Clinical and histological characterization of transient dermal pain triggered by sweating stimuli

Takahagi, Shunsuke; Okamoto, Minoru; Ishii, Kaori; Tanaka, Akio; Mizuno, Hayato; Harada, Naoe; Yanagida, Nozomi; Hide, Michihiro

doi:10.1016/j.alit.2022.01.003

Cited by 6 publications

(18 citation statements)

References 39 publications

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“…Histological analyses focus on pore obstruction, reduction in the number and atrophy of sweat glands, and surrounding inflammatory infiltration. [1,17–19]…”

Section: Discussionmentioning

confidence: 99%

“…[1] Although short lived, the pain is severe and significantly disrupts patients daily lives, resulting in absenteeism or withdrawal from school or work. [1] Consequently, there is a substantial unmet need to understand the underlying mechanisms and develop effective treatments.…”

Section: Introductionmentioning

confidence: 99%

“…In a certain population of individuals, the exposure to sweating stimuli such as bathing, exercise, or mental stress, leads to severe dermal pain. [1][2][3] The sweating-induced dermal pain may occur alone or more frequently be accompanied by transient eruptions and/or generalized hypohidrosis. When accompanied by such symptoms, the condition can also be referred to as cholinergic urticaria [2] or acquired idiopathic generalized anhidrosis.…”

Section: Introductionmentioning

confidence: 99%

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A single-blind, randomized, crossover study on the efficacy of icatibant for sweating-induced dermal pain (icatibant for sweating-induced dermal pain)

et al. 2023

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Introduction: Severe dermal pain triggered by sweating stimuli, such as bathing, exercise, and mental stress, significantly affects patients’ daily lives. The pathomechanism underlying the sweating-induced dermal pain remains poorly understood and there exists no standard treatment for such pain. This study aims to evaluate the effectiveness of icatibant as an analgesic, a bradykinin B2 receptor antagonist, in treating sweating-induced dermal pain, and to establish the role of bradykinin in pain induction. Methods/design: A multicenter, exploratory, crossover, single-blinded, placebo-controlled randomized, comparative study will be conducted to evaluate the efficacy of subcutaneous icatibant injection (30 mg) in treating sweating-induced dermal pain. Ten patients will be enrolled and assigned randomly in a 1:1 ratio to either the icatibant-placebo or placebo-icatibant groups. The primary endpoint is the change in the visual analog scale scores for dermal pain induced by thermal load before and after treatment with icatibant or placebo. Secondary endpoints include changes in the duration of dermal pain, blood and plasma histamine levels, serum angiotensin-converting enzyme levels, and histological evaluation of skin tissue samples at the site of dermal pain. Discussion: The effectiveness of icatibant against sweating-induced dermal pain would provide clear evidence for the involvement of the bradykinin-bradykinin B2 receptor pathway in the pathogenesis of this condition. This finding may contribute to a better understanding of the underlying mechanisms of dermal pain associated with sweating stimuli and has the potential to improve patients’ quality of life by suggesting potential treatment options, specifically, using drugs that inhibit bradykinin or suppress its production.

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“…Histological analyses focus on pore obstruction, reduction in the number and atrophy of sweat glands, and surrounding inflammatory infiltration. [1,17–19]…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A single-blind, randomized, crossover study on the efficacy of icatibant for sweating-induced dermal pain (icatibant for sweating-induced dermal pain)

et al. 2023

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“…Finally, the subjective symptom of CholU is a feeling of stinging or tingling pain and/or itching during sweating. A recent study focusing on dermal pain triggered by sweating stimuli showed that ten of 30 patients with dermal pain triggered by sweating stimuli did not develop eruptions [ 69 ]. In other words, as there is a group of patients without eruptions that show subjective symptoms similar to those of CholU, this pathological condition should be differentiated.…”

Section: Diagnosis Of Cholumentioning

confidence: 99%

“…Omalizumab was shown to be effective in a patient with CholU-Anhd with atopic dermatitis [ 85 ]. Medications acting on nervous systems transiently attenuate dermal pain triggered by sweating stimuli including CholU-Anhd [ 69 ]. Takahagi et al reported that Ca 2+ channel α2δ ligands and anti-anxiety agents might be effective for dermal pain (response ratio, 33% and 60%) [ 69 ].…”

Section: Management Of and Therapeutic Approach To Cholumentioning

confidence: 99%

Cholinergic Urticaria: Subtype Classification and Clinical Approach

et al. 2022

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Cholinergic urticaria (CholU) is a subtype of chronic inducible urticaria with a chief complaint of itching and/or stinging, painful papular wheals that develop simultaneously with sweating. This review specifically focuses on several subtypes of CholU and specifically investigates the relationship between CholU and anhidrosis. We review recent publications and update the evidence around CholU, including the epidemiology, clinical features, diagnostic approaches, physiopathology, subtype classification, and therapeutic approaches. Multiple mechanisms contribute in a complex manner to the development of CholU, including histamine, sweat allergy, cholinergic-related substances, poral occlusion, and hypohidrosis/anhidrosis. A new schematic of the currently known pathological conditions has been created. Specific methods for diagnosing CholU, a provocation test, and evaluation methods for disease severity/activity and disease burden of CholU are summarized. The characteristics of the diseases that should be differentiated from CholU and examination methods are also summarized. The primary finding of this review is that CholU should be categorized based on the etiology and clinical characteristics of each subtype to properly manage and treat the disease. This categorization leads to improvement of therapeutic resistance status of this disease. In particular, a sweating abnormality should be given more attention when examining patients with CholU. Because CholU is not a homogeneous disease, its subtype classification is important for selection of the most suitable therapeutic method. Further elucidation of the pathophysiology of each subtype is expected.

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