Course and Predictors of Pruritus Following Burns: A Multilevel Analysis

Kwa, Kelly A.A.; Pijpe, Anouk; Rashaan, Z.M.; Tuinebreijer, W.E.; Breederveld, R.S.; Loey, Nancy E. Van

doi:10.2340/00015555-2935

Cited by 18 publications

(9 citation statements)

References 23 publications

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“…Higher PTS symptom levels were particularly associated with the chronic itch & pain profile. This is in line with studies showing a link between PTS symptoms and higher itch intensity (10,39). Possibly, PTS symptoms affect central processing, potentially decreasing the threshold for pain, and perhaps also for itch.…”

Section: Discussionsupporting

confidence: 92%

Role of burn severity and posttraumatic stress symptoms in the co-occurrence of itch and neuropathic pain after burns: A longitudinal study

et al. 2022

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Itch and pain are common after burns. Neuropathic mechanisms may underlie both modalities but remain not well-understood. This study aims to prospectively document neuropathic pain symptoms and to identify potential itch symptom profiles that differ regarding duration and co-occurrence with neuropathic pain which may inform underlying pathophysiological mechanisms and respond to different treatments. Adult burn survivors (n = 192) self-reported itch and neuropathic pain at 2 weeks post-discharge, 3, 6, 12, and 18 months post-burn. Based on the presence of itch and pain symptoms over time, participants were allocated to one itch profile: transient itch/pain, chronic itch, or chronic itch & pain. Profiles were compared on itch intensity over time using General Linear Modeling. Age, gender, burn severity, posttraumatic stress (PTS) symptoms and baseline itch intensity were examined as potential predictors of the profiles in a Multi-nominal regression analysis. Neuropathic pain occurred in 54% after discharge which decreased to 24% 18 months later. Itch intensity was highest in the chronic itch & pain profile. Compared to the transient itch profile, the chronic itch & pain profile was associated with higher burn severity and more PTS symptoms. Compared to the chronic itch profile, the chronic itch & pain profile was associated with more PTS symptoms. Findings suggest that biological and psycho-dermatological processes underlie both chronic neuropathic pain and itch processes in burn scars. Further research should elucidate the mechanisms underlying the different itch profiles, with specific focus on skin innervation and psychological factors.

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Section: Discussionsupporting

confidence: 92%

Role of burn severity and posttraumatic stress symptoms in the co-occurrence of itch and neuropathic pain after burns: A longitudinal study

et al. 2022

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“…The results of the current study indicate that there is no correlation between age and maximum itch intensity in sensitive skin. Kwa et al (33) and André et al (34) found no difference in age or sexes on itch intensity score. Bahali et al (35) reported no association between age and pruritus among patients with psoriasis, but a more prominent pruritus in females.…”

Section: Discussionmentioning

confidence: 94%

Characterization of Cowhage-induced Pruritus in Sensitive Skin: An Observational Laboratory Study

Zuo¹,

Jiang²,

Wan³

et al. 2021

Acta Derm Venereol

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Sensitive skin is a prevalent syndrome, characterized by discomfort in response to mild stimuli, which impacts on quality of life. Pruritus is one of the major symptoms of sensitive skin. However, the pathomechanism of sensitive skin is insufficiently understood. As an experimental model for pruritus, the cowhage skin prick test might provide insight into the understanding of sensitive skin. This study aimed to specify the characteristics of cowhage-induced pruritus in sensitive skin. Female volunteers, 20 with sensitive skin and 20 controls, were recruited. Self-report questionnaires were distributed and the responses evaluated; moreover, alongside assessments by dermatologists, skin physiology assessments, lactic acid sting test, capsaicin test and cowhage skin challenge were performed. Pruritus in sensitive skin was perceived as more intense and longer-lasting than in normal skin, with different qualities of accompanying sensations. Cowhage skin challenge results showed moderate consistency with clinical assessments. The results suggest that cowhage skin challenge could be a new tool for the assessment of sensitive skin.

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“…Pain, itch, abnormal pigmentation, and restricted range of motion due to contraction of burn scars are common problems that impair quality of life for burn survivors [2]. In particular, itch is considered a major problem that contributes significantly to reduced quality of life in burn survivors [4, 5]. Itch is present in most pediatric burn patients at the time of discharge and a majority still experience itching two years after injury [6]; similar trends have been reported in the adult burn population [7].…”

Section: Introductionmentioning

confidence: 99%

Identification of Merkel cells associated with neurons in engineered skin substitutes after grafting to full thickness wounds

et al. 2019

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Engineered skin substitutes (ESS), prepared using primary human fibroblasts and keratinocytes with a biopolymer scaffold, were shown to provide stable closure of excised burns, but relatively little is known about innervation of ESS after grafting. This study investigated innervation of ESS and, specifically, whether Merkel cells are present in healed grafts. Merkel cells are specialized neuroendocrine cells required for fine touch sensation in skin. We discovered cells positive for keratin 20 (KRT20), a general marker for Merkel cells, in the basal epidermis of ESS after transplantation to mice, suggesting the presence of Merkel cells. Cells expressing KRT20 were not observed in ESS in vitro . However, widely separated KRT20-positive cells were observed in basal epidermis of ESS by 2 weeks after grafting. By 4 weeks, these cells increased in number and expressed keratins 18 and 19, additional Merkel cells markers. Putative Merkel cell numbers increased further between weeks 6 and 14; their densities varied widely and no specific pattern of organization was observed, similar to Merkel cell localization in human skin. KRT20-positive cells co-expressed epidermal markers E-cadherin and keratin 15, suggesting derivation from the epidermal lineage, and neuroendocrine markers synaptophysin and chromogranin A, consistent with their identification as Merkel cells. By 4 weeks after grafting, some Merkel cells in engineered skin were associated with immature afferents expressing neurofilament-medium. By 8 weeks, Merkel cells were complexed with more mature neurons expressing neurofilament-heavy. Positive staining for human leukocyte antigen demonstrated that the Merkel cells in ESS were derived from grafted human cells. The results identify, for the first time, Merkel cell-neurite complexes in engineered skin in vivo . This suggests that fine touch sensation may be restored in ESS after grafting, although this must be confirmed with future functional studies.

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Course and Predictors of Pruritus Following Burns: A Multilevel Analysis

Cited by 18 publications

References 23 publications

Role of burn severity and posttraumatic stress symptoms in the co-occurrence of itch and neuropathic pain after burns: A longitudinal study

Role of burn severity and posttraumatic stress symptoms in the co-occurrence of itch and neuropathic pain after burns: A longitudinal study

Characterization of Cowhage-induced Pruritus in Sensitive Skin: An Observational Laboratory Study

Identification of Merkel cells associated with neurons in engineered skin substitutes after grafting to full thickness wounds

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