Investigation of serum substance P status in patients with chronic pruritic skin lesions due to sulfur mustard: a cross-sectional study.

PURPOSE: Chronic cutaneous complications of sulfur mustard (SM) are quite common among intoxicated patients. Among these complications, pruritus represents the most frequent symptom which has significant influence on the quality of life (QoL). The present was undertaken to assess serum levels of substance P in patients who suffer from chronic pruritic lesions due to SM. METHODS: For this cross-sectional study, patients suffering from chronic SM-induced pruritic skin lesions (n = 40) and atopic dermatitis (AD)-induced pruritus (n = 20) were recruited. Healthy subjects (n = 10) with no dermatologic disorder were also recruited as control groups. Serum substance P was measured using an enzyme-linked immunosorbent assay. Pruritus severity was assessed using pruritus score and visual analogue scale (VAS). QoL was evaluated using the dermatology life quality index (DLQI). RESULTS: Significantly elevated serum concentrations of SP were found in the SM compared to the control (p < 0.001) and AD group (p < 0.001). Pruritus score was also higher in the SM compared to both control (p < 0.001) and AD groups (p < 0.001). While there was a higher VAS score in the SM vs. AD group (p = 0.019), no significant difference was observed for DLQI scores (p > 0.05). Significant correlations were found between serum SP and pruritus score in all assessed groups (p < 0.05). CONCLUSION: In light of the present findings, elevated SP levels might be regarded as an important contributor of SM-induced chronic pruritus and a potential target for reducing the symptoms.

Management of sulfur mustard-induced chronic pruritus: a review of clinical trials.

Skin is among the most heavily damaged organs upon sulfur mustard (SM) exposure. Chronic complications due to SM-induced dermatotoxicity are quite frequent among intoxicated patients. Nevertheless, the exact pathophysiology of SM-induced chronic cutaneous complications has not been well clarified yet. The present review highlights clinically important findings on the management of SM-induced chronic skin complications with a particular focus on pruritus as the most prevalent symptom that has a significant impact on patients' quality of life. Some methodological pitfalls that implicate the validity of the trials have also been identified.

Cetirizine, doxepine, and hydroxyzine in the treatment of pruritus due to sulfur mustard: a randomized clinical trial.

A 4-week randomized, double-blind safety and efficacy study was conducted to compare the safety and efficacy of cetirizine, doxepine, and hydroxyzine 5 in the treatment of chronic pruritus due to sulfur mustard. Patients were treated in the Dermatology Clinic of Baqiyatallah Hospital. The study population consisted of 75 patients with chronic pruritus due to sulfur mustard exposure. Patients were given either cetirizine 10 mg, doxepine 10 mg, or hydroxyzine 25 mg/day, for 4 weeks. A calculated pruritic score for each patient was taken before and 1 month after treatment. Mean before-treatment pruritic scores were 38.2 +/- 4.8, 37.2 +/- 4.9, and 37.3 +/- 5.1 in the cetirizine, doxepine, and hydroxyzine groups, respectively. After treatment, the mean pruritic scores were 24.8 +/- 3.1, 17.8 +/- 2.5, and 16.7 +/- 2.3 in the cetirizine, doxepine, and hydroxyzine groups, respectively. In addition, 65%, 75%, and 80% of patients in the cetirizine, doxepine, and hydroxyzine groups were downgraded in the severity of pruritus (P 1/4 0.465). Sedation effects were reported in 6, 14, and 18 patients in the cetirizine, doxepine, and hydroxyzine groups, respectively. Hydroxyzine 25 mg/day has equal results compared to doxepine 10 mg once daily; but greater than cetirizine 10 mg once a day in controlling the symptoms of patients with chronic pruritus.