Pruritus

2014 ◽  
Author(s):  
Hong-Liang Tey ◽  
Gil Yosipovitch ◽  
Jeffrey D Bernhard
Keyword(s):  
Treatment Options ◽  
Clinical Signs ◽  
Calcineurin Inhibitors ◽  
Clinical Findings ◽  
Screening Tests ◽  
Topical Calcineurin Inhibitors ◽  
Chronic Itch ◽  
Chronic Pruritus ◽  
Systemic Therapies

Pruritus, or itch, can be defined as a sensation that elicits the desire to scratch. Normal physiologic "acute" itch occurs daily and can usually be abolished by scratching the affected area. On the other hand, chronic itch (defined as itch that persists for 6 weeks or more) is often made worse by scratching and is associated with significant morbidity. The focus of this chapter is on chronic pruritus. Discussion includes causes, clinical evaluation, investigation of, and treatment for chronic pruritus. Tables cover the etiologic classification of chronic pruritus, a morphologic approach to typically pruritic dermatoses and their classic distribution (with illustrative images), systemic diseases and associated clinical signs, localized pruritus and underlying neuropathy, screening tests for pruritus, further investigations following results of clinical findings and screening tests, general measures for patients managing pruritus, topical treatment, topical calcineurin inhibitors, systemic therapies, recommended stepwise treatment options, and phototherapy. Also included are a patient history checklist, an algorithm outlining the approach to chronic pruritus, and images depicting various forms of pruritus. This review contains 16 highly rendered figures (including table images), 13 tables, and 41 references.

Pruritus

2014 ◽  
Author(s):  
Hong-Liang Tey ◽  
Gil Yosipovitch ◽  
Jeffrey D Bernhard
Keyword(s):  
Treatment Options ◽  
Clinical Signs ◽  
Calcineurin Inhibitors ◽  
Clinical Findings ◽  
Screening Tests ◽  
Topical Calcineurin Inhibitors ◽  
Chronic Itch ◽  
Chronic Pruritus ◽  
Systemic Therapies

Pruritus, or itch, can be defined as a sensation that elicits the desire to scratch. Normal physiologic "acute" itch occurs daily and can usually be abolished by scratching the affected area. On the other hand, chronic itch (defined as itch that persists for 6 weeks or more) is often made worse by scratching and is associated with significant morbidity. The focus of this chapter is on chronic pruritus. Discussion includes causes, clinical evaluation, investigation of, and treatment for chronic pruritus. Tables cover the etiologic classification of chronic pruritus, a morphologic approach to typically pruritic dermatoses and their classic distribution (with illustrative images), systemic diseases and associated clinical signs, localized pruritus and underlying neuropathy, screening tests for pruritus, further investigations following results of clinical findings and screening tests, general measures for patients managing pruritus, topical treatment, topical calcineurin inhibitors, systemic therapies, recommended stepwise treatment options, and phototherapy. Also included are a patient history checklist, an algorithm outlining the approach to chronic pruritus, and images depicting various forms of pruritus. This review contains 16 highly rendered figures (including table images), 13 tables, and 41 references.

scholarly journals Breaking the Itch–Scratch Cycle: Topical Options for the Management of Chronic Cutaneous Itch in Atopic Dermatitis

Medicines ◽  
2019 ◽  
Vol 6 (3) ◽  
pp. 76 ◽  
Author(s):  
Ian P. Harrison ◽  
Fabrizio Spada
Keyword(s):  
Atopic Dermatitis ◽  
Treatment Options ◽  
Calcineurin Inhibitors ◽  
Cost Of Treatment ◽  
Topical Calcineurin Inhibitors ◽  
Chronic Itch ◽  
Itch Sensation ◽  
Chronic Pruritus

Chronic itch is an unpleasant sensation that triggers a desire to scratch that lasts for six weeks or more. It is a major diagnostic symptom of myriad diseases, including atopic dermatitis for which it is the most prominent feature. Chronic itch can be hugely debilitating for the sufferer, damaging in terms of both the monetary cost of treatment and its socioeconomic effects, and few treatment options exist that can adequately control it. Corticosteroids remain the first line treatment strategy for atopic dermatitis, but due to the risks associated with long-term use of corticosteroids, and the drawbacks of other topical options such as topical calcineurin inhibitors and capsaicin, topical options for itch management that are efficacious and can be used indefinitely are needed. In this review, we detail the pathophysiology of chronic pruritus, its key features, and the disease most commonly associated with it. We also assess the role of the skin and its components in maintaining a healthy barrier function, thus reducing dryness and the itch sensation. Lastly, we briefly detail examples of topical options for the management of chronic pruritus that can be used indefinitely, overcoming the risk associated with long-term use of corticosteroids.

scholarly journals Atopic Dermatitis: Drug Delivery (Management) and Approaches (Strategies) in Perspective

2018 ◽  
Vol 54 (02) ◽  
pp. 078-089
Author(s):  
Virendra N. Sehgal
Keyword(s):  
Drug Delivery ◽  
Atopic Dermatitis ◽  
Treatment Options ◽  
Calcineurin Inhibitors ◽  
Cutaneous Manifestations ◽  
Topical Calcineurin Inhibitors ◽  
Systemic Corticosteroids ◽  
Age Related ◽  
Management Approaches ◽  
Minor Criteria

ABSTRACTAge-related cutaneous manifestations are definitive pointer to the diagnosis of atopic dermatitis, the confirmation of which is solicited by 3 major and 3 minor criteria. Its unpredictable course is punctuated by exacerbations and remissions. Several treatment options, namely: 1st, 2nd and 3rd line are in vogue ever since. The 1st line envisages general measures, 2nd encompasses topical applications, while the 3rd take into account drug therapy comprising, systemic Corticosteroids, Cyclosporin, Azathioprine, Thymopentin, Interferon–therapy, Topical Calcineurin inhibitors: Tacrolimus and Pimecrolimus. The mode of action, their dosages and adverse drug reaction (ADR), in particular, have been focused in this paper with special attention to refresh their drug delivery (management) approaches (strategies) in perspective. An endeavor to focus attention to emerging etio-pathogenesis, and its application in the contemporary context has also been made.

Evidence Review of Topical Calcineurin Inhibitors for the Treatment of Adult Atopic Dermatitis

2019 ◽  
Vol 23 (4_suppl) ◽  
pp. 5S-10S ◽  
Author(s):  
Chih-ho Hong ◽  
Melinda Gooderham ◽  
Robert Bissonnette
Keyword(s):  
Atopic Dermatitis ◽  
Treatment Options ◽  
Calcineurin Inhibitors ◽  
Term Treatment ◽  
Effective Treatment Option ◽  
Short Term Treatment ◽  
Topical Calcineurin Inhibitors ◽  
Recommended Treatment ◽  
The Face ◽  
Contemporary Management

Topical calcineurin inhibitors (TCIs) were approved in the early 2000s for the treatment of atopic dermatitis (AD), and despite the recent introduction of newer topical and systemic therapies for AD, TCIs such as tacrolimus ointment (0.03% and 0.1%) and pimecrolimus cream (1%), remain recommended treatment options in contemporary management guidelines. The goal of this article is to review the evidence supporting the approved indications for TCIs in adults with AD, including short-term treatment of active disease and as intermittent or maintenance treatment for the prevention of flares. Other evidence reviewed in this article includes the treatment of specific body areas (such as the face and eyelids), combination or sequential use of TCIs with topical corticosteroids, and the comparative efficacy of the 2 commercially available TCIs. This review of the evidence confirms that TCIs remain an effective treatment option for the management of adult AD.

Topical Treatment of Mild to Moderate Psoriasis

2010 ◽  
Vol 16a (2) ◽  
pp. 17-25
Author(s):  
Daniel Gold ◽  
Saad I. Almohizea
Keyword(s):  
Vitamin D ◽  
Salicylic Acid ◽  
Topical Treatment ◽  
Coal Tar ◽  
Calcineurin Inhibitors ◽  
Vitamin D Analogs ◽  
Topical Calcineurin Inhibitors ◽  
Systemic Therapies

Topical therapies are used by most psoriasis patients either alone or in combination with systemic therapies and phototherapy. The objective of this paper is to review the different topical therapies to treat mild to moderate psoriasis, including corticosteroids, vitamin D analogs, tazarotene, topical calcineurin inhibitors, anthralin, salicylic acid, and coal tar and assess their effectiveness and tolerability. Topical therapies are important for treating psoriasis and will continue to play a major role even as new systemic therapies emerge.

Therapy-related issues: skin

2017 ◽  
Author(s):  
Philip Wiffen ◽  
Marc Mitchell ◽  
Melanie Snelling ◽  
Nicola Stoner
Keyword(s):  
Wound Care ◽  
Coal Tar ◽  
Calcineurin Inhibitors ◽  
Wound Dressings ◽  
Topical Calcineurin Inhibitors ◽  
Topical Antimicrobials ◽  
Skin Conditions ◽  
Selection Of

This chapter outlines information relevant to pharmacists and other healthcare professionals related to selected skin conditions. The review of wound care includes classification of wounds, selection of wound dressings, and a discussion of other wound care products and practices including topical antimicrobials, honey, larval therapy, and vacuum-assisted closure. Management of eczema covers the use of emollients, corticosteroids, and topical calcineurin inhibitors. The different treatments available to treat psoriasis are discussed, ranging from older agents such as coal tar to the role of biologics.

Feline comorbidities: Recognition, diagnosis and management of the cushingoid diabetic

2021 ◽  
Vol 23 (1) ◽  
pp. 4-16
Author(s):  
Audrey K Cook ◽  
Jeremy B Evans
Keyword(s):  
Insulin Resistance ◽  
Treatment Options ◽  
Clinical Signs ◽  
Evidence Base ◽  
Clinical Findings ◽  
Cell Dysfunction ◽  
Insulin Requirements ◽  
Insulin Dependence ◽  
Process Failure ◽  
Ongoing Assessment

Practical relevance: Diabetes mellitus (DM) is a common feline endocrinopathy, and is often driven by underlying insulin resistance with associated pancreatic beta (β)-cell dysfunction. Although spontaneous hyperadrenocorticism (HAC) with hypercortisolemia (hypercortisolism) is relatively uncommon in cats, it is a well-established cause of insulin resistance and is routinely associated with DM in this species. Clinical challenges: Many of the clinical signs associated with feline HAC are subtle and may be attributed to concurrent DM or the aging process. Failure to recognize HAC in the diabetic cat can impact patient wellbeing and predispose the patient to progressive compromise. Unfortunately, it can be difficult to establish a diagnosis of HAC, as test results may be influenced by poor diabetic regulation, and protocols are different to those used in canine patients. Treatment options depend on the underlying cause, and often require careful, ongoing assessment and modulation of both adrenal function and insulin requirements. However, various approaches have been shown to either improve glycemic control in cats with sustained insulin dependence, or facilitate diabetic remission. Evidence base: This review summarizes the current literature on feline HAC, with a particular focus on cats with concurrent DM. The clinical findings that suggest HAC are discussed, along with an outline of diagnostic options and their limitations. Published outcomes for various medical options, surgical procedures and radiation therapy are provided. The authors also share their thoughts on the safe and effective management of cats with HAC and DM, with an emphasis on the anticipation and recognition of changing insulin requirements.

Vitiligo: An Updated Narrative Review

2020 ◽  
Vol 16 ◽  
Author(s):  
Alexander K. C. Leung ◽  
Joseph M. Lam ◽  
Kin Fon Leong ◽  
Kam Lun Hon
Keyword(s):  
Present Article ◽  
English Literature ◽  
Disease Onset ◽  
Clinical Manifestations ◽  
Calcineurin Inhibitors ◽  
Ultraviolet B ◽  
Lower Limbs ◽  
Treatment Modalities ◽  
Topical Corticosteroids ◽  
Topical Calcineurin Inhibitors

Background: Vitiligo is a relatively common acquired pigmentation disorder that can cause significant psychological stress and stigmatism. Objective: This article aims to familiarize physicians with the clinical manifestations, evaluation, diagnosis, and management of vitiligo. Methods: A Pubmed search was conducted in Clinical Queries using the key term "vitiligo". The search included metaanalyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to the English literature. The information retrieved from the above search was used in the compilation of the present article. The information retrieved from the above search was used in the compilation of the present article. Results: Approximately one quarter of patients with vitiligo have the onset before 10 years of age. Genetic, immunological, neurogenic and environmental factors may have a role to play in the pathogenesis. Vitiligo typically presents as acquired depigmented, well-demarcated macules/patches that appear milk- or chalk-white in color. Lesions tend to increase in number and enlarge centrifugally in size with time. Sites of predilection include the face, followed by the neck, lower limbs, trunk, and upper limbs. The clinical course is generally unpredictable. In children with fair skin, no active treatment is usually necessary other than the use of sunscreens and camouflage cosmetics. If treatment is preferred for cosmesis, topical corticosteroids, topical calcineurin inhibitors, and narrowband ultraviolet B phototherapy are the mainstays of treatment. Conclusion: The therapeutic effect of all the treatment modalities varies considerably from individual to individual. As such, treatment must be individualized. In general, the best treatment response is seen in younger patients, recent disease onset, darker skin types, and head and neck lesions. Topical corticosteroids and calcineurin inhibitors are the treatment of choice for those with localized disease. Topical calcineurin inhibitors are generally preferred for lesions on genitalia, intertriginous areas, face, and neck. Narrowband ultraviolet B phototherapy should be considered in patients who have widespread vitiligo or those with localized vitiligo associated with a significant impact on the quality of life who do not respond to treatment with topical corticosteroids and calcineurin inhibitors.

Sign in / Sign up

Export Citation Format

Share Document