such as anxiety and depression, while continued increased negative emotions can also promote exacerbation of pruritus, which drives the itch scratch cycle, thereby further aggravating skin damage. More and more studies have explored the mechanism of pruritus, anxiety and depression. This article mainly reviews the clinical relationship between pruritus and anxiety, depression and the new progress of its possible mechanism, providing reference for the prevention, control and effective treatment of chronic pruritus, anxiety and depression.

Advances in Diagnostic Criteria and Severity Assessment of Atopic Dermatitis / 中国医学科学院学报

Atopic dermatitis(AD),a chronic and relapsing skin disease,is characterized by dry skin and pruritus,severely affecting the quality of patients' life.Accurately grasping the diagnostic criteria and severity assessment is essential and helps to avoid misdiagnosis and missed diagnosis.Moreover,it facilities the development and adjustment of the therapeutic schedule according to the therapeutic reaction and disease control conditions.This article reviews the research advances in the diagnostic criteria and severity assessment of AD.

An Anterior Cingulate Cortex-to-Midbrain Projection Controls Chronic Itch in Mice / 神经科学通报·英文版

Itch is an unpleasant sensation that provokes the desire to scratch. While acute itch serves as a protective system to warn the body of external irritating agents, chronic itch is a debilitating but poorly-treated clinical disease leading to repetitive scratching and skin lesions. However, the neural mechanisms underlying the pathophysiology of chronic itch remain mysterious. Here, we identified a cell type-dependent role of the anterior cingulate cortex (ACC) in controlling chronic itch-related excessive scratching behaviors in mice. Moreover, we delineated a neural circuit originating from excitatory neurons of the ACC to the ventral tegmental area (VTA) that was critically involved in chronic itch. Furthermore, we demonstrate that the ACC→VTA circuit also selectively modulated histaminergic acute itch. Finally, the ACC neurons were shown to predominantly innervate the non-dopaminergic neurons of the VTA. Taken together, our findings uncover a cortex-midbrain circuit for chronic itch-evoked scratching behaviors and shed novel insights on therapeutic intervention.

The Anterior Insula and its Projection to the Prelimbic Cortex are Involved in the Regulation of 5-HT-Induced Itch / 神经科学通报·英文版

Itch is an unpleasant sensation that urges people and animals to scratch. Neuroimaging studies on itch have yielded extensive correlations with diverse cortical and subcortical regions, including the insular lobe. However, the role and functional specificity of the insular cortex (IC) and its subdivisions in itch mediation remains unclear. Here, we demonstrated by immunohistochemistry and fiber photometry tests, that neurons in both the anterior insular cortex (AIC) and the posterior insular cortex (PIC) are activated during acute itch processes. Pharmacogenetic experiments revealed that nonselective inhibition of global AIC neurons, or selective inhibition of the activity of glutaminergic neurons in the AIC, reduced the scratching behaviors induced by intradermal injection of 5-hydroxytryptamine (5-HT), but not those induced by compound 48/80. However, both nonselective inhibition of global PIC neurons and selective inhibition of glutaminergic neurons in the PIC failed to affect the itching-scratching behaviors induced by either 5-HT or compound 48/80. In addition, pharmacogenetic inhibition of AIC glutaminergic neurons effectively blocked itch-associated conditioned place aversion behavior, and inhibition of AIC glutaminergic neurons projecting to the prelimbic cortex significantly suppressed 5-HT-evoked scratching. These findings provide preliminary evidence that the AIC is involved, at least partially via aversive emotion mediation, in the regulation of 5-HT-, but not compound 48/80-induced itch.

Effect of quercetin and role of nitric oxide pathway in chloroquine-induced scratching

Abstract Nitric oxide (NO) is an abundant mediator which is demonstrated to be involved in pruritus. Assuming that the increased NO also mediates chloroquine-induced pruritus, which is a frequent complication seen in the chronic chloroquine treatment, the current study aimed to investigate the effect of quercetin and the role of NO in chloroquine-induced pruritus in C57BL/6 mice. Model was created with subcutaneous chloroquine (400µg/site) injection to the nape of the mice. Effect of quercetin and role of NO were investigated with administration of quercetin, and co-administration with L-NAME, 7-NI and L-arginine before chloroquine injection. Locomotor activity was assessed by activity cage and number of the scratching bouts after chloroquine injection was recorded for 30 minutes. Our results show that quercetin significantly reduced scratching bouts at the doses of 10, 20, 40 and 80 mg/kg. Locomotor activity was decreased at the 40 and 80 mg/kg doses of quercetin. Additionally, decrease of the number of scratching bouts by quercetin prevented by L-arginine treatment, while L-NAME and 7-NI enhanced the anti-pruritic effect of sub-effective doses of quercetin. Therefore, our study demonstrated that acute injection of quercetin significantly diminished chloroquine-induced scratching behavior, and this effect is partly mediated by inhibition of neuronal nitric oxide synthase enzyme.

Caso clínico: Notalgia parestésica / Case report: Notalgia Paresthetica

Notalgia paresthetica (NP) is an under-diagnosed condition characterized by the presence of neuropathic pain associated with itching, in most cases localized at the dermatomes corresponding to the dorsal column of T2-T6; these symptoms are associated with the presence of skin lesions described as hyperpigmented macules in the affected areas. The etiology is multifactorial and multiple theories have been described, among them, the compromise of the cutaneous endings coming from the posterior branch of the nerve roots from T2 to T6. Different approaches are mentioned in the literature as treatment for NP, including systemic pharmacological management with neuromodulators, topical management with local anesthetics and capsaicin, and interventional analgesic strategies, among others. We present the case of a patient with NP who received multimodal pharmacological management with a favorable response.

La notalgia parestésica (NP) es una condición poco diagnosticada que se caracteriza por la presencia de dolor de componente neuropático y prurito, se localiza a nivel de los dermatomas correspondientes a la columna dorsal de T2-T6 en la mayoría de los casos; dichos síntomas se asocian a la presencia de lesiones en piel descritas como máculas hiperpigmentadas en los sitios afectados. Su etiología es multifactorial y se han descrito múltiples teorías, dentro de ellas se destaca el compromiso de las terminaciones cutáneas provenientes de la rama posterior de las raíces nerviosas de T2 a T6. Como tratamiento de la NP se menciona en la literatura diferentes abordajes incluyendo el manejo farmacológico sistémico con neuromoduladores, tópico con anestésicos locales y capsaicina y tratamiento analgésico intervencionista entre otros. Se presenta el caso de un paciente con NP que ha recibido manejo farmacológico multimodal con una respuesta favorable.

Indicaciones off-label de la lidocaína en infusión en cuidados paliativos: Manejo de dolor neuropático y prurito refractario / Off-label indications of lidocaine infusion in palliative care: Management of neuropathic pain and refractory pruritus

INTRODUCTION: Lidocaine is a local anesthetic agent, with intravenous route indications for use in contexts different from symptom control in oncologic patients. Evidence regarding its usefulness in neuropathic pain and refractory pruritus exists. This review aims to describe available evidence supporting its use in those aforementioned conditions. CONCLUSION: Lidocaine infusion has demonstrated effectiveness as a therapeutic intervention for neuropathic pain and refractory pruritus. It is required a larger body of evidence for its standardized application.

INTRODUCCIÓN: La lidocaína es un anestésico local con indicaciones para su administración intravenosa en contextos diferentes al manejo sintomático en pacientes oncológicos. Existe evidencia acerca de la utilidad de la infusión de lidocaína en pacientes con dolor neuropático y pacientes con prurito refractario. Esta revisión tiene como objetivo describir la evidencia que a lo largo del tiempo ha demostrado la efectividad de la lidocaína en infusión frente a estas dos condiciones. CONCLUSIÓN: La infusión de lidocaína ha demostrado ser efectiva como parte del tratamiento del dolor neuropático y del prurito refractario. Se requiere mayor evidencia para poder estandarizar su aplicación.

Un caso de Paederus: enfermedad desapercibida en Cochabamba / A case of Paederus: unnoticed disease in Cochabamba / Um caso de Paederus: doença despercebida em Cochabamba

INTRODUCCIÓN: la dermatitis por Paederus es una inflamación irritante de la piel, caracterizada por eritema y lesiones ampollosas, de aparición en las zonas expuestas del cuerpo, que tienen contacto con el artrópodo del mismo nombre. CASO CLÍNICO: pacientes de 39 años, indica que mientras hacía labores de jardinería estuvo en contacto con un artrópodo de dos colores que se encontraba en región inguinal y procedió a aplastarla al intentar alejarlo. A los 2 días presento prurito intenso continúo acompañado de una placa eritematosa única, amplia, de bordes no definidos, además de una pequeña pápula, no fluctuante, localizada en la región inguinal derecha; después de 12 horas refirió dolor quemante en zona afectada que le impidió deambular. Fue tratado con antibióticos y antihistamínicos con resolución del cuadro a los 10 días. DISCUSIÓN: esta dermatitis debe ser considerada frente a lesiones de inicio súbito, pruriginosas, en zonas expuestas del cuerpo. Contribuyen en forma importante al diagnóstico los antecedentes epidemiológicos.

Abstrat Introduction: Paederus dermatitis is an irritating inflammation of the skin characterized by erythema and blistering lesions, appearance in exposed areas of the body, which have contact with the arthropod of the same name. Clinical case: 39-year-old patient, indicates that while doing gardening work he was in contact with a two-color arthropod that was in the inguinal region and proceeded to crush it when trying to move it away. Two days later, I presented continuous intense itching accompanied by a single, wide, erythematous plaque with undefined edges, in addition to a small, non-fluctuating papule located in the right inguinal region; after 12 hours, he reported burning pain in the affected area that prevented him from walking. He was treated with antibiotics and antihistamines, with resolution of the condition after 10 days. Discussion: This dermatitis should be considered against sudden onset, pruritic lesions in exposed areas of the body. Epidemiological history makes an important contribution to diagnosis.

Introdução. Pederus dermatite é uma inflamação irritante da pele caracterizada por eritema e lesões vesiculares, de aparecimento em áreas expostas do corpo, que têm contato com o artrópode de mesmo nome. Caso clínico: Paciente de 39 anos, refere que ao realizar trabalhos de jardinagem esteve em contato com um artrópode bicolor que se encontrava na região inguinal e procedeu a esmagá-lo ao tentar afastá-lo. Dois dias depois, apresentava prurido intenso contínuo acompanhado de placa única, larga, eritematosa com bordas indefinidas, além de pequena pápula não flutuante localizada na região inguinal direita; após 12 horas, relatou dor em queimação na área afetada que o impedia de caminhar. Foi tratado com antibióticos e anti-histamínicos com resolução do quadro após 10 dias. Discussão: Esta dermatite deve ser considerada contra lesões pruriginosas de início súbito em áreas expostas do corpo. A história epidemiológica contribui de forma importante para o diagnóstico.

Diretriz Latino-americana sobre o Diagnóstico e Tratamento da Alergia Ocular ­ Em nome da Sociedade Latinoamericana de Alergia, Asma e Imunologia (SLAAI) / Latin American Guideline on the Diagnosis and Treatment of Ocular Allergy ­ On behalf of the Latin American Society of Allergy, Asthma and Immunology (SLAAI)

A alergia ocular, também conhecida como conjuntivite alérgica (CA), é uma reação de hipersensibilidade mediada por imunoglobulina E (IgE) do olho desencadeada por aeroalérgenos, principalmente ácaros da poeira doméstica e pólen de gramíneas. Os sintomas geralmente consistem em prurido ocular ou periocular, lacrimejamento e olhos vermelhos que podem estar presentes durante todo o ano ou sazonalmente. A alergia ocular tem frequência elevada, é subdiagnosticada e pode ser debilitante para o paciente. É potencialmente danosa para a visão, nos casos em que ocasiona cicatrização corneana grave, e na maioria dos pacientes associa-se a outros quadros alérgicos, principalmente rinite, asma e dermatite atópica. É classificada em conjuntivite alérgica perene, conjuntivite alérgica sazonal, ceratoconjuntivite atópica e ceratoconjuntivite vernal. O diagnóstico procura evidenciar o agente etiológico e a confirmação se dá pela realização do teste de provocação conjuntival. O tratamento baseia-se em evitar o contato com os desencadeantes, lubrificação, anti-histamínicos tópicos, estabilizadores de mastócitos, imunossupressores e imunoterapia específica com o objetivo de obter o controle e prevenir as complicações da doença.

Ocular allergy, also known as allergic conjunctivitis, is an immunoglobulin E-mediated hypersensitivity reaction of the eye triggered by airborne allergens, primarily house dust mites and grass pollen. Symptoms usually consist of ocular or periocular itching, watery eyes, and red eyes that may be present year-round or seasonally. Ocular allergy has a high frequency, is underdiagnosed, and can be debilitating for the patient. It is potentially harmful to vision in cases of severe corneal scarring, and in most patients, it is associated with other allergic conditions, especially rhinitis, asthma, and atopic dermatitis. It is classified as perennial allergic conjunctivitis, seasonal allergic conjunctivitis, atopic keratoconjunctivitis, and vernal keratoconjunctivitis. Diagnosis seeks to identify the etiologic agent, and confirmation is given by conjunctival provocation testing. Treatment is based on avoiding contact with triggers, lubrication, topical antihistamines, mast cell stabilizers, immunosuppressants, and specific immunotherapy with the aim of achieving control and preventing disease complications.

Mitochondrial Reactive Oxygen Species Elicit Acute and Chronic Itch via Transient Receptor Potential Canonical 3 Activation in Mice / 神经科学通报·英文版

Mitochondrial reactive oxygen species (mROS) that are overproduced by mitochondrial dysfunction are linked to pathological conditions including sensory abnormalities. Here, we explored whether mROS overproduction induces itch through transient receptor potential canonical 3 (TRPC3), which is sensitive to ROS. Intradermal injection of antimycin A (AA), a selective inhibitor of mitochondrial electron transport chain complex III for mROS overproduction, produced robust scratching behavior in naïve mice, which was suppressed by MitoTEMPO, a mitochondria-selective ROS scavenger, and Pyr10, a TRPC3-specific blocker, but not by blockers of TRPA1 or TRPV1. AA activated subsets of trigeminal ganglion neurons and also induced inward currents, which were blocked by MitoTEMPO and Pyr10. Besides, dry skin-induced chronic scratching was relieved by MitoTEMPO and Pyr10, and also by resveratrol, an antioxidant. Taken together, our results suggest that mROS elicit itch through TRPC3, which may underlie chronic itch, representing a potential therapeutic target for chronic itch.

Clinical effects of autologous follicular unit extraction transplantation in the treatment of small area secondary cicatricial alopecia after burns / 中华烧伤杂志

Objective: To explore the clinical effects of autologous follicular unit extraction (FUE) transplantation in the treatment of small area secondary cicatricial alopecia (hereinafter referred to as cicatricial alopecia) after burns. Methods: A retrospective observational study was carried out. According to the adopted treatment methods, 18 patients (12 males and 6 females, aged (29±6) years) who received autologous FUE transplantation for small area cicatricial alopecia after burns from March 2017 to November 2019 in the First Affiliated Hospital of Air Force Medical University were included in FUE transplantation group, and 18 patients (13 males and 5 females, aged (33±5) years) who were treated with expanded flap transplantation for small area cicatricial alopecia after burns by the same surgery team during the same period in the same hospital were included in expanded flap transplantation group. All the patients were followed up for more than 1 year. At the last follow-up, the follicular unit density in the transplanted area was measured by Folliscope hair detection system and the hair survival rate was calculated; the visual analogue scale (VAS) method was adopted to evaluate the treatment effect; patients were asked their satisfaction with the treatment effect and the occurrence of complications during follow-up; the hair growth and the scalp thickness, pain, pruritus, pigmentation, and surface roughness of the transplanted area were recorded. Data were statistically analyzed with Fisher's exact probability test and independent sample t test. Results: At the last follow-up, the follicular unit density in the transplanted area of patients in FUE transplantation group was (46.8±2.0)/cm2, which was significantly higher than (42.5±4.3)/cm2 in expanded flap transplantation group (t=3.84, P<0.01); the hair survival rates of patients were similar between the two groups (P>0.05). At the last follow-up, VAS scores evaluating the treatment effect of patients were similar between the two groups (P>0.05); the satisfaction score of patients toward the treatment effect in FUE transplantation group was 8.6±1.1, which was significantly higher than 7.6±0.8 in expanded flap transplantation group (t=2.89, P<0.01). During the follow-up, no inflammation or infection occurred in patients of the two groups, but only 2 patients in expanded flap transplantation group had postoperative pain. At the last follow-up, the transplanted area of patients in the two groups was covered with new hair, and the hair growth direction was basically consistent with the surrounding normal hair; scalp thickness, pain, pruritus, pigmentation, and surface roughness of the transplanted area of patients were similar between the two groups (P>0.05). Conclusions: Autologous FUE transplantation has better long-term follicular unit density and patients' satisfaction than expanded flap transplantation in the treatment of small area cicatricial alopecia after burns, showing better postoperative effect and a good prospect of clinical application.

A Randomized Clinical Trial on Therapeutic Effects of Myrtus communis L. Cream on Chronic Skin Lesions and Quality of Life of Sulfur Mustard-exposed Veterans

Abstract: Sulfur mustard is one of the chemical warfare agent. It rapidly reacts with the cutaneous tissues and other tissues, leading to various devastating long-term effects on human health. Mustard-exposed veterans suffer from its chronic skin problems, including itching, burning sensation, and eczema. We aimed to evaluate the protective effects of Myrtus communis L. (myrtle) on chronic skin lesions and quality of life of sulfur mustard-exposed veterans. In this randomized, double-blind clinical trial, 60 sulfur mustard-exposed patients were evaluated. Thirty patients received myrtle essence 5% cream (case group) and 30 patients received Eucerin cream (placebo group) twice in a day for one month. Then, We assessed the chronic skin problems and itching-related parameters (such as the itching time, severity, distribution, frequency, and calculated itching score), duration of sleep, number of waking up at night, and quality of life in the both groups. Our analysis of data revealed that application of myrtle cream effectively decreased skin problems including; itching and burning sensation. Additionally, myrtle markedly decreased skin lesion symptoms such as excoriation in the case group as compared with before treatment. Noticeably, myrtle cream significantly improved quality of life of the patients in the case group. The present study provides more in-depth information regarding the protective role of myrtle on the sulfur mustard-induces skin complication. Also, myrtle effectively improved quality of life of the sulfur mustard-exposed veterans.

Aprepitant, una posible alternativa para el prurito refractario: Reporte de caso / Aprepitant, a possible alternative for refractory pruritus: Case report

Refractory pruritus can be a symptom difficult to manage. We describe a case of a 37-year-old female patient with an oncological diagnosis of high-grade mesenchymal osteosarcoma in the left sacrum, hospitalized for urinary tract infection and polymicrobial bacteremia. During hospitalization, she presented pruritus of unknown cause, refractory to multiple treatments. Given the severity of symptoms and refractoriness, we administered aprepitant obtaining a complete resolution of the pruritus. With these findings, we raise the possibility of using aprepitant as a treatment for refractory pruritus.

El prurito refractario puede ser un síntoma de difícil manejo. Se presenta un reporte de caso de una paciente femenina de 37 años con diagnóstico oncológico de osteosarcoma mesenquimal de alto grado en sacro izquierdo, hospitalizada por infección de vías urinarias y bacteriemia polimicrobiana, quien presentó prurito de causa desconocida, refractario a múltiples manejos antipruriginosos. Dada la severidad de los síntomas y refractariedad, se administró aprepitant, obteniendo resolución completa del cuadro. Con estos hallazgos se plantea la posibilidad del empleo de aprepitant como tratamiento para el prurito refractario.

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

Abstract Background: Lichen simplex chronicus is a dermatological condition due to excessive scratching, with few studies on psychoneuroimmunology. Objective: We 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. Methods: Thirty-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. Results: The 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 limitations: A direct causal relationship was not addressed. Conclusion: Lichen 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.