European Guideline on Chronic Pruritus

Abstract

effective for urticaria. Medications that modulate neurologic function, including gabapentin, are effective for recalcitrant pruritus and less sedating than oral antihistamines.2 Treatment of comorbid depression or anxiety can also improve the symptoms and burden of pruritus.Patients without a dermatologic, neurologic, or psychiatric cause for pruritus should be asked about the presence of fevers, chills, night sweats, and/or unintended weight loss, as well as undergoing a full review of systems to assess for localizing symptoms. Physical examination would include palpation of the lymph nodes, spleen, and liver. Testing for a metabolic or neoplastic source of pruritus should be considered for patients with chronic, generalized pruritus who lack a primary skin disease.3 Systemic evaluation of these patients can include malignant neoplasm and thyroid, renal, hepatic, and infectious diseases. 4 Thus, it is important to remember the association of chronic pruritus and internal systemic diseases but to limit screening to the patients without recognizable skin disease. LESS IS MORE Competing Mortality in Cancer Screening A Teachable Moment Story From the Front LinesA 70-year-old man saw his primary care clinician and ex pressed concern about his lung cancer risk after learning a friend had recently died of it. The patient had had an 80-pack-year history, and had quit 7 years previously. His physician ordered a screening chest computed tomographic (CT) scan, which demonstrated a spiculated 12-mm lung nodule that was new when compared with scans done previously for other reasons. This prompted a positron emission tomographic scan, which showed metabolic activity, raising the suspicion for lung cancer. He was referred to a pulmonary-nodule clinic. The man presented to the pulmonary clinic in a wheel chair while receiving continuous oxygen. His medical history revealed severe diastolic heart failure; chronic obstructive pulmonary disease; obesity (his body mass index, calculated as weight in kilograms divided by height in meters squared, was 54); diabetes mellitus with microvascular complications, including stage III chronic kidney disease; and peripheral neuropathy. Additional medical history included several recent falls attributed to progressive neuropathy and deconditioning. These considerations were discussed with the patient and ultimately, invasive diagnostic testing was discouraged. A conservative plan that included a repeated CT scan in 4 months was mutually agreed on. Two months after this visit, the patient was admitted and treated for pneumonia. While recovering in the hospital, his primary team noted that this nodule had not undergone workup and he had another CT scan, which demonstrated interval growth. He was scheduled for an outpatient CT-guided biopsy.Prior to the biopsy, the patient was rehospitalized for pneumonia, this time requiring intensive care unit admission. His medical history was addressed at a multidisciplinary thoracic tumor conference. He was not a surgical candidate, and attempts to biopsy...

Menthoxypropanediol inhibits nerve growth factor‐induced nerve fibre sprouting in coculture models of sensory neurons and skin cells

“…MPD inhibited neurite outgrowth of histamine-treated dermal fibroblasts as well as nerve fibre sprouting in innervated skin models, comprising atopic fibroblasts and normal keratinocytes, by reducing NGF expression. As elevated NGF levels and increased cutaneous nerve fibre density are associated with itch (3-5), these observations point to an antipruritic effect of MPD that is based not only on the activation of cold-sensing nerve fibres (6,7), but also on a modified crosstalk between nerve endings and skin cells. information tab for this article: Figure S1.…”

“…In AD, inflammation is related to an elevated skin cell-derived release of nerve growth factor (NGF), leading to an increased density of cutaneous C-fibres (3,4) that might be linked to pruritus (5). Cooling agents, such as menthol or icilin, suppress itch by activating transient receptor potential ion channel M8 (TRPM8) on cutaneous Ad fibres (6,7) and have therefore been used as an antipruritic treatment for many years (8). Additionally, TRPM8 activation has recently been shown to attenuate inflammatory responses in a mouse model of colitis (9).…”

Priority topics for European multidisciplinary guidelines on the management of chronic kidney disease in older adults

“…The group acknowledged the high prevalence of this symptom [21] and its importance to patients [22], but deemed it more appropriate to explore the applicability of existing non-renal guidelines [23], or develop pruritus management guidelines targeting CKD stage 3b-5 patients in general.…”

Chronic Itching Dermatosis in Children: Modern Methods of Treatment and Efficient Termination of Subjective Complaints

“…Зуд -это локализующееся, вызывающее стресс неприятное ощущение, приводящее к сильному жела-нию почесаться, к которому невозможно адаптиро-ваться [1]. ПАТОГЕНЕЗ Зуд -наиболее частый симптом, описанный в дер-матологии.…”

“…Существует множество опубликованных классифика-ций зуда, основанных на этиологии и клинической мор-фологии хронического зуда [1]. Международный форум изучения зуда (International Forum for Study of Itch, IFSI) предлагает классификацию, разделяющую пациентов с хроническим зудом на 3 группы на основании клини-ческих и отличительных диагностических признаков [4]:…”