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1.
Skin Therapy Lett ; 28(6): 7-9, 2023 11.
Article in English | MEDLINE | ID: mdl-38016088

ABSTRACT

Prurigo nodularis (PN) is a chronic inflammatory skin condition characterized by the presence of pruritic nodules. Dupilumab was approved by the US Food and Drug Administration in September 2022 and Health Canada in July 2023 for the treatment of PN. Dupilumab is a human monoclonal immunoglobulin G4 antibody that binds the interleukin (IL)-4 receptor alpha subunit, blocking intercellular signalling of IL-4 and IL-13. Inhibition of these cytokines downregulates the inflammatory response and improves disease severity and pruritus. Two randomized controlled trials have shown dupilumab to be effective in reducing pruritus and lesion count in patients with PN. The approval of dupilumab for PN represents the first approved therapy for PN and may indicate a paradigm shift in the way this condition is treated.


Subject(s)
Antibodies, Monoclonal, Humanized , Neurodermatitis , Prurigo , Humans , Antibodies, Monoclonal/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Interleukin-4 Receptor alpha Subunit/therapeutic use , Neurodermatitis/drug therapy , Prurigo/drug therapy , Pruritus/drug therapy
3.
J Med Case Rep ; 15(1): 80, 2021 Feb 17.
Article in English | MEDLINE | ID: mdl-33593424

ABSTRACT

INTRODUCTION: Lichen simplex chronicus has been defined as a localized skin condition characterized by thickening, hyperpigmentation and accentuated skin markings from chronic itching and from repeated scratching. The affected skin area is usually described as demarcated, and often circumscribed. It has even been defined as a "psychogenic pruritic disorder". The idea of a neurological component has also been suggested, hence the term 'neurodermatitis circumscripta'. However, the pathophysiology of this condition remains unclear. Several associations and etiologies have been reported in literature, including strong links with mental disorders-anxiety and obsessive compulsive disorder to be specific. We report this case, most importantly, to highlight the value of an open-minded approach to patients and the 'old-fashioned' physician character of empathy, the skill of detailed history taking and physical examination, and lastly to suggest that lichen simplex chronicus may not always present as a localized, 'circumscripta' or demarcated area of skin. CASE DESCRIPTION: When a sixty-five year-old Caucasian female presented to our clinic agitated, intensely scratching her entire body and complaining of severe pruritus, an open-minded detailed approach during history taking and physical examination led to the working diagnosis of diffuse lichenification from chronic scratching secondary to a "possible" cutaneous disorder. Her medical history was unremarkable, but her psychiatric history was significant for Anxiety disorder. She remained on her anxiolytic medication. Her presenting symptom was reported to have persisted for more than 9 months. Review of previous unremarkable lab results and a remarkable findings on detailed skin inspection led to an empiric, trial regimen consisting of three topical preparations: an anti-pruritic-to break the itch-scratch cycle, anti-inflammatory-to curb any inflammatory/immune response and a 'last-ditch' scabicidal application. Follow-up was scheduled, but the patient called the office requesting an earlier follow up appointment. The lesions had significantly improved and the hyper-pigmented, indurated and escoriated skin appearance had resolved; and most importantly, the pruritus. CONCLUSION: Thus we conclude that lichen simplex chronicus may not always present as circumscribed or localized area of skin as currently noted in literature. Also, in patients with psychiatric conditions including anxiety and obsessive-compulsive disorder in particular, effort should be made to avoid stereotyping their presentation as part of their mental disorder spectrum. The value of detailed history and physical examination, mixed with empathy is highlighted. We make our recommendation considering the profound turnaround in the patient's condition and quality of life after several months of emotional and psychological suffering.


Subject(s)
Anxiety Disorders/complications , Neurodermatitis/diagnosis , Pruritus/diagnosis , Scabies/complications , Aged , Diagnostic Errors , Female , Humans , Neurodermatitis/drug therapy , Neurodermatitis/parasitology , Pruritus/drug therapy , Pruritus/parasitology , Scabies/drug therapy
4.
J Dermatolog Treat ; 32(7): 684-692, 2021 Nov.
Article in English | MEDLINE | ID: mdl-31884840

ABSTRACT

Lichen simplex chronicus (LSC) is a disorder characterized by thickened areas of skin from repeated rubbing or scratching. The multifactorial nature of LSC makes management difficult and there are currently no evidence-based guidelines for treatment. We conducted a systematic review of the literature to evaluate treatments for LSC and provide an evidence-based summary of the current treatments as well as highlight novel therapies. A total of 21 studies were included which comprised 682 patients with LSC involving various areas. The most robust evidence was seen with the use of topical corticosteroids (n = 7 RCTs) and limited data suggest benefit with other treatments such as topical immunomodulators, topical antipruritic agents, oral antihistamines, antiepileptics and antidepressants. We also discuss novel treatment approaches using transcutaneous electrical nerve stimulation, focused ultrasound, and phototherapy. Despite emerging evidence there remains a paucity of high-quality studies supporting treatments for LSC and larger controlled trials are needed.


Subject(s)
Neurodermatitis , Humans , Neurodermatitis/drug therapy , Skin
6.
Mayo Clin Proc ; 92(3): 449-454, 2017 03.
Article in English | MEDLINE | ID: mdl-28259230

ABSTRACT

Mature women often present with symptomatic vulvovaginal atrophy and vulvar dermatoses, causing noncoital pain, dyspareunia, and sexual changes. Diagnosis of these conditions can be challenging, and long-term management is required to decrease morbidity and enhance quality of life. Vaginal estrogen therapies remain safe and effective for treating symptomatic vulvovaginal atrophy. A vulvar biopsy is easy to perform and generally well tolerated when indicated for the diagnosis of lichen simplex chronicus, lichen sclerosus, and lichen planus. Therapy with moderate- to high-potency corticosteroids is effective for these frequently debilitating conditions.


Subject(s)
Dyspareunia/etiology , Estrogens/administration & dosage , Postmenopause/physiology , Sexual Dysfunction, Physiological/diagnosis , Skin Diseases/diagnosis , Vulva/pathology , Vulvar Diseases/diagnosis , Women's Health , Administration, Intravaginal , Atrophy/drug therapy , Dermatologic Agents/administration & dosage , Dermatologic Agents/therapeutic use , Diagnosis, Differential , Dyspareunia/prevention & control , Estrogen Replacement Therapy/methods , Estrogens/therapeutic use , Female , Humans , Lichen Planus/diagnosis , Lichen Planus/drug therapy , Neurodermatitis/diagnosis , Neurodermatitis/drug therapy , Quality of Life , Sexual Dysfunction, Physiological/drug therapy , Sexual Dysfunction, Physiological/etiology , Skin Diseases/drug therapy , Vaginal Creams, Foams, and Jellies/administration & dosage , Vaginal Creams, Foams, and Jellies/therapeutic use , Vulvar Diseases/drug therapy , Vulvar Lichen Sclerosus/diagnosis , Vulvar Lichen Sclerosus/drug therapy
7.
An Bras Dermatol ; 91(4): 549-51, 2016.
Article in English | MEDLINE | ID: mdl-27579762

ABSTRACT

This is a cross-sectional study, conducted from May to November/2014, in a dermatology reference unit, through review of medical records and interviews. In a sample of 49 patients with brachioradial pruritus, we observed higher prevalence of Caucasian (81.6%) and women (73.5 %), with a mean age of 56.1 years. Pruritus occurred in the topography of brachioradialis muscle in 87.8% of cases; 59.2% of the sample reported worsening of pruritus with sun exposure; the mean intensity of this symptom before treatment was 8.63. Therapy effectiveness was described as "very good/good" in 79.2% of cases, and for 55.3% relapses were categorized as "uncommon".


Subject(s)
Neurodermatitis/drug therapy , Neurodermatitis/epidemiology , Pruritus/drug therapy , Pruritus/epidemiology , Aged , Anticonvulsants/therapeutic use , Antidepressive Agents, Tricyclic/therapeutic use , Antipsychotic Agents/therapeutic use , Brazil/epidemiology , Cross-Sectional Studies , Drug Therapy, Combination , Female , Humans , Male , Middle Aged , Sex Distribution , Treatment Outcome
9.
BMC Cardiovasc Disord ; 15: 173, 2015 Dec 18.
Article in English | MEDLINE | ID: mdl-26681197

ABSTRACT

BACKGROUND: Thalidomide has been reported to cause numerous thromboembolic events. Deep vein thrombosis and pulmonary embolism are more common. It can also cause bradycardia and even total atrioventricular block. Rarely, it causes coronary artery spasm and even myocardial infarction. But almost simultaneous onset of myocardial infarction, third degree atrioventricular block and pulmonary embolism in one patient has not been reported so far. CASE PRESENTATION: A 53-year old man presented because of chest pain, nausea and then syncope for several minutes. Previous medical history included neurodermitis for which thalidomide was given and hypercholesterolemia with simvastatin taking. The patient didn't exhibit any other established risk factors for coronary artery disease. Electrocardiography showed sinus rhythm with third degree atrioventricular block and complete right bundle branch block, and precordial leads ST segment elevation. The diagnosis of acute coronary syndrome was suspected, but further coronary angiography demonstrated no flow-limiting lesions in coronary arteries, and temporary pacemaker was implanted. After admission, low SpO2 and elevated D-dimer level was mentioned. Further computed tomography pulmonary angiography revealed pulmonary embolism. Thalidomide was thought to be the cause of hypercoagulability and coronary spasm, so it was ceased immediately. Therapeutic low molecule weight heparin was initiated and then switched to warfarin with appropriate INR, and nifedipine was described for coronary spasm. The patient's symptoms completely relived and SpO2 recovered, and atrioventricular block had disappeared during hospitalization with pacemaker removed. CONCLUSION: This is the very first case in which myocardial infarction, third degree atrioventricular block and pulmonary embolism almost simultaneously developed. We should be ware that anti-thrombotic prophylaxis, which needs further investigation for optimal drug and dosage, may be beneficial in thalidomide therapy. And it is also important to monitor patients taking thalidomide for signs and symptoms of bradycardia or higher degree atrioventricular block.


Subject(s)
Atrioventricular Block/chemically induced , Dermatologic Agents/adverse effects , Myocardial Infarction/chemically induced , Neurodermatitis/drug therapy , Pulmonary Embolism/chemically induced , Thalidomide/adverse effects , Anticoagulants/therapeutic use , Atrioventricular Block/diagnosis , Atrioventricular Block/therapy , Cardiac Pacing, Artificial , Coronary Angiography , Electrocardiography , Humans , International Normalized Ratio , Magnetic Resonance Imaging , Male , Middle Aged , Myocardial Infarction/diagnosis , Myocardial Infarction/drug therapy , Neurodermatitis/diagnosis , Pulmonary Embolism/diagnosis , Pulmonary Embolism/drug therapy , Severity of Illness Index , Tomography, X-Ray Computed , Treatment Outcome , Vasodilator Agents/therapeutic use
11.
Pan Afr Med J ; 17: 280, 2014.
Article in French | MEDLINE | ID: mdl-25317228

ABSTRACT

Cerebral venous thrombosis (CVT) is a rare origin of stroke, the clinical presentation and etiologies vary. The prognosis is shown to be better compared to arterial thrombosis. Magnetic Resonance Imaging (MRI) and MR Venograpgy (MRV) are currently important tools for the diagnostic. We studied 30 cases of CVT diagnosed in the department of neurology of the University Hospital of Fez (Morocco). Patients diagnosed with CVT signs between January 2003 and October 2007 were included in the study. Cerebral CT-scan was performed in 27 cases (90%) while the MRI examination was done in 18 patients (67%); and most patients (90%) received anticoagulant therapy. The mean age of our patients was of 29 years (age range between 18 days and 65 years). A female predominance was observed (70%). The clinical presentation of patients was dominated by: headache in 24 cases (80%), motor and sensory disability in 15 cases (50%), seizures in 10 cases (33%) , consciousness disorder in 10 cases (33%). CVT was associated to post-partum in 10 cases (33%), infectious origin in 8 cases (26%), Behcet disease in 2 cases (7%), pulmonary carcinoma in 1 case, thrombocytemia in 1 case and idiopathic in 7 cases (23%). The evolution was good in 20 cases (67%), minor squelaes were observed in 6 patients (20%), while major squelaes was observed in 2 cases. Two cases of death were registered. The CVT is a pathology of good prognosis once the diagnosis is promptly established and early heparin treatment initiated.


Subject(s)
Neurodermatitis/diagnosis , Pruritus Ani/diagnosis , Administration, Topical , Anal Canal/pathology , Anti-Inflammatory Agents/administration & dosage , Betamethasone/administration & dosage , Betamethasone/analogs & derivatives , Humans , Male , Middle Aged , Neurodermatitis/complications , Neurodermatitis/drug therapy , Pruritus Ani/drug therapy , Pruritus Ani/etiology
12.
Dermatol Ther ; 27(1): 21-3, 2014.
Article in English | MEDLINE | ID: mdl-24502306

ABSTRACT

Lichen simplex chronicus (LSC) is a skin disorder characterized by chronic itching and scratching, which can lead to thick, leathery, brownish skin, sometimes with papules and can be associated with atopic eczema. We report the case of a 52-year-old man with a 45-year atopic condition and presenting LSC in his dorsum. After a 3-month treatment with alitretinoin at the daily dosage of 30 mg, we have observed a moderate improvement of the hand eczema together with a substantial clinical improvement of LSC and an almost complete resolution of pruritus. We want to report this peculiar case to suggest the use of oral alitretinoin for LSC.


Subject(s)
Dermatitis, Atopic/drug therapy , Hand Dermatoses/drug therapy , Neurodermatitis/drug therapy , Tretinoin/therapeutic use , Alitretinoin , Humans , Male , Middle Aged
14.
Lik Sprava ; (5): 35-44, 2012.
Article in Russian | MEDLINE | ID: mdl-23534270

ABSTRACT

An overview of the literature of the dermatitis of the vulva is presented. The etiology, epidemiology, clinical manifestations, diagnosis, pathological diagnosis, treatment, and prevention of contact, allergic-contact, atopic, and seborrheic dermatitis of the vulva are described in details. Lichen simplex chronicus is additionally described as complication of chronic itching dermatitis.


Subject(s)
Dermatitis, Allergic Contact/pathology , Dermatitis, Atopic/pathology , Dermatitis, Irritant/pathology , Dermatitis, Seborrheic/pathology , Eczema/pathology , Neurodermatitis/pathology , Vulva/pathology , Adrenal Cortex Hormones/therapeutic use , Anti-Inflammatory Agents/therapeutic use , Chronic Disease , Dermatitis, Allergic Contact/diagnosis , Dermatitis, Allergic Contact/drug therapy , Dermatitis, Atopic/diagnosis , Dermatitis, Atopic/drug therapy , Dermatitis, Irritant/diagnosis , Dermatitis, Irritant/drug therapy , Dermatitis, Seborrheic/diagnosis , Dermatitis, Seborrheic/drug therapy , Diagnosis, Differential , Eczema/diagnosis , Eczema/drug therapy , Female , Histamine Antagonists/therapeutic use , Humans , Neurodermatitis/diagnosis , Neurodermatitis/drug therapy , Vulva/drug effects
15.
Hautarzt ; 62(3): 178-88, 2011 Mar.
Article in German | MEDLINE | ID: mdl-21340649

ABSTRACT

Within the past years, health services research projects have analyzed critically the management of atopic eczema (AE) in routine care, quantified the utility of controlling severe AE, and introduced an international standardization of core outcome measures for AE. With a prevalence of 16%, AE is the most frequent chronic condition at all among children and adolescents seeking medical care. Despite lower prevalence in adults, about 60% of patients with AE in routine care are adults. There is a clinically relevant comorbidity of AE and psychiatric conditions. Independent of patient's age and physician's medical discipline topical corticosteroids dominate outpatient treatment of AE. However, there is considerable heterogeneity in the management of AE between treating physicians. Despite a lack of clinical trials, systemic corticosteroids are most frequently prescribed for severe AE. In contrast, cyclosporine only plays a minor role in routine care of severe AE although its efficacy is well-documented in trials. This observation stimulated a head-to-head trial that indicated superiority of cyclosporine over prednisolone for severe adult AE. The control of severe AE has high priority from the perspective of the general population and from the patients' perspective. Competence of the treating physician, disease severity and patient's competence to adjust treatment to disease activity are the main determinants of patient satisfaction. Aiming for a better comparability of clinical trials and better translation of trial evidence into clinical practice, we conducted a Delphi exercise including clinical experts from 11 countries, editors of international dermatological journals, regulatory agencies, and patient representatives. The preliminary core set of outcome domains for eczema trials as defined by the panel included symptoms, physician-assessed clinical signs, and a measurement for long-term control of flares. Symptoms such as itching should be regularly assessed in clinical practice. The presented studies indicate that health services research not only describes and critically analyzes the effectiveness of routine clinical care, but is also translational research in that it may stimulate clinical trials and generate new, clinically relevant hypotheses for experimental studies.


Subject(s)
Cyclosporine/therapeutic use , Dermatitis, Atopic/drug therapy , Dermatitis, Atopic/epidemiology , Dermatologic Agents/therapeutic use , Health Services Research/statistics & numerical data , National Health Programs/statistics & numerical data , Neurodermatitis/drug therapy , Neurodermatitis/epidemiology , Prednisolone/therapeutic use , Adolescent , Adult , Child , Clinical Trials as Topic , Comorbidity , Cross-Sectional Studies , Delphi Technique , Evidence-Based Medicine , Germany , Humans , Practice Patterns, Physicians'/statistics & numerical data , Quality Assurance, Health Care/statistics & numerical data , Translational Research, Biomedical , Treatment Outcome
16.
Menopause Int ; 16(3): 117-20, 2010 Sep.
Article in English | MEDLINE | ID: mdl-20956687

ABSTRACT

In spite of overwhelming evidence that vulvovaginal symptoms plague up to 46% of menopausal and perimenopausal women, and that there persists a reluctance to seek help among patients, adequate vulval and sexual histories are still woefully rare in general gynaecology clinics. This review aims to present the key points of an effective vulval history and an overview of the accepted current management of vulval disease postmenopause, in order that our patients feel encouraged to present with their problems.


Subject(s)
Postmenopause , Vulvar Diseases/diagnosis , Vulvar Diseases/drug therapy , Administration, Topical , Dermatitis, Contact/diagnosis , Dermatitis, Contact/drug therapy , Female , Hormone Replacement Therapy , Humans , Lichen Planus/diagnosis , Lichen Planus/drug therapy , Lichen Sclerosus et Atrophicus/diagnosis , Lichen Sclerosus et Atrophicus/drug therapy , Neurodermatitis/diagnosis , Neurodermatitis/drug therapy , Practice Guidelines as Topic , Sexual Behavior , Vulvovaginitis/diagnosis , Vulvovaginitis/drug therapy
17.
Dermatol Ther ; 23(2): 194-8, 2010.
Article in English | MEDLINE | ID: mdl-20415827

ABSTRACT

Psychocutaneous conditions are frequently encountered in dermatology practice. Prurigo nodularis and lichen simplex chronicus are two frustrating conditions that are classified in this category. They are often refractory to classical treatment with topical corticosteroids and antihistamines. Severe, generalized exacerbations require systemic therapy. Phototherapy, erythromycine, retinoids, cyclosporine, azathiopurine, naltrexone, and psychopharmacologic agents (pimozide, selective serotonin reuptake inhibitor antidepressants) were tried with some success. Here five cases with lichen simplex chronicus and four cases with prurigo nodularis, who responded well to gabapentin, are presented.


Subject(s)
Amines/therapeutic use , Analgesics/therapeutic use , Anticonvulsants/therapeutic use , Cyclohexanecarboxylic Acids/therapeutic use , Neurodermatitis/drug therapy , Prurigo/drug therapy , gamma-Aminobutyric Acid/therapeutic use , Adolescent , Adult , Aged , Female , Gabapentin , Humans , Male , Middle Aged , Neurodermatitis/pathology , Prurigo/pathology , Treatment Outcome , Young Adult
20.
Ann Dermatol Venereol ; 136 Suppl 4: S129-36, 2009 May.
Article in French | MEDLINE | ID: mdl-19576479

ABSTRACT

Botulinum toxin could represent nowadays a new treatment modality especially for cutaneous conditions in course of which conventional treatments remain unsuccessful. Besides palmar and plantar hyperhidrosis, botulinum toxin has demonstrated efficacy in different conditions associated with hyperhidrosis, such as dyshidrosis, multiple eccrine hidrocystomas, hidradenitis suppurativa, Frey syndrome, but also in different conditions worsened by hyperhidrosis such as Hailey-Hailey disease, Darier disease, inversed psoriasis, aquagenic palmoplantar keratoderma, pachyonychia congenital. Moreover, different cutaneous conditions associated with sensitive disorders and/or neurological involvements could benefit from botulinum toxin, for example anal fissures, leg ulcers, lichen simplex, notalgia paresthetica, vestibulitis. Endly, a case of cutis laxa was described where the patient was improved by cutaneous injections of botulinum toxin.


Subject(s)
Botulinum Toxins/therapeutic use , Dermatologic Agents/therapeutic use , Neuromuscular Agents/therapeutic use , Skin Diseases/drug therapy , Darier Disease/drug therapy , Female , Fissure in Ano/drug therapy , Hidradenitis Suppurativa/drug therapy , Hidrocystoma/drug therapy , Humans , Hyperhidrosis/drug therapy , Keratoderma, Palmoplantar/drug therapy , Leg Ulcer/drug therapy , Nails, Malformed/drug therapy , Neurodermatitis/drug therapy , Paresthesia/drug therapy , Pemphigus, Benign Familial/drug therapy , Psoriasis/drug therapy , Sensation Disorders/drug therapy , Sweating, Gustatory/drug therapy , Treatment Outcome , Vulvar Vestibulitis/drug therapy
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