Prurigo nodular crónico / Chronic nodular prurigo

El prurigo nodular crónico se caracteriza por un ciclo de prurito y excoriación en el que intervienen mecanismos neurodérmicos, asociado a diversas enfermedades. Se manifiesta con placas o nódulos hiperqueratósicos cupuliformes. El tratamiento, enfocado en reducir el prurito, representa un desafío por la frecuente resistencia a las terapéuticas habituales. Se describe el caso de un hombre de 72 años, con antecedentes psiquiátricos, que presentó una dermatosis pruriginosa recalcitrante refractaria a múltiples esquemas de tratamiento.

Chronic prurigo nodularis is characterized by a cycle of itching and excoriation involving neurodermal mechanisms, associated with various diseases. It manifests with cupuliform hyperkeratotic plaques or nodules. Treatment is focused on reducing itching and is a challengue due to the frequent resistance to the usual therapies. We present the case of a 72-year-old man with a psychiatric history, who presented a recalcitrant pruritic dermatosis refractory to multiple treatment regimens.

Case for diagnosis. A pruritic eruption of keratotic papules over the face and neck

Abstract Generalized eruptive keratoacanthoma of Grzybowski is a rare variant of multiple keratoacanthomas counting with about 40 cases reported. It is a chronic and progressive disease for which none of the described therapeutic options has been entirely satisfactory. We report a case of an 83-year-old female who presented with a 3-month history of extremely pruritic, multiple, skin-coloured to erythematous to brownish, millimetric papules, with a keratotic centre. Histological examination of an incisional biopsy was consistent with the diagnosis of keratoacanthoma. The patient started acitretin 25 milligrams daily with a complete resolution of pruritus and regression of numerous lesions.

Medicinal plants as a source of future anti-pruritic drugs: a comprehensive review / Las plantas medicinales como fuente de futuros fármacos antipruríticos: una revisión exhaustiva

Pruritus is a distressing sensation of the skin that provokes the desire to scratch. Medicinal plants have been proposed as a worthful source for identifying new bioactive molecules. The aim of this study was to evaluate some medicinal plants and their phytochemicals used in the management of pruritus. Medicinal plants including Avena sativa, Borago officinalis, Capsicum frutescens, Curcuma longa, Fumaria spp., Mentha x piperita and Oenothera biennis showed the promising anti-pruritic activity in human studies. In experimental studies, Angelica sinensis, Betula platyphylla, Matricaria chamomilla, Rumex Japonicus, Saururus chinensis and Vaccinium myrtillus are among the best medicinal plants for management of pruritus. Essential oils, alkaloids, saponins, sterols, terpens, phenolic compounds, and fatty acids were the bioactive constituents of herbs which exhibited their anti-pruritic activity through different mechanisms. The most predominant mechanisms involved in activity of plant-derived molecules in pruritis include reducing serum IgE and proinflammatory cytokines, stabilizing mast cells, suppressing the Th2 cellular response, suppressing the expression of substance P and NF- κB, inhibiting prostaglandin E2 production, and activating receptors involved in itch sensation. Overall, several medicinal plants and its bioactive compounds have shown marked activity in the management of pruritus and therefore can be considered as an alternative source of treatment.

El prurito es una sensación molesta en la piel que provoca el deseo de rascarse. Las plantas medicinales han sido propuestas como una fuente valiosa para identificar nuevas moléculas bioactivas. El objetivo de este estudio fue evaluar algunas plantas medicinales y sus fitoquímicos en el manejo del prurito. Plantas medicinales que incluyen Avena sativa, Borago officinalis, Capsicum frutescens, Curcuma longa, Fumaria spp., Mentha x piperita y Oenothera biennis mostraron una prometedora actividad antiprurítica en estudios humanos. En estudios experimentales, Angelica sinensis, Betula platyphylla, Matricaria chamomilla, Rumex Japonicus, Saururus chinensis y Vaccinium myrtillus se encuentran entre las mejores plantas medicinales para el manejo del prurito. Los aceites esenciales, alcaloides, saponinas, esteroles, terpenos, compuestos fenólicos y ácidos grasos fueron los constituyentes bioactivos de las hierbas que mostraron actividad antiprurítica a través de diferentes mecanismos. Los mecanismos más predominantes implicados en la actividad de las moléculas derivadas de plantas en el prurito incluyen la reducción de la IgE sérica y las citoquinas proinflamatorias, la estabilización de los mastocitos, la supresión de la respuesta celular Th2, la supresión de la expresión de la sustancia P y NF-κB, la inhibición de la producción de prostaglandina E2 y la activación de receptores implicados en la sensación de picazón. En general, varias plantas medicinales y sus compuestos bioactivos han mostrado una actividad efectiva en el manejo del prurito y, por lo tanto, pueden ser consideradas como una fuente alternativa para su tratamiento.

¿Es efectivo el aciclovir en el tratamiento de la varicela en niños y adolescentes? / Is acyclovir effective for the treatment of varicella in children and adolescents?

Resumen INTRODUCCIÓN: La varicela es una enfermedad infecciosa frecuente y altamente contagiosa, producida por el virus Varicella Zoster. Tradicionalmente se ha recomendado tratarla en forma sintomática, ya que existe controversia en relación a la utilidad del tratamiento antiviral, en especial en niños y adolescentes. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos tres revisiones sistemáticas, que en conjunto incluyen tres estudios primarios, todos correspondientes a ensayos aleatorizados. Concluimos que el uso de aciclovir podría no disminuir las complicaciones asociadas, y no está claro si disminuye las lesiones o el prurito porque la certeza de la evidencia es muy baja.

Abstract INTRODUCTION: Varicella (chickenpox) is a frequent and highly contagious infectious disease, caused by the Varicella zoster virus. Traditionally, it has been recommended to focus on the management of symptoms, since there is controversy about the role of antivirals, particularly in children and adolescents. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified three systematic reviews including three studies overall, all of them corresponding to randomized trials. We concluded the use of acyclovir might not decrease the associated complications, and it is not clear whether it reduces lesions or itching because the certainty of the evidence is very low.

Impact of drug therapy on brachioradial pruritus

Abstract: Few studies have described therapeutic options in brachioradial pruritus. We describe a cross-sectional study of brachioradial pruritus patients treated in an outpatient unit. We reviewed medical records and interviewed brachioradial pruritus patients without indication for decompressive surgery, in order to access the perceptions of intensity of pruritus prior to treatment and response to therapy. We found that antidepressants and anticonvulsants were the most frequently prescribed drugs. Best reductions in pruritus were associated with its highest intensities prior to treatment, and with longer periods of therapy.

Psychotropics in different causes of itch: systematic review with controlled studies

Abstract Among the wide range of symptoms neglected or resistant to conventional treatments in clinical practice, itch is emerging gradually as a theme to be studied. Itch complaints and the negative effects in the quality of life are observed in several medical fields. Although the partially obscure pathophysiology, some researchers decided to check and test the use of psychotropic drugs in resistant itch to conventional topical treatments and antihistamines. The objective of this study was to evaluate scientific evidence in psychotropic use in the treatment of itch of various causes. This is a systematic review of scientific literature. The following databases were used: PubMed, Web of Science, Scopus and Scielo. Randomized controlled trials that should focus on treatment with psychotropic drugs of pruritus of various causes were the inclusion criteria. All articles were analyzed by the authors, and the consensus was reached in cases of disagreement. Fifteen articles were included after analysis and selection in databases, with the majority of clinical trials focusing on psychopharmacological treatment of itch on account of chronic kidney disease. Clinical trials with psychotropic drugs mostly indicated significant improvement in the itching. In most trials of chronic kidney disease as basal disease for itch, greater effectiveness was observed with the use of psychotropic drugs compared with placebo or other antipruritic. However, the small amount of controlled trials conducted precludes the generalization that psychiatric drugs are effective for itch of various causes.

Serie parasitosis en dermatología: escabiosis / Series parasitosis in dermatology: scabies

La escabiosis es una ectoparasitosis pruriginosa producida por el ácaro Sarcoptes scabiei, variedad hominis, específica del ser humano. Si bien su distribución es universal, con frecuencia es subdiagnosticada por asociarla únicamente a hacinamiento y malos hábitos de higiene. Se transmite por contacto directo con una persona afectada o a través de fómites, por lo que es muy común el contagio de los convivientes. Presentamos un caso de escabiosis en una paciente anciana evaluada por prurito generalizado. (AU)

Scabies is a human specific pruritic ectoparasitosis produced by the mite Sarcoptes scabiei var. hominis. Although it has a worldwide distribution, it is often underdiagnosed because it is only associated with overcrowding and poor hygiene. It is transmitted by a direct contact with an affected person or through fomites. The transmission to cohabitants is very common. We present a case of scabies in an elderly patient with generalized pruritus. (AU)

Nuevas terapias para la colestasis / New therapies in cholestasis

The introduction of ursodeoxycholic acid (UDCA) in the treatment of patients with cholestasis enabled remarkable progress and improvements in hepatic inflammatory activity, progression to cirrhosis and quality of life. However, the benefits of UDCA are particularly evident in patients with primary biliary cirrhosis and also 30 percent of patients have sub optimal response. For this reason, in order to improve the number of people with complete responses to therapy, new pharmacological alternatives have been investigated to add to UDCA treatment. This review aims to show potential new therapies against cholestasis that have been investigated by systematizing them depending on the receptor or target on which they act. Finally, a special reference will be made in relation to the treatment of pruritus associated with cholestasis.

La introducción del ácido ursodeoxicólico (AUDC) en el tratamiento de los pacientes con colestasia permitió notables avances con mejoras en la actividad inflamatoria hepática, progresión hacia la cirrosis y calidad de vida. Sin embargo, los beneficios de AUDC se aprecian especialmente en pacientes con cirrosis biliar primaria y además, 30 por ciento de los pacientes tiene una respuesta sub óptima. Por esta razón, con la finalidad de mejorar el número de personas con respuestas completas a la terapia, se han investigado nuevas alternativas farmacológicas para adicionar al tratamiento con AUDC. La presente revisión pretende mostrar las nuevas posibles terapias contra la colestasia estudiadas sistematizándolas según el tipo de receptor o diana sobre el que actúan. Finalmente se hará referencia especial en relación al tratamiento del prurito asociado a la colestasia.

Brachioradial pruritus in a patient with cervical disc herniation and Parsonage-Turner syndrome

Abstract Brachioradial pruritus is a chronic sensory neuropathy of unknown etiology which affects the skin of the shoulders, arms and forearms on the insertion of the brachioradialis muscle. We describe the case of a 60-yearold woman recently diagnosed with multiple myeloma who refers paresis, severe pruritus and itching lesions on the right arm with 6 months of evolution. Investigation led to a diagnosis of Brachioradial pruritus consequent to the presence of cervical disc herniation and Parsonage-Turner syndrome. The patient started gabapentin 900mg/day with good control of itching. Corticosteroids and antihistamines are often ineffective in the treatment of BP. Gabapentin has been used with encouraging results. All patients with Brachioradial pruritus should be evaluated for cervical spine injuries.

Efficacy of gabapentin in the improvement of pruritus and quality of life of patients with notalgia paresthetica

BACKGROUND: notalgia paresthetica is a subdiagnosed sensory neuropathy presenting as a condition of intense itching and hyperchromic macule on the back that interferes with daily habits. OBJECTIVES: To determine the efficacy of treatment of notalgia paresthetica using oral gabapentin, assessing the degree of improvement in itching and influence on quality of life. Moreover, to evaluate the signs and symptoms associated with notalgia paresthetica. METHODS: We conducted an experimental, non-randomized, parallel, non-blinded study including 20 patients with clinical and histopathological diagnosis of notalgia paresthetica. After application of the visual analogue scale of pain adapted for pruritus and of the questionnaire of dermatology life quality index (DLQI), ten patients with visual analogue scale > 5 were given treatment with gabapentin at the dose of 300 mg/day for four weeks. The other ten were treated with topical capsaicin 0.025% daily for four weeks. After the treatment period, patients answered again the scale of itching. RESULTS: The use of gabapentin was responsible for a significant improvement in pruritus (p=0.0020). Besides itching and hyperchromic stain on the back, patients reported paresthesia and back pain. It was observed that the main factor in the worsening of the rash is heat. CONCLUSION: Gabapentin is a good option for the treatment of severe itching caused by nostalgia paresthetica. .

Cutaneous lesions and finger clubbing uncovering hypocomplementemic urticarial vasculitis and hepatitis C with mixed cryoglobulinemia / Lesoes cutaneas e baqueteamento digital reveladores de vasculite urticariforme hipocomplementemica e hepatite C com crioglobulinemia mista

Urticarial vasculitis is a rare clinicopathologic entity characterized by urticarial lesions that persist for more than 24 hours and histologic features of leukocytoclastic vasculitis. Patients can be divided into normocomplementemic or hypocomplementemic. The authors report the case of a healthy 49-year-old woman with a 1-year history of highly pruritic generalized cutaneous lesions and finger clubbing. Laboratory tests together with histopathologic examination allowed the diagnosis of hypocomplementemic urticarial vasculitis, chronic hepatitis C and type II mixed cryoglobulinemia. The patient started symptomatic treatment and was referred to a gastroenterologist for management of the hepatitis C, with progressive improvement of the skin condition. The development of hypocomplementemic urticarial vasculitis in the context of chronic hepatitis C is exceedingly rare and possible pathogenic mechanisms are discussed.

A vasculite urticariforme é uma entidade clinico-patológica rara caracterizada por lesões urticariformes com duração superior a 24 horas e uma vasculite leucocitoclásica na histologia. É dividida em normo e hipocomplementêmica. Os autores relatam o caso de uma mulher saudável de 49 anos, com lesões cutâneas intensamente pruriginosas e baqueteamento digital com 1 ano de evolução. O estudo efectuado permitiu efectuar os diagnósticos de vasculite urticariforme hipocomplementêmica, hepatite C crônica e crioglobulinêmia mista tipo II. A doente iniciou tratamento sintomático e foi referenciada para a Gastroenterologia para orientação da hepatite, com melhoria progressiva das lesões cutâneas. O desenvolvimento de vasculite urticariforme hipocomplementêmica no contexto de hepatite C crónica é raro e os possíveis mecanismos patogênicos são discutidos.

Clinical use of a ceramide-based moisturizer for treating dogs with atopic dermatitis

In humans, skin barrier dysfunction is thought to be responsible for enhanced penetration of allergens. Similar to conditions seen in humans, canine atopic dermatitis (CAD) is characterized by derangement of corneocytes and disorganization of intercellular lipids in the stratum corenum (SC) with decreased ceramide levels. This study was designed to evaluate the effects of a moisturizer containing ceramide on dogs with CAD. Dogs (n = 20, 3~8 years old) with mild to moderate clinical signs were recruited and applied a moisturizer containing ceramide for 4 weeks. Transepidermal water loss (TEWL), skin hydration, pruritus index for canine atopic dermatitis (PICAD) scores, and canine atopic dermatitis extent and severity index (CADESI) scores of all dogs were evaluated. Skin samples from five dogs were also examined with transmission electron microscopy (TEM) using ruthenium tetroxide. TEWL, PICAD, and CADESI values decreased (p < 0.05) and skin hydration increased dramatically over time (p < 0.05). Electron micrographs showed that the skin barrier of all five dogs was partially restored (p < 0.05). In conclusion, these results demonstrated that moisturizer containing ceramide was effective for treating skin barrier dysfunction and CAD symptoms.

Pruritus: still a challenge / Prurido: ainda um desafio

Pruritus is a symptom that may be associated with a wide array of diseases - skin diseases, systemic diseases or even those without a defined cause. According to its severity and evolution, it may compromise the patients' quality of life in a significant way. New therapeutic approaches, in which histamine release is not the main event, are being described for pruritus control. Therefore, taking into account the origin of the mediators of pruritus, we conducted a review of the available resources emphasizing that, although very important, anti-histamines are not the answer for every kind of pruritus.

Prurido é um sintoma que pode estar associado a uma gama ampla de patologias, sejam elas cutâneas, sistêmicas ou mesmo sem causa definida . Conforme sua intensidade e evolução pode comprometer de forma significativa a qualidade de vida dos pacientes. Novas abordagens terapêuticas estão sendo descritas para o controle do prurido, onde a liberação da histamina não é o fator principal. Assim, baseando-se na origem de seus mediadores, faz-se uma revisão desses recursos e ressalta-se que, embora de grande importância no arsenal terapêutico, os anti-histamínicos não são a panacéia para todos os tipos de prurido.

Prurito neuropático / Neuropathic pruritus

El prurito neuropático es una forma patológica de prurito, donde la curva estímulo-respuesta que rige la sensación normal se ha distorsionado y la sensación de prurito está fuera de proporción o incluso completamente independiente de los estímulos pruritogénicos. Al igual que el dolor neuropático, el prurito neuropático aún es poco conocido, a pesar de los avances en la comprensión de los mecanismos de éste. La causa del prurito neuropático puede ser extremadamente difícil de precisar. El tratamiento eficaz requiere de la identificación anatómica y etiológica del problema neurológico y la instauración de un tratamiento modificador de la enfermedad. En algunos casos, esto puede ser neuroquirúrgico. El prurito neuropático no suele responder a antihistamínicos, esteroides tópicos u otros medicamentos eficaces para tratar el prurito convencional. Por otra parte, al igual que otros síntomas neurológicos, el prurito puede indicar un problema neurológico potencialmente grave que puede necesitar tratamiento rehabilitador.

Neuropathic Pruritus is a pathological form of itching, where stimulus-response curve governing normal sensation, has been distorted and itching sensation is out of proportion or even completely independent pruritogenic stimuli. As neuropathic pain, neuropathic pruritus is still poorly understood, despite advances in understanding the mechanisms thereof. The cause of neuropathic itch can be extremely difficult to pinpoint. Effective treatment requires identification of anatomical and etiological neurological problem, and the establishment of a disease-modifying treatment. In some cases, this may be neurosurgical. The neuropathic pruritus not usually respond to antihistamines, topical steroids or other effective drugs to treat itching conventional. Moreover, like other neurological symptoms, pruritus may indicate a potentially serious neurological problem that may need rehabilitation treatment.

Uremic pruritus in hemodialysis patients: treatment with desloratidine versus gabapentin / Prurido urêmico em pacientes em hemodiálise: tratamento com desloratidina versus gabapentina

INTRODUCTION: Uremic pruritus is common among dialysis patients. Effective treatments are not readily available. Early evidence with antihistamines and gabapentin indicate variable effects. OBJECTIVE: To compare the efficacy and side effects of gabapentin and desloratadine in patients with dialysis pruritus. METHODS: Prospective, open-label, cross-over clinical trial in 22 patients on chronic hemodialysis with sustained pruritus over a period of at least 60 days. After a one-week run-in period, we assigned patients to three weeks of either gabapentin 300 mg thrice weekly or desloratadine 5 mg thrice weekly. After a one-week washout period, each patient crossed-over to the alternate regimen for three more weeks. The primary endpoint of the study was the change in the visual analogue pruritus score (VAS). RESULTS: Nineteen subjects completed the two treatment blocks and were available for analysis. VAS scores decreased with both treatments (5.95 to 4.6 with gabapentin, p = 0.07; 5.89 to 3.4 with desloratadine, p = 0.004), but only desloratadine reached statistical significance. There were no differences when comparing the final pruritus score with gabapentin and desloratadine (4.6 versus 3.4, p = 0.16) Excessive sedation was common with gabapentin. Desloratadine was well tolerated. CONCLUSION: Desloratadine provides significant relief of uremic pruritus compared with no therapy. gabapentin has marginal efficacy. Desloratadine is better tolerated than gabapentin.

INTRODUÇÃO: Prurido urêmico é comum entre pacientes em diálise. Tratamentos eficazes não estão disponíveis até o momento. Provas recentes com anti-histamínicos e gabapentina indicam vários efeitos. OBJETIVO: Comparar a eficiência e os efeitos colaterais da gabapentina e da desloratadina em pacientes com prurido na diálise. MÉTODOS: Estudo prospectivo, aberto e comparativo com 22 pacientes em hemodiálise crônica com prurido constante durante um período de pelo menos 60 dias. Após uma semana, submetemos os pacientes a três semanas de gabapentina 300 mg, três vezes por semana, ou desloratadina 5 mg três vezes por semana. Após um período de eliminação de uma semana, os pacientes trocaram de regime por mais três semanas. O objetivo primário do estudo foi a mudança na escala visual analógica (EVA) de prurido. RESULTADOS: Dezenove indivíduos completaram os dois tratamentos e foram submetidos à análise. Os escores da EVA caíram com ambos os tratamentos (5,95 para 4,6 com gabapentina, p = 0,07; 5,89 para 3,4 com desloratadina, p = 0,004), mas somente a desloratadina teve significância estatística. Nenhuma diferença foi observada ao comparar o escore final do prurido com gabapentina e desloratadina (4,6 versus 3,4, p = 0,16). Excesso de sedação foi comum com gabapentina. A desloratadina teve alto nível de tolerância. CONCLUSÃO: A desloratadina dá alívio significante do prurido urêmico quando comparada a nenhum tratamento. A gabapentina tem eficiência marginal. A desloratadina tem maior nível de tolerância em relação à gabapentina.

Seabather's eruption: report of case in northeast region of Brazil / Prurido do traje do banho: relato de caso na região nordeste do Brasil

Seabather's eruption is characterized by the occurrence of intensely itchy erythematous papules observed mainly in the region covered by swimwear. The dermatitis occurs due to the contact of planula larvae of scyphomedusae Linuche unguiculata with the skin. The swimsuit pressure triggers the action of the poisonous stinging structures carried by the larvae. The case described occurred in a child who, while bathing in the ocean waters of the Northeast coast of Bessa's Beach located in the city of Joao Pessoa, state of Paraiba, showed typical clinical signs of the disease. It was concluded that the report of the case showed clinical and therapeutic implications for doctors working in all of the Brazilian coastal areas.

O prurido do traje de banho é uma erupção caracterizada por pápulas eritematosas, intensamente pruriginosas, localizadas principalmente sob os trajes dos banhistas de mar. A dermatite ocorre pelo contato com as larvas plânulas da cifomedusa Linuche unguiculata que disparam seus nematocistos na pele do acidentado a partir das suas células de defesa, os cnidócitos. O caso ocorreu em uma criança que ao se banhar nas águas oceânicas do litoral da Região Nordeste na Praia do Bessa localizada na cidade de João Pessoa, Estado da Paraíba, apresentou quadro clínico típico da enfermidade. Concluiu-se que o relato do caso evidenciou implicações clínicas e terapêuticas para os médicos que atuam em todas as áreas litorâneas brasileiras.

Topical capsaicin therapy for uremic pruritus in patients on hemodialysis

Pruritus is one of the common problems in patients on hemodialysis. There are several causes for pruritus, and different treatment modalities are applied to control it. The aim of this study was to evaluate the therapeutic effect of capsaicin on pruritus, compared with placebo, in patients on hemodialysis. This randomized double-blinded cross-over clinical trial was performed on 34 patients on hemodialysis with uremic pruritus. The patients were divided into 2 groups, one group received capsaicin 0.03% and the other, placebo, for 4 weeks. Treatment was stopped for 2 weeks as washout period and continued as a cross-over technique. Pruritus scores were analyzed and compared. Thirty-four patients on long-term hemodialysis, 14 men and 20 women with a mean age of 57.0 +/- 18.6 years were studied. The mean of pruritus score before capsaicin treatment was 15.9 +/- 6.3, which was reduced to 6.4 +/- 3.9, 4.7 +/- 3.1, 3.2 +/- 2.9, and 2.5 +/- 2.5 on weeks 1 to 4, respectively [P < .001]. In the placebo group, pruritus score before treatment was 15.0 +/- 6.0 on average, and it was 11.7 +/- 5.8, 9.4 +/- 5.9, 7.9 +/- 5.5, and 7.2 +/- 5.5, respectively, on weeks 1 to 4 [P < .001]. There was no significant difference in pruritus scores before the treatment between the two groups, but after each week, the difference was significant [P < .001]. Repeated measurement test showed that decreasing in pruritus severity in the capsaicin group was more than that in the placebo group during treatment period [P < .001]. Capsaicin is a new safe and effective topical treatment for hemodialysis-induced pruritus in patients with end-stage renal disease

[Evaluation of therapeutic effect of capsaicin pomade [Caspian 0.03%] in hemodialysis related pruritus]

Pruritus is one of the common problems in hemodialysis patients with end stage renal disease. Approximately, 60% of these patients suffer from this condition. There are several causes for pruritus, thus, various treatments are applied in order to control it. The aim of this study was to evaluate the therapeutic effect of capsaicin on pruritus, compared with placebo, in hemodialysis patients. This randomized double blind cross over clinical trial study, was performed on 34 hemodialysis patients with uremic pruritus in 1386. All patients were divided in two groups. One group received Caspian 0.03%, while the other, placebo for four weeks. Treatment was stopped for two weeks and continued as cross over technique. Pruritus scores were analyzed with Paired t-test and Repeated measurement ANOVA. In this study, the difference between Mean of pruritus score before capsian treatment and in weeks following 1 to 4 was statistically significant [P=0.0001]. In placebo group, the difference between pruritus score before treatment and in weeks 1 to 4 was statistically significant [P=0.0001]. There was no significant difference before treatment in two groups, however, after each week, the difference was significant [P=0.0001]. Repeated measurement test showed that reduction in pruritus severity in capsian group was more than placebo group, during treatment period [P=0.0001]. Although our study indicated the appropriate effects of Capsian in pruritus, the placebo also has a good effect in controlling hemodialysis related pruritus. Our placebo had emollient property; therefore, we can apply it to control the pruritus in these patients

Prophylactic intravenous ondansteron and nalbuphine for reduction of subarachnoid fentanyl-induced pruritus in patients undergoing elective cesarean delivery

Addition of fentanyl to spinal anaesthesia with bupivacaine improves the quality and success of anaesthesia. However, it has a frequent incidence of pruritus and a substantial incidence of nausea and vomiting. tn this placebo controlled study, we compared the prophylactic efficacy of ondansetron and nalbuphine for the prevention of intrathecal fentanyl-induced pruri tus after cesarean delivery. Ninety elective parturients were assigned to one of the groups: Group 0 [Ondansetron 8mg IV n=30], Group N [Nalbuphine 4mg IV n=30] and Group S [Saline 0.9% IV n=30] as placebo. The study drugs were administered immediately after the umbilical cord was clamped. The occurrence of pruritus, nausea, pain and adverse reactions from ondansetron and nalbuphine was evaluated by pruritus score, 4-point rating score and visual analog scale respectively, at 15 minutes in the first hour after the injection of the study drugs. Afterward, evaluations were performed at 1, 2, 3 and 4 hours after the administration of study drugs. The overall incidence of pruritus, it was significantly more frequent in Group S [62%] compared with both Group 0 [43%] and Group N [42.5%]. The incidence of pruritus during the different study intervals showed significant increase in Group S compared with the other groups mainly at 45mm and 1 hour. The pruritus score was significantly different between Group 0 and Group S and between Group N and Group S [p<0.0S] respectively, it was mostly mild in Group 0 and Group N and mostly moderate in Group S. Treatment for pruritus was requested by patients in, 10%, 11% and 29% of patients in the Group 0, Group N and Group 5, respectively. There was no significant difference in the overall incidence and the severity of nausea andlor vomiting at different time study intervals for all groups. However, the number of patients requesting treatment for nausea and/or vomiting was significantly less in Group 0 and Group N when compared with Group S. No significant adverse reactions related to the study drugs reported during the different study intervals. Although IV ondansetron and nalbuphine significantly decreased the incidence of of fentanyl-induced pruritus more than placebo after cesarean delivery, further studies are recommended to show the other possible mecha nisms might be involved in the pathogenesis of fentanylinduced pruritus

Granular parakeratosis presenting with facial keratotic papules.

A 27-year-old female presented with pruritic keratotic papules over the left side of the face since one month. The lesions developed a few days after working in a hot humid environment and were preceded by severe uncontrollable pruritus for which she had repeatedly wiped the area with handkerchiefs and towels. A biopsy from one of the keratotic papules revealed granular parakeratosis with a markedly thick stratum corneum that had parakeratosis and also housed keratohyaline granules. Similar changes were seen in keratotic plugs of dilated follicular infundibula.