2018-2019 Annual Report to Membership
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European Guideline Chronic Pruritus Final Version
EDF-Guidelines for Chronic Pruritus In cooperation with the European Academy of Dermatology and Venereology (EADV) and the Union Européenne des Médecins Spécialistes (UEMS) E Weisshaar1, JC Szepietowski2, U Darsow3, L Misery4, J Wallengren5, T Mettang6, U Gieler7, T Lotti8, J Lambert9, P Maisel10, M Streit11, M Greaves12, A Carmichael13, E Tschachler14, J Ring3, S Ständer15 University Hospital Heidelberg, Clinical Social Medicine, Environmental and Occupational Dermatology, Germany1, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Poland2, Department of Dermatology and Allergy Biederstein, Technical University Munich, Germany3, Department of Dermatology, University Hospital Brest, France4, Department of Dermatology, Lund University, Sweden5, German Clinic for Diagnostics, Nephrology, Wiesbaden, Germany6, Department of Psychosomatic Dermatology, Clinic for Psychosomatic Medicine, University of Giessen, Germany7, Department of Dermatology, University of Florence, Italy8, Department of Dermatology, University of Antwerpen, Belgium9, Department of General Medicine, University Hospital Muenster, Germany10, Department of Dermatology, Kantonsspital Aarau, Switzerland11, Department of Dermatology, St. Thomas Hospital Lambeth, London, UK12, Department of Dermatology, James Cook University Hospital Middlesbrough, UK13, Department of Dermatology, Medical University Vienna, Austria14, Department of Dermatology, Competence Center for Pruritus, University Hospital Muenster, Germany15 Corresponding author: Elke Weisshaar -
Pruritus: Scratching the Surface
Pruritus: Scratching the surface Iris Ale, MD Director Allergy Unit, University Hospital Professor of Dermatology Republic University, Uruguay Member of the ICDRG ITCH • defined as an “unpleasant sensation of the skin leading to the desire to scratch” -- Samuel Hafenreffer (1660) • The definition offered by the German physician Samuel Hafenreffer in 1660 has yet to be improved upon. • However, it turns out that itch is, indeed, inseparable from the desire to scratch. Savin JA. How should we define itching? J Am Acad Dermatol. 1998;39(2 Pt 1):268-9. Pruritus • “Scratching is one of nature’s sweetest gratifications, and the one nearest to hand….” -- Michel de Montaigne (1553) “…..But repentance follows too annoyingly close at its heels.” The Essays of Montaigne Itch has been ranked, by scientific and artistic observers alike, among the most distressing physical sensations one can experience: In Dante’s Inferno, falsifiers were punished by “the burning rage / of fierce itching that nothing could relieve” Pruritus and body defence • Pruritus fulfils an essential part of the innate defence mechanism of the body. • Next to pain, itch may serve as an alarm system to remove possibly damaging or harming substances from the skin. • Itch, and the accompanying scratch reflex, evolved in order to protect us from such dangers as malaria, yellow fever, and dengue, transmitted by mosquitoes, typhus-bearing lice, plague-bearing fleas • However, chronic itch lost this function. Chronic Pruritus • Chronic pruritus is a common and distressing symptom, that is associated with a variety of skin conditions and systemic diseases • It usually has a dramatic impact on the quality of life of the affected individuals Chronic Pruritus • Despite being the major symptom associated with skin disease, our understanding of the pathogenesis of most types of itch is limited, and current therapies are often inadequate. -
Update of the Guideline on Chronic Pruritus
Update of the Guideline on Chronic Pruritus Developed by the Guideline Subcommittee “Chronic Pruritus” of the European Dermatology Forum Subcommittee Members: Prof. Dr. Elke Weisshaar, Heidelberg (Germany) Prof. Dr. Sonja Ständer, Münster (Germany) Prof. Dr. Erwin Tschachler, Wien (Austria) Prof. Dr. Torello Lotti, Florence (Italy) Prof. Dr. Johannes Ring, Munich (Germany) Prof. Dr. Laurent Misery, Brest (France) Dr. Markus Streit, Aarau (Switzerland) Prof. Dr. Thomas Mettang, Wiesbaden (Germany) Prof. Dr. Jacek Szepietowski, Wroclaw (Poland) Prof. Dr. Joanna Wallengren, Lund (Sweden) Dr. Peter Maisel, Münster (Germany) Prof. Dr. Uwe Gieler, Gießen (Germany) Prof. Dr. Malcolm Greaves (Singapore) Prof. Dr. Ulf Darsow, Munich (Germany) Prof. Dr. Julien Lambert, Antwerp (Belgium) Members of EDF Guideline Committee: Prof. Dr. Werner Aberer, Graz (Austria) Prof. Dr. Dieter Metze, Münster (Germany) Prof. Dr. Martine Bagot, Paris (France) Dr. Kai Munte, Rotterdam (Netherlands) Prof. Dr. Nicole Basset-Seguin, Paris (France) Prof. Dr. Gilian Murphy, Dublin (Ireland) Prof. Dr. Ulrike Blume-Peytavi, Berlin (Germany) Prof. Dr. Martino Neumann, Rotterdam (Netherlands) Prof. Dr. Lasse Braathen, Bern (Switzerland) Prof. Dr. Tony Ormerod, Aberdeen (UK) Prof. Dr. Sergio Chimenti, Rome (Italy) Prof. Dr. Mauro Picardo, Rome (Italy) Prof. Dr. Alexander Enk, Heidelberg (Germany) Prof. Dr. Johannes Ring, Munich (Germany) Prof. Dr. Claudio Feliciani, Rome (Italy) Prof. Dr. Annamari Ranki, Helsinki (Finland) Prof. Dr. Claus Garbe, Tübingen (Germany) Prof. Dr. Berthold Rzany, Berlin (Germany) Prof. Dr. Harald Gollnick, Magdeburg (Germany) Prof. Dr. Rudolf Stadler, Minden (Germany) Prof. Dr. Gerd Gross, Rostock (Germany) Prof. Dr. Sonja Ständer, Münster (Germany) Prof. Dr. Vladimir Hegyi, Bratislava (Slovakia) Prof. Dr. Eggert Stockfleth, Berlin (Germany) Prof. Dr. -
Pathophysiology and Treatment of Pruritus in Elderly
International Journal of Molecular Sciences Review Pathophysiology and Treatment of Pruritus in Elderly Bo Young Chung † , Ji Young Um †, Jin Cheol Kim , Seok Young Kang , Chun Wook Park and Hye One Kim * Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University, Seoul KS013, Korea; [email protected] (B.Y.C.); [email protected] (J.Y.U.); [email protected] (J.C.K.); [email protected] (S.Y.K.); [email protected] (C.W.P.) * Correspondence: [email protected] † These authors contributed equally to this work. Abstract: Pruritus is a relatively common symptom that anyone can experience at any point in their life and is more common in the elderly. Pruritus in elderly can be defined as chronic pruritus in a person over 65 years old. The pathophysiology of pruritus in elderly is still unclear, and the quality of life is reduced. Generally, itch can be clinically classified into six types: Itch caused by systemic diseases, itch caused by skin diseases, neuropathic pruritus, psychogenic pruritus, pruritus with multiple factors, and from unknown causes. Senile pruritus can be defined as a chronic pruritus of unknown origin in elderly people. Various neuronal mediators, signaling mechanisms at neuronal terminals, central and peripheral neurotransmission pathways, and neuronal sensitizations are included in the processes causing itch. A variety of therapies are used and several novel drugs are being developed to relieve itch, including systemic and topical treatments. Keywords: elderly; ion channel; itch; neurotransmission pathophysiology of itch; pruritogen; senile pruritus; treatment of itch 1. Introduction Citation: Chung, B.Y.; Um, J.Y.; Kim, Pruritus is a relatively common symptom that anyone can experience at any point in J.C.; Kang, S.Y.; Park, C.W.; Kim, H.O. -
Copyrighted Material
1 Index Note: Page numbers in italics refer to figures, those in bold refer to tables and boxes. References are to pages within chapters, thus 58.10 is page 10 of Chapter 58. A definition 87.2 congenital ichthyoses 65.38–9 differential diagnosis 90.62 A fibres 85.1, 85.2 dermatomyositis association 88.21 discoid lupus erythematosus occupational 90.56–9 α-adrenoceptor agonists 106.8 differential diagnosis 87.5 treatment 89.41 chemical origin 130.10–12 abacavir disease course 87.5 hand eczema treatment 39.18 clinical features 90.58 drug eruptions 31.18 drug-induced 87.4 hidradenitis suppurativa management definition 90.56 HLA allele association 12.5 endocrine disorder skin signs 149.10, 92.10 differential diagnosis 90.57 hypersensitivity 119.6 149.11 keratitis–ichthyosis–deafness syndrome epidemiology 90.58 pharmacological hypersensitivity 31.10– epidemiology 87.3 treatment 65.32 investigations 90.58–9 11 familial 87.4 keratoacanthoma treatment 142.36 management 90.59 ABCA12 gene mutations 65.7 familial partial lipodystrophy neutral lipid storage disease with papular elastorrhexis differential ABCC6 gene mutations 72.27, 72.30 association 74.2 ichthyosis treatment 65.33 diagnosis 96.30 ABCC11 gene mutations 94.16 generalized 87.4 pityriasis rubra pilaris treatment 36.5, penile 111.19 abdominal wall, lymphoedema 105.20–1 genital 111.27 36.6 photodynamic therapy 22.7 ABHD5 gene mutations 65.32 HIV infection 31.12 psoriasis pomade 90.17 abrasions, sports injuries 123.16 investigations 87.5 generalized pustular 35.37 prepubertal 90.59–64 Abrikossoff -
Neuropathic Itch
cells Review Neuropathic Itch James Meixiong 1, Xinzhong Dong 2,3 and Hao-Jui Weng 4,5,* 1 Solomon H. Snyder Department of Neuroscience and Medical Scientist Training Program, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; [email protected] 2 Solomon H. Snyder Department of Neuroscience, Department of Dermatology, and Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; [email protected] 3 Howard Hughes Medical Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA 4 Department of Dermatology, Taipei Medical University-Shuang Ho Hospital, New Taipei City 23561, Taiwan 5 Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan * Correspondence: [email protected] Received: 23 September 2020; Accepted: 8 October 2020; Published: 9 October 2020 Abstract: Neurologic insults as varied as inflammation, stroke, and fibromyalgia elicit neuropathic pain and itch. Noxious sensation results when aberrantly increased afferent signaling reaches percept-forming cortical neurons and can occur due to increased sensory signaling, decreased inhibitory signaling, or a combination of both processes. To treat these symptoms, detailed knowledge of sensory transmission, from innervated end organ to cortex, is required. Molecular, genetic, and behavioral dissection of itch in animals and patients has improved understanding of the receptors, cells, and circuits involved. In this review, we will discuss neuropathic itch with a focus on the itch-specific circuit. Keywords: pruritus; neuropathy; inflammation 1. Introduction Both microscopic damage, such as small-fiber neuropathy, and macroscopic trauma such as that occurring from spinal cord transection can result in neuropathic pain or itch [1]. -
Brachioradial Pruritus, Notalgia Paresthetica, Post-Herpetic Neuralgia, Vulvodynia, Small Fiber Neuropathy
Pruritus in the ElDerly "Help, I Think I'm Going Crazy!": An approach to pruritus in the elderly Dr. Danielle Mintsoulis MD PGY2 [FM] Western University Dr. Saadia Hameed MBBS MClSc[FM] CFPC DipPDerm Associate Professor Dept. of FM Western University Indigenous Land Acknowledgement • We wish to acknowledge the Ancestral Traditional Territories of the Ojibway, the Anishnabe and, in particular, the Mississauga’s of the New Credit whose territory we are gathered on today. This territory is covered by the Upper Canada Treaties. Presenter Disclosure • Presenters: Dr. Danielle Mintsoulis and Dr. Saadia Hameed • Relationships with financial sponsors: none to declare – Grants/Research Support: None – Speakers Bureau/Honoraria: None – Consul8ng Fees: None – Patents: None – Other: None Pruritus in the Elderly Objectives At the conclusion of this session, participants will be able to: • Perform an initial evaluation (history, physical examination, investigations) to determine the underlying etiology of pruritus. • Describe the common dermatological and non-dermatological differential diagnoses of the elderly patient with pruritus. • Implement non-pharmacological and applicable pharmacological treatments for the management of pruritus. Pruritus in the Elderly Neurobiology of Pruritus What is pruritus or itch? Pruritus in the Elderly Pruritus Pruritus in the Elderly Title Here Pruritus in the Elderly Akihiko Ikoma et al. Neuroscience 2006 Chronic Itch Pruritus lasting more than 6 weeks Is pruritus a problem? Pruritus and QOL ● Most common skin disorder in the elderly ● Worldwide prevalence of 7.3 to 37.5% ● ⅔ rd of geriatric pa1ents reported pruritus as their major skin complaint ● Patients with chronic pruritus are often sleep deprived ● 11.5% of hospital admissions in elderly pa1ents ● Effect on QOL comparable to that of chronic pain or dialysis ● Recent study: Pruritus ~ visual analogue pain scale 6 in geriatric par1cipants Kenneth R. -
A Deep Learning System for Differential Diagnosis of Skin Diseases
A deep learning system for differential diagnosis of skin diseases 1 1 1 1 1 1,2 † Yuan Liu , Ayush Jain , Clara Eng , David H. Way , Kang Lee , Peggy Bui , Kimberly Kanada , ‡ 1 1 1 Guilherme de Oliveira Marinho , Jessica Gallegos , Sara Gabriele , Vishakha Gupta , Nalini 1,3,§ 1 4 1 1 Singh , Vivek Natarajan , Rainer Hofmann-Wellenhof , Greg S. Corrado , Lily H. Peng , Dale 1 1 † 1, 1, 1, R. Webster , Dennis Ai , Susan Huang , Yun Liu * , R. Carter Dunn * *, David Coz * * Affiliations: 1 G oogle Health, Palo Alto, CA, USA 2 U niversity of California, San Francisco, CA, USA 3 M assachusetts Institute of Technology, Cambridge, MA, USA 4 M edical University of Graz, Graz, Austria † W ork done at Google Health via Advanced Clinical. ‡ W ork done at Google Health via Adecco Staffing. § W ork done at Google Health. *Corresponding author: [email protected] **These authors contributed equally to this work. Abstract Skin and subcutaneous conditions affect an estimated 1.9 billion people at any given time and remain the fourth leading cause of non-fatal disease burden worldwide. Access to dermatology care is limited due to a shortage of dermatologists, causing long wait times and leading patients to seek dermatologic care from general practitioners. However, the diagnostic accuracy of general practitioners has been reported to be only 0.24-0.70 (compared to 0.77-0.96 for dermatologists), resulting in over- and under-referrals, delays in care, and errors in diagnosis and treatment. In this paper, we developed a deep learning system (DLS) to provide a differential diagnosis of skin conditions for clinical cases (skin photographs and associated medical histories). -
Brachioradial Pruritus and Notalgia Paresthetica
Jacek Szepietowski and Joanna Berny-Moreno Serbian Journal of Dermatology and Venereology 2009; 2: 68-72 Brachioradial pruritus and notalgia paresthetica DOI: 10.2478/v10249-011-0006-z Neuropathic itch caused by nerve root compression: brachioradial pruritus and notalgia paresthetica Joanna BERNY-MORENO1, Jacek C. SZEPIETOWSKI 1,2 1 Department of Dermatology, Venereology and Allergology, Wroclaw, University of Medicine, Poland 2 Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland *Correspondence: Jacek C. SZEPIETOWSKI, E-mail: [email protected] UDC 616.515-009 Abstract Neuropathic itch (itching or pruritus) arises from a pathology located at any point along the afferent pathway of the nervous system. It may be related to damage to the peripheral nervous system, such as in postherpetic neuropathy, brachioradial pruritus or notalgia paresthetica. It has many clinical features similar to neuropathic pain. Patients complain of itching, which is associated with burning sensation, aching, and stinging. Brachioradial pruritis (BP) is an intense itching sensation of the arm, usually between the shoulder and elbow of one or both arms. It is an enigmatic condition with a controversial etiology; some authors consider BP to be a photodermatosis, whereas other authors attribute BP to compression of cervical nerve roots. Notalgia paresthetica is an isolated mononeuropathy involving the skin over or near the scapula. Patients have a pruritus on the mid-upper back. The treatment is usually difficult, but capsaicin and local analgesic agents are the options of choice. Brachioradial pruritus and notalgia paresthetica are often unrecognized neurocutaneous conditions and therefore, a thorough history and physical examination are of utmost importance to distinguish symptoms and apply accurate therapeutic options. -
50 Practical Dermatology December 2008 Lucocorticosteroids Are a Mainstay in the Dermatol- Side Effects
50 Practical Dermatology December 2008 lucocorticosteroids are a mainstay in the dermatol- side effects. However, menstrual irregularities often occur in ogist’s armamentarium. In fact, almost 90 percent premenopausal women who are not on anovulatory drugs. of dermatologists responding to a survey of the San This has been shown to be a result of suppression of cyclical Francisco Dermatologic Society in 1974 indicated gonadotrophins, leading to decreased estrogen and markedly Gthey used long-acting parenteral corticosteroids in low levels of progesterone.1 their practice, mostly the acetonide salt of triamcinolone Endometrial biopsies from such women show proliferative (TAC-A1). Despite the age of the survey, findings likely still changes, and spotting is believed to be due to low-estrogen reflect practice, as no reliable alternatives to glucocorticos- shedding. These occurrences are unique to TAC-A. Other teroids have emerged for the most common dermatologic injectables, such as betamethasone, methylprednisolone and indications. triamcinolone diacetate, do not have this effect and may be substituted but are less effective with much shorter durations TAC-A in the Clinic of action. Despite its popularity and its general safety and tolerability, Another predictable effect of TAC-A is suppression of the triamcinolone acetonide is associated with potential short- hypophyseal-pituitary-adrenal (HPA) axis. In studies of the comings. TAC-A is a suspension and must be shaken vigor- axis in patients treated with very high doses of TAC-A, there ously prior to injection. “Clumping” renders the product less remains some production of cortisol by the adrenals, and this effective, and irreversible clumping will occur with freezing. -
Voss Atopic Dermatitis and Itch
DISCLOSURES 2018 MOAPA Primary Care Update Conference ATOPIC This speaker has no disclosures to Susan T. Voss DNP, DERMATITIS declare FNP-BC, DCNP, FAANP & ITCH Riverside Dermatology OBJECTIVES ATOPIC DERMATITIS Atopic Dermatitis Itch/Pruritus ▪ Atopic dermatitis (AD) is a chronic, pruritic inflammatory skin disease of unknown origin ▪ Describe the pathophysiology of ▪ Define itch/pruritus ▪ Commonly referred to as eczema AD ▪ Describe the pathophysiology of ▪ Usually starts in early infancy. ▪ Discuss the presentation and itch ▪ In US impacts 10-12% of children diagnostic workup ▪ List/Describe the etiological ▪ Present treatment options classifications of chronic pruritus ▪ Affects a substantial number of adults. ▪ In US 0.9% ▪ Present an algorithm for assessment of itch ▪ AD is commonly associated with elevated levels of immunoglobulin ▪ Discuss pharmacologic and E (IgE). nonpharmacologic treatment options ATOPIC DERMATITIS: ATOPIC DERMATITIS: PATHOPHYSIOLOGY PATHOPHYSIOLOGY ▪Atopic dermatitis arises because of a complex Two main hypotheses have been proposed regarding the interaction of genetic and environmental development of inflammation that leads to AD. factors. ▪The first suggests a primary immune dysfunction resulting in IgE sensitization, allergic inflammation, and a secondary ▪These include defects in skin barrier function epithelial barrier disturbance. making the skin more susceptible to irritation ▪The second proposes a primary defect in the epithelial barrier by soap and other contact irritants, the leading to secondary -
Healthcare Bulletin
Happy New Year 2003 JANUARY 2003 VOL 11 NO 1 ISSN 1681-5552 healthcare bulletin ◆ Common Dermatological Disorders ◆ Eczema ◆ Pruritus ◆ Urticaria ◆ Product Profile: Oni® ◆ Glimpse of MSD Activities 2002 ◆ SQUARE in International Business ◆ Medical Updates Published as a service to medical professionals by JANUARY 2003 VOL 11 NO 1 IN THIS ISSUE: Common Dermatological Disorders ... Page 1 Eczema ... Page 3 Pruritus ... Page 7 Urticaria ... Page 12 Product Profile: Oni® ... Page 16 Glimpse of MSD Activities 2002 ... Page 17 From the Desk of Managing Editor SQUARE in International Business ... Page 19 Dear Doctor: Medical Updates ... Page 20 "! You have already noticed Greetings everyone and Happythe New SQUARE Year! Welcome to this edition of " the new look of this issue! We have updated our design to make it more enjoyable for you. Our vision and determination is to give you the most accurate, " is "Dermatology" special and includes reliable andthe easy SQUARE to understand health information every time. This “the SQUARE” issue of " updated information on common dermatological disorders, Managing Editor pruritus, eczema, urticaria. Besides, our regular features comprise, Omar Akramur Rab MBBS, FCGP, FIAGP, FRSH medical updates, product profile and others. Executive Editor We welcome your suggestions and comments to help us provide Latifa Nishat the highest quality and most useful service. In addition we MBBS appreciate all of the comments and feedback we have received Members of the Editorial Board from those who have taken the time to write. Muhammadul Haque We believe you will enjoy reading this publication and that MBA hope and A. H. Mahbub Alam the contents provided will prove helpful towardsSQUARE your goal of M Pharm, PhD optimum health! Shaokat Zaman MBBS We, on behalf of the management of Information Assistance pray that you have a safe and healthy life throughout all of Md.