Density of mast cells and intensity of pruritus in psoriasis vulgaris: a cross sectional study

Abstract: BACKGROUND: Psoriasis is a chronic and prevalent disease, and the associated pruritus is a common, difficult-to-control symptom. The mediators involved in psoriatic pruritus have not been fully established. OBJECTIVE: To evaluate associations between the number of mast cells in psoriatic lesions and the intensity of pruritus. METHODS: 29 patients with plaque psoriasis were recruited. In all participants, Psoriasis Area and Severity Index and Body Surface Area were assessed. A questionnaire was administered to obtain clinical information and the Dermatology Life Quality Index. Pruritus was assessed using a visual analog scale and skin biopsies were performed for staining with Giemsa and Immunohistochemistry with C-Kit. RESULTS: Pruritus was observed in 91.3% of our patients. Median VAS was 6 (p25-75: 2-8). The immunohistochemical method revealed a mean of 11.32 mast cells/field and Giemsa staining revealed a mean of 6.72 mast cells/field. There was no correlation between the intensity of pruritus and mast cell count, neither in Immunohistochemistry (p = 0.15; rho = -0.27) nor in Giemsa (p = 0.16; rho = -0.27). Pruritus did not impact on the Dermatology Life Quality Index (p = 0.51; rho = -0.13). STUDY LIMITATIONS: The small sample size may be considered the main limitation of our study. CONCLUSIONS: Although mast cells are mediators of pruritus in many cutaneous diseases, our findings support that psoriatic pruritus is a complex disorder with multifactorial, complex pathophysiology, involving pruritogenic mediators others than mast cells.

The efficacy and safety of phototherapy in geriatric patients: a retrospective study

Abstract: Background: While phototherapy is a well-established treatment for many dermatoses, data from the literature regarding its use in elderly patients are quite limited. Objective: In this study, we aimed to determine the phototherapy indications in geriatric patients and to evaluate the effectiveness and reliability of phototherapy in this group. Methods: This study included 95 patients of 65 years of age and older who were treated in our phototherapy unit between 2006 and 2015. The data for this study were collected retrospectively from patient follow-up forms in the phototherapy unit. Results: Phototherapy was administered to 28 (29.5%) patients for mycosis fungoides, 25 (26.3%) patients foplaque type psoriasis, 12 (12.6%) patients for palmoplantar psoriasis, 12 (12.6%) patients for generalized pruritus, and 18 (19%) for other dermatoses. Of the patients, 64.2% had received a narrowband UVB (NB-UVB), 21.1% oral psoralen UVA (PUVA), and 14.7% local PUVA treatment. A complete response was achieved in 76.9-85.7% of the mycosis fungoides and in 73.71-100% of the psoriasis vulgaris patients treated with NB-UVB and PUVA, respectively. All the patients with generalized pruritus were treated with NB-UVB, and 80% of these patients achieved significant improvement. The erythema rate was found to be 0.43% per session for NB-UVB treatment and 0.46% per session for PUVA treatment as a side effect. Study limitations: The limitations of our study are that it was retrospective and the remission durations of the patients are not known. Conclusion: This study showed that phototherapy is effective and reliable in the elderly population with proper dose increases and close follow-up.

Pruritus in cholestasis / Prurido na colestase

Pruritus represents one of the main clinical complaints in medical practice, and leads to significant impairment of life quality and some discomfort. Although the knowledge of its main primary and secondary etiologies is well-established in Internal Medicine, especially in Hepatology, its pathophysiological basis and specific therapeutic-directed approaches are still very complex and need a proper systematization for comprehension. This review aims to present the main current themes regarding the main clinical, pathophysiological, therapeutical and management aspects of cholestasis-associated pruritus. METHODS: The authors performed a wide review of practical clinical guidelines, review articles and original articles from manuscripts published and indexed in PubMed. CONCLUSIONS: Pruritus in cholestasis represents a complex symptom in clinical practice and can be secondary to different pathophysiological mechanisms; its early recognition allows a proper therapeutic approach in most cases.

O prurido representa uma das principais queixas clínicas na prática médica e origina importante comprometimento da qualidade de vida, além de desconforto. Apesar de suas principais etiologias primárias e secundárias serem de conhecimento bem estabelecido na Clínica Médica, em especial na Hepatologia, suas bases fisiopatológicas e os princípios da terapêutica específica direcionada são bastante complexos e necessitam uma sistematização adequada para sua compreensão apropriada. Esta revisão objetiva abordar os principais temas atuais referentes às bases clínicas, fisiopatológicas, terapêuticas e de manejo do prurido relacionados à colestase. Os autores realizaram ampla revisão em diretrizes clínicas práticas, artigos de revisão e publicações originais de artigos publicados e indexados na base PubMed. O prurido na colestase representa um sintoma complexo na prática clínica e pode decorrer de diferentes mecanismos fisiopatológicos secundários. Seu reconhecimento precoce possibilita a abordagem terapêutica apropriada na maioria dos casos.

Prurido no idoso / Pruritus in the elderly

Entende-se por prurido uma sensação cutânea desagradável que leva o indivíduo a coçar-se, podendo estar relacionado a doenças dermatológicas ou até mesmo sistêmicas. Esta dermatose é queixa frequente no idoso e, por vezes, apresenta um grande impacto em sua qualidade de vida. O objetivo deste estudo foi rever suas possíveis causas. Analisaram-se também os aspectos relacionados ao seu diagnóstico e tratamento. O prurido, na senilidade, pode ser associado a várias causas, sendo a xerose (pele seca) a mais frequente. A busca pela etiologia correta é um fator decisivo para a escolha do tratamento eficaz. É importante ressaltar que, nessa faixa etária, a ocorrência de reações adversas a medicamentos é alta, devido, principalmente, ao uso concomitante de vários fármacos.Uma boa avaliação, incluindo anamnese e exame físico completo, é de suma importância para que se possa fazer um raciocínio clínico adequado e aplicação de um tratamento eficaz.

Pruritus is understood as an unpleasant skin sensation that makes people scratch themselves. It may be related to skinor systemic diseases. It is a frequent complaint of the elderly and many times it highly impacts patient's quality of life. The objective of this work was to study pruritus possible causes, also analyzing aspects related to its diagnosis and treatment. Among the elderly, pruritus can be associated to various causes and the most frequent one is xerosis (dry skin). The search for the correct etiology is a decision factor for the choice of an effective treatment. It is important to highlight that in this age the occurrence of adverse drug reactions is elevated, especially because of concomitant use of multiple drugs. A welldone evaluation, including anamnesis and complete physical examination, is extremely important for an adequate clinical reasoning and for effective treatment application.

Effects of Aroma Massage on Pruritus, Skin pH, Skin Hydration and Sleep in Elders in Long-term Care Hospitals

PURPOSE: The purpose of this study was to examine the effects of aroma massage on pruritus, skin pH, skin hydration and sleep in elders in long-term care hospitals. METHODS: The participants were elders over 65 years old admitted to long-term care. They were assigned to the experimental group (26) or control group (28). Data were collected from May to August, 2012. Visual Analogue Scale and Verran and Snyder-Halpern Sleep scale were used to identify levels of pruritus and sleep. A skin-pH meter and moisture checker were used to measure skin pH and skin hydration. Aroma massage was performed three times a week for 4 weeks for elders in the experimental group. The data were analyzed using the SPSS Win 17.0 program. RESULTS: There were significant differences in pruritus, skin pH and skin hydration between the two groups. However there was no significant difference in sleep. CONCLUSION: The results indicate that aroma massage is effective in reducing pruritus, skin pH and increasing skin hydration in elders. Therefore, this intervention can be utilized in clinical practice as an effective nursing intervention to reduce pruritus in elders in long-term care hospitals.

Novedades en enfermedades colestásicas / Latest advances in cholestatic diseases

Cholestatic liver diseases arise from impaired hepatobiliary production and excretion of bile. They have some common clinical manifestations and pathogenic features, but at the same time differences that require a special approach. Intrahepatic cholestasis of pregnancy and drug induced liver cholestasis are the most common reversible intrahepatic cholestasis. Primary biliary cirrhosis and primary sclerosing cholangitis are chronic cholestatic diseases. This review will be focused on these two types, in particular their clinical and therapeutic management and complications. While in recent years there has not been much change in the basic clinical approach of these diseases, every day we receive more information from both the basic and clinical science studies, which has enabled to develop new therapeutic lines and reject others that have not confirmed effectiveness.

Las enfermedades colestásicas se caracterizan por la disminución de la formación o excreción del flujo de bilis. Ellas tienen ciertas manifestaciones clínicas y mecanismos patogénicos comunes, pero a su vez diferencias que requieren un enfrentamiento no siempre similar. La colestasia intrahepática del embarazo(CIE) y la colestasia secundaria a fármacos son las más frecuentes dentro de las colestasias intrahepáticas reversibles. La cirrosis biliar primaria (CBP) y la colangitis esclerosante primaria (CEP), son las enfermedades colestásicas crónicas en que centramos esta revisión, en particular en los aspectos clínicos y de manejo terapéutico tanto de éstas, como de sus complicaciones. Si bien en los últimos años no ha habido un cambio significativo en el manejo fundamental de estas enfermedades, cada vez tenemos más información tanto en el área de ciencias básicas como en aspectos clínicos, lo que ha permitido ir desarrollando nuevas líneas terapéuticas y descartando otras que no han confirmado efectividad.

effect of peppermint oil on symptomatic treatment of pruritus in pregnant women

Itching is one of the most common skin symptoms. Generalized pruritus occurs in 1-8% of pregnant women. It can create unpleasant feeling for these women especially at nights. Most pregnant women avoid using synthetic drugs because of their side effects. Peppermint is a plant which has been used as a traditional drug in Iran. It decreases skin's temperature. This study was done to determine the effects of peppermint oil on symptomatic treatment of pruritus in pregnant women attending to Rasoul Akram Hospital in Rasht, 2011. In this triple-blind clinical trial, 96 randomly selected subjects diagnosed with pruritus gravidarum were studied [47 cases and 49 controls]. A bottle containing 60 mL of peppermint oil 0.5% in sesame oil and identical placebos were provided to be taken twice a day during 2 weeks by the case and control groups, respectively. The severity of the itch was assessed and compared before and after the study by VAS system. The results were analyzed by SPSS. Statistical methods such as descriptive analysis, independent samples' t-test, paired samples' t-test and Chi-square were employed. The severity of the itch in the treated group with peppermint oil in comparison with the placebo group, showed a significant statistical difference [p = 0.003]. In accordance with the results of this study, it seems that peppermint oil can be effective in reducing the severity of Pruritus Gravidarum. More studies with larger sample sizes are required to confidently declare the mentioned results

Manejo eficiente del prurito con emolientes y gabapentina en el paciente urémico y su impacto en la calidad de vida / Treatment of the uremic patient’s pruritus with emolients and gabapentine and life quality impact

Introducción. Entre los síntomas que con mayor frecuencia presentan los pacientes con enfermedad renal crónica terminal en la terapia de reemplazo renal de tipo hemodiálisis y diálisis peritoneal, se encuentra el prurito urémico. Objetivo. Comparar la efectividad de los emolientes con la de la gabapentina en el manejo del prurito urémico y el impacto en la calidad de vida en los pacientes con enfermedad renal crónica terminal en terapia de reemplazo renal de tipo hemodiálisis y diálisis peritoneal, en el Servicio de Terapia Renal del Hospital Pablo Tobón Uribe, entre enero y abril de 2010. Metodología. Se realizó un ensayo clínico controlado de asignación aleatoria, sin cegamiento, en el que se administraron tratamientos con emolientes o gabapentina a grupos de pacientes con insuficiencia renal crónica y prurito, que acudieron al Servicio de Terapia Renal del Hospital Pablo Tobón Uribe, para recibir terapia de reemplazo renal, ya fuera hemodiálisis o diálisis peritoneal. Resultados. En ambos grupos se observó mejoría sustancial del prurito. En 15 pacientes que fueron tratados con gabapentina, se encontró una disminución de la intensidad del prurito, medido por la escala visual análoga, pasando de una media de 6,6 al inicio a una de 1,1 al final. Del mismo modo ocurrió con los 18 pacientes del grupo que recibió emolientes, pasando de una media de 5,2 al inicio a una de 1,3 al final. Con respecto a la evaluación de la calidad de vida, se observó diferencia únicamente para el dominio de la funcionalidad social en el grupo de emolientes entre la primera y segunda evaluación, sin apreciarse diferencias significantes en el grupo de gabapentina. Conclusión. Los pacientes experimentaron una mejoría estadísticamente significativa en el prurito con los dos tratamientos; sin embargo, cuando se compararon, no se observó diferencia significativa, por lo que no se puede aseverar, con el tamaño de muestra obtenido, que un tratamiento sea mejor que el otro. En cuanto a la calidad de vida, únicamente en el grupo de emolientes se apreció mejoría en el dominio de funcionalidad social.

Antagonista de opioides para o tratamento do prurido associado à colestase. Relato de caso / Opiate antagonist therapy for the cholestasis pruritus. Case report

JUSTIFICATIVA E OBJETIVOS: Pacientes com lep­tospirose podem desenvolver colestase, levando à queixa de prurido. Existem vários tratamentos propostos para o prurido, porém nenhum deles é satisfatoriamente efetivo. O objetivo deste artigo foi relatar o emprego de um antagonista opioide para o tratamento de prurido associado à 3 colestase em paciente com leptospirose.RELATO DO CASO: Paciente do sexo masculino, 51 anos, apresentou quadro de leptospirose, referindo dentre 11 as principais queixas prurido intenso. A queixa manteve-se até o quarto dia de internação, quando se optou pelaprescrição de um antagonista opioide, levando à remissão completa do quadro. CONCLUSÃO: O sucesso da terapia no caso apresentado soma-se a outros relatos da literatura que demonstram evidências de que os antagonistas opioides são bem tolerados e rêduzem significativamente o prurido associado à colestase.

El prurito en el eczema / Pruritus in eczema

Se describe la interrelación entre el sistema nervioso y la etiopatogenia y fisiopatología del prurito, lo que se denomina la neurobiología cutánea. Se describe los últimos estudios sobre los diferentes mecanismos patogénicos de la producción del prurito entre los cuales se describe una serie de vías, receptores, neurotransmisores y además se discute el papel de los aspectos psicológicos en el prurito especialmente el relacionado con los diversos tipos de eccema.

Interrelation between nervous system and etiopathogeny and pathophysiologyis described, this is known as cutaneous neurobiology. The last studies about the pathogenic mechanisms of production of pruritus like receptors, neurtransmisors and psicological aspects are described, specially pruritus associated to diverse kinds of eczema.

Prurido: abordagem inicial e manejo clínico / Pruritus: initial approach and clinical management

Os autores têm como objetivo realizar uma revisão relacionada ao sintoma prurido, abordando sua fisiopatologia, doenças relacionadas, investigação e formas de tratamento.

therapeutic efficacy of pharmacological versus non-pharmacological measures in the management of post burn itch

To standardize the management protocol of post burn itch by comparing therapeutic efficacy of pharmacological with non-pharmacological measures. A prospective, clinical investigative and quasi-experimental study. This study was conducted at Burn emergency Unit, Liaquat University of Medical and Health Sciences Jamshoro for the period of 18 months from January 2006 to June 2007. A total of 80 patients were included in the study, and equally divided into 2 groups. Group A received an oral antihistamine with topical Ibuprofen while Group B received olive oil massage followed by wearing of compressive garments. The demographic data and initial assessment of the severity of itch on linear descriptive scale was made by the research team; while subsequent data for the entire study period was obtained by the attending burn clinician who was blind to the allocated regimen. Results were analyzed using computer statistical software SPSS Group A included 40 patients with 23 males and 17 females having mean age of 28.13 [SD +/- 13.03] and mean body surface area affected 15.387% [SD +/- 5.408] and mean itch scale of 5.500 [SD +/- 2.219]. Group B comprised of 40 patients with 21 males and 19 females with a mean age of 29.38 [SD +/- 14.35] with mean affected body surface area of 16.150% [SD +/- 5.555] and mean itch scale of 5.350 [SD +/- 1.762]. The main outcome measure was the improvement in burn itch. The results after 12 weeks of treatment for both groups showed a remarkable improvement in Group B when compared to Group A [p-value 0.000 and 0.365 respectively]. The non-pharmacological measures are superior to the pharmacologic measure with respect to their clinical efficacy and their improvement is highly significant after 4 weeks of treatment

Prurito / Pruritus

El prurito es la causa más común de consulta en Dermatología. En el presente articulo se hace una revisión de los estudios más relevantes sobre el prurito y se revisan la fisiopatogenia y la relación con enfermedades de distinto tipo. Es importante recalcar la relación entre el prurito y la respuesta del SNC, en lo que se ha llamado la inflamación neurobiológica. Establecemos una forma racional de enfrentar el prurito tanto desde el punto de vista de laboratorio como de terapéutica.

Pruritus is the most common symptom in dermatology. We present a review of the most relevant studies of pruritus its physiopathology and relations with other types of diseases. It is important to emphasize the relation between pruritus the CNS in what is known as neurobiological. Additionally we. Additionally we propase a rational means of facing pruritus from both laboratory and therapeutic perspectives.

Prurito cutaneo / Skin pruritus

El prurito es un síntoma relativamente frecuente, que reconoce numerosos y diversos factores desencadenantes, que actúan a través de mecanismos fisiopatológicos muy variados pero no bien precisados. El prurito puede instalarse sobre una piel previamente sana. Estos casos corresponden a los llamados pruritos primarios, esenciales o médicos. Por el contrario, cuando el prurito afecta una piel con lesiones (previas al gratage y a sus consecuencias) se habla de prurito secundario y dermatológico, el que de hecho corresponde a dermatopatías pruriginosas.

Avaliaçäo aberta do lactato de amônio 12: loçäo no tratamento da xerose cutänea moderada ou intensa / Open-label evaluation of ammonium lactate 12: lotion in the treatment of a moderate or severe dry skin

Quadro centros brasileiros participaram deste estudo cujo objetivo era avaliar a eficácia e segurança do lactato de amônio em pacientes com xerose cutänea de intensidade moderada a grave. Os 61 pacientes foram tratados por três semanas passando o produto duas vezesao dia, seguidas de um intervalo de duas semanas sem uso da medicaçäo para um posterior avaliaçäo final. Dos pacientes, 62(porcento) ficaram muito satisfeitos e 38(porcento) satisfeitos com os resultados obtidos. Foi constatado, portanto, que o lactato de amônio é eficaz e seguro no tratamento das xeroses

Prurido urêmico / Uremic pruritus

A insuficiência renal crônica produz várias manifestaçöes dermatológicas, como a hiperceratose folicular, xerose, unhas ®half-and-half¼, hiperpigmentaçäo e prurido. Dessas, a que mais pode comprometer a qualidade de vida do paciente urêmico é, sem dúvida, o prurido. De etiologia näo completamente compreendida, o prurido urêmico acomete grande parte dos pacientes renais e seu tratamento envolve vários aspectos do gerenciamento da síndrome urêmica como diálise, controle do hiperparatireoidismo e correçäo da anemia. Esta revisäo discorre sobre os principais aspectos da fisiopatologia e tratamento desta freqüente manifestaçäo da uremia.

Efeito da Acupuntura no tratamento da rinite alérgica / Acunpucture effect on the treatment of allergic rhinitis

O presente estudo tem por objetivo avaliar a eficácia da acupuntura no tratamento dos principais sintomas clínicos da rinite alérgica (obstruçao nasal, coriza e prurido nasal). Material - No período de abril a dezembro de 1997 foram tratados 14 pacientes portadores de rinite alérgica, com períodos de exacerbaçoes presentes pelo menos nos últimos 12 meses. Dos 14 pacientes, 9 eram do sexo masculino e 5, do feminino. Os pacientes tinham idade entre 14 e 35 anos de idade, com média de 24,5 anos. Método - Os pacientes foram submetidos a 10 aplicaçoes de Acupuntura, semanalmente, utilizando-se os pontos de acupuntura: VG-20 (Baihui), VG-23 (Shangxing), Yintang, Bitong, IG-4 (Hegu), IG-11 (Quchi), VC-17 (Shan-zhong), P-9 (Yuji), E-36 (zusanli), R-3 (Taixi), F-3 (Tai-chong), BP-6 (Sanyinjiao), bilateralmente. Resultado - Em relaçao à obstruçao nasal houve melhora significante em 71,5 por cento dos pacientes e a melhora ocorreu a partir da 7Ý semana; em relaçao à coriza e ao prurido nasal houve melhora significante em 85,7 por cento dos pacientes, a partir da 5Ý semana de tratamento. Conclusao - O tratamento pela Acupuntura, com a metodologia empregada, mostrou melhora significante em relaçao aos parâmetros clínicos (obstruçao nasal, coriza e prurido) da rinite alérgica, em uma proporçao de 85,7 por cento para a coriza e o prurido nasal e 71,5 por cento para a obstruçao nasal.

Ventana analgésica y antiemética post-operatoria / Analgesic and anti-emetic trans-operative window

A cuarenta y cinco pacientes se les practicó histerectomía abdominal bajo anestesis general balanceada. Fueron clasificados en tres grupos para comparar el control del dolor, la náusea y el vómito postoperatorios. Al primer grupo se les administraron los analgésicos cuando lo solicitaron y si presentaban náusea y vómito se les aplicaba ondansetron. Los del segundo grupo recibieron los analgésicos inmediatamente después de la emersión anestésica sin que manifestaran dolor, y el antiemético únicamente si era requerido. El último grupo constituía la ventana analgésica y antiemética y se les prescribieron los medicamentos antes de terminar el procedimiento anestésico. En el 40 por ciento de las pacientes (18), bastó una dosis de buprenorfina para control del dolor asociada a dipirona con horario fijo, de los cuales, 12 pacientes (26.5 por ciento) pertenecían al tercer grupo. El efecto terapéutico del ondansetron quedó claramente demostrado al inhibir la náusea y el vómito que presentaron las pacientes del primero y segundo grupos, en tanto que la acción profiláctica fue evidente en las mujeres del tercer grupo. La somnolencia fue el efecto colateral más común (58 por ciento) que coadyuvó a la tranquilidad con que evolucionaron nuestras pacientes y que prueban categóricamente la ausencia de estas complicaciones post-operatorias

Prurido nas afecçöes sistêmicas / Pruritus in sistemic diseases

Os autores revisam o prurido e sua correlaçäo com doenças sistêmicas.