scholarly journals The Role of Psychiatric, Analgesic, and Antiepileptic Medications in Chronic Pruritus

Cureus ◽  
2021 ◽  
Author(s):  
Parth Patel ◽  
Keshav Patel ◽  
Karan Pandher ◽  
Ruqiya Shama Tareen
Keyword(s):  
Chronic Pruritus ◽  
Antiepileptic Medications

Chronic Pruritus Associated with Helicobacter Pylori

2002 ◽  
Vol 6 (2) ◽  
pp. 103-108
Author(s):  
Roshini Kandyil ◽  
Nadia S. Satya ◽  
Robert A. Swerlick
Keyword(s):  
Helicobacter Pylori ◽  
Antibiotic Therapy ◽  
Breath Test ◽  
Urea Breath Test ◽  
Complete Relief ◽  
Active Infection ◽  
Temporary Relief ◽  
Chronic Pruritus ◽  
H Pylori

Background: Helicobacter pylori is an established cause of gastritis and has been implicated in extradigestive diseases. Objective: To investigate the role of H. pylori in patients with unexplained refractory pruritus. Methods: Ten patients with severe pruritus unresponsive to conventional therapy were evaluated for active H. pylori infection by H. pylori serology followed by either esophagogastroduodenoscopy (EGD) or urea breath test. Of the 10 patients, 8 were found to have active infection. All 10 received anti- H. pylori antibiotic therapy and were reevaluated for relief of pruritus. Results: Of 8 patients with active H. pylori infection, 87.5% (7/8) had some type of pruritus relief after triple therapy. Of these, 62.5% (5/8) had complete relief and 25% (2/8) had temporary relief of pruritus. The remaining 12.5% (1/8) did not respond. Two control patients without active H. pylori infection had no relief of pruritus with therapy. Conclusions: We have identified a population of patients with refractory pruritus and active H. pylori infection whose pruritus resolved after eradication of H. pylori.

Antihistamines in the Treatment of Atopic Dermatitis

2003 ◽  
Vol 7 (6) ◽  
pp. 467-473 ◽  
Author(s):  
Sari M. Herman ◽  
Ronald B. Vender
Keyword(s):  
Atopic Dermatitis ◽  
Medline Search ◽  
Conventional Management ◽  
Search Terms ◽  
Early Evidence ◽  
Cell Release ◽  
Inflammatory Skin Disorder ◽  
Chronic Pruritus ◽  
Enhance Patient Care

Background: Atopic dermatitis (AD) is an inflammatory skin disorder that is exceedingly challenging to treat. A prominent feature of AD is chronic pruritus. Early evidence suggested that pruritus in AD was partially due to mast cell release of histamine. Conversely, recent studies do not validate the role of histamine in the pathogenesis of pruritus. Conventional management continues to include the wide use of antihistamines to treat the persistent itch, however, there is an urgent need for therapy which will reduce the severity of pruritus for these patients. Objective: To review the evidence in the literature for the use of antihistamines in the treatment of atopic dermatitis. Methods: A MEDLINE search (1966–2002) was performed to obtain studies examining the use of antihistamines in the treatment of atopic dermatitis. Search terms included: atopic dermatitis; eczema; antihistamines; azatadine; brompheniramine; cetirizine; chlorpheniramine; clemastine; cyclizine; cyproheptadine; desloratadine; diphenhydramine; fexofenadine; hydroxyzine; loratadine; meclizine; promethazine; trimeprazine. Further references were gathered from these publications. Results: Historically, antihistamines have been used in the treatment of AD. However, this review shows that the evidence for its use is inconclusive. At present, several antihistamines continue to provide relief of pruritus by central sedation, and they can also be used therapeutically for concomitant allergic conditions associated with AD. More clinical trials examining the therapeutic efficacy of antihistamines, especially with the newer nonsedating antihistamines, are necessary to elucidate their role in the treatment of AD. Conclusion: Dermatologists require additional evidence regarding the efficacy of antihistamines and their mechanism of action in the treatment of AD to enhance patient care.

The role of topical anesthetics in the management of chronic pruritus

2016 ◽  
Vol 28 (4) ◽  
pp. 338-341 ◽  
Author(s):  
Alice He ◽  
Shawn G. Kwatra ◽  
Divya Sharma ◽  
Kazuki M. Matsuda
Keyword(s):  
Topical Anesthetics ◽  
Chronic Pruritus

The role of patient chronotypes on circadian pattern of chronic pruritus: a latent growth modeling analysis

2013 ◽  
Vol 44 (5) ◽  
pp. 807-814 ◽  
Author(s):  
Serap Gunes Bilgili ◽  
Adem Aydin ◽  
Yavuz Selvi ◽  
Ayse Serap Karadag ◽  
Murat Boysan ◽  
...  
Keyword(s):  
Growth Modeling ◽  
Latent Growth Modeling ◽  
Circadian Pattern ◽  
Latent Growth ◽  
Modeling Analysis ◽  
Chronic Pruritus

scholarly journals Neurokinin-1 receptor antagonist tradipitant improves itch associated with mild atopic dermatitis: Results from EPIONE a randomized clinical trial

2020 ◽  
Author(s):  
Sarah E Welsh ◽  
Changfu Xiao ◽  
Michael A Mohrman ◽  
Alyssa R Kaden ◽  
Jennifer L Brzezynski ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Atopic Dermatitis ◽  
Substance P ◽  
Receptor Antagonist ◽  
Phase 3 ◽  
Neurokinin 1 Receptor ◽  
Neurokinin 1 ◽  
Chronic Pruritus ◽  
Lesion Severity

AbstractImportanceSafe oral systemic treatments are needed to treat itch associated with atopic dermatitis (AD).ObjectiveTo examine the efficacy and safety of tradipitant, a neurokinin-1 receptor antagonist, in adults with mild to severe AD.Design, Setting, and ParticipantsEPIONE was a phase 3, randomized, placebo-controlled, double-blind clinical trial conducted from July 09, 2018 to December 27, 2019 at 74 US centers. Patients were adults 18 years or older with worst itch rated ≥7 on the Worst Itch Numerical Rating Scale (WI-NRS) and ≥ 1% body surface area of AD involvement at screening.InterventionsPatients were randomly assigned (1:1) to twice-daily oral placebo or tradipitant (85 mg) for 8 weeks.Main Outcomes and MeasuresThe primary endpoint was mean improvement in WI-NRS (baseline to Week 8). Secondary endpoints included disease severity improvement measured by SCORing Atopic Dermatitis (SCORAD) index, the Eczema Area and Severity Index (EASI), and validated Investigator Global Assessment for Atopic Dermatitis (vIGA-AD™).Results341 patients (mean [SD]: age, 41.8 [15.0] years; sex, 243 [64.8%] female) were randomly assigned to placebo (n = 187) or tradipitant (n = 188). EPIONE did not meet its primary endpoint of reduction in pruritus (LS Mean difference (95% CI), −0.2 (−0.8 to 0.4), P = 0.567). However, robust antipruritic effect was observed in patients with mild lesion severity (rated 1 or 2 by the vIGA-AD at baseline, −1.6 (−2.9 to −0.3), P = 0.015). This result was confirmed by daily diary (−2.09 (−3.31 to −0.87), P = 0.001) and observed after one full day of treatment (−0.61 (−1.21 to −0.01), P = 0.0457). Treatment-emergent adverse events (TEAEs) were reported in 63 of 188 (33.5%) tradipitant patients and 43 of 187 (23.0%) placebo patients. TEAEs with > 2% incidence and twice that of placebo included diarrhea (VLY-686 = 5 (2.7%), PBO = 1 (0.5%)), fatigue (VLY-686 = 5 (2.7%), PBO = 0 (0.0%)), and worsening of AD (VLY-686 = 4 (2.1%), PBO = 1 (0.5%)).Conclusions and RelevanceDuring 8 weeks of treatment, tradipitant was well-tolerated for all study participants, but did not significantly improve worst itch in the overall study population. However, in patients with mild AD at baseline, tradipitant was observed to have a large and rapid antipruritic effect. These data support the role of neurokinin-1 antagonism and substance P signaling in chronic pruritus related to mild AD. If these findings replicate in the on-going phase 3 study, EPIONE2, tradipitant may represent a promising new oral therapy for these mild AD patients.Trial RegistrationClinicaltrials.gov: NCT03568331, https://clinicaltrials.gov/ct2/show/NCT03568331Key PointsQuestionIs tradipitant, a selective neurokinin-1 receptor antagonist, efficacious and safe for improving worst itch in patients with mild to severe atopic dermatitis (AD)?FindingsIn 375 mild to severe AD patients, tradipitant did not significantly improve worst itch. However, in a subgroup of 79 AD patients with mild lesion severity at baseline, tradipitant significantly improved worst itch and sleep during 8 weeks of treatment.MeaningThese data support the role of neurokinin-1 antagonism and substance P signaling in chronic pruritus related to mild AD, and further suggest tradipitant may represent a new oral systemic option for mild AD patients based on the well-tolerated safety profile and improvement in itch and sleep.

scholarly journals Exploration of Sensory and Spinal Neurons Expressing GRP in Itch and Pain

2018 ◽  
Author(s):  
Devin M. Barry ◽  
Xue-Ting Liu ◽  
Qianyi Yang ◽  
Xian-Yu Liu ◽  
Xiansi Zeng ◽  
...  
Keyword(s):  
Sensory Neurons ◽  
Nerve Fibers ◽  
List Type ◽  
Spinal Neurons ◽  
Genetic Ablation ◽  
Conditional Deletion ◽  
Pain Transmission ◽  
Chronic Pruritus ◽  
Stimulation Of

AbstractGastrin-releasing peptide (GRP) is a putative itch-specific neurotransmitter, but definite evidence in the dorsal root ganglion (DRG) and spinal cord is lacking. We generated and validated a Grp-Cre knock-in (GrpCre-KI) mouse line whereby Grp neurons are genetically labeled. Cre-dependent marking analysis revealed exclusive innervation of the upper epidermis of the skin by GRP fibers. Importantly, optical stimulation of Grp fibers expressing channel rhodopsin (ChR2) in the skin evoked itch but not pain-related scratching behaviors, while conditional deletion of Grp in sensory neurons attenuated non-histaminergic itch. In contrast, intersectional genetic ablation of spinal Grp neurons did not affect itch nor pain transmission. Our study demonstrates a role of GRP in sensory neurons in itch and suggests that GRP sensory neurons are dedicated to itch transmission. GrpCre-KI mice provide a long-sought avenue for investigating peripheral coding mechanism of itch and further interrogation of itch-nerve fibers in the skin under chronic pruritus.HighlightsValidated expression of a Grp-Cre knock-in line in sensory neurons that innervate the skinOpto-activation of Grp sensory neurons evokes itch behaviorConditional deletion of Grp in sensory neurons reduces non-histaminergic itch behaviorIntersectional ablation of Grp spinal neurons does not affect itch or pain behaviors

scholarly journals Microglia are Involved in Pruritus Induced by DNFB via the CX3CR1/p38 MAPK Pathway

2015 ◽  
Vol 35 (3) ◽  
pp. 1023-1033 ◽  
Author(s):  
Ying Zhang ◽  
Jia Yan ◽  
Rong Hu ◽  
Yu Sun ◽  
Yiwen Ma ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
P38 Mapk ◽  
Mapk Pathway ◽  
Intrathecal Administration ◽  
P38 Inhibitor ◽  
P38 Mapk Pathway ◽  
Chronic Itch ◽  
Repeated Applications ◽  
Chronic Pruritus

Background/Aims: Pruritus, also known as itch, is a common, unpleasant sensation that can be difficult to treat. Frequently, chronic itch is associated with the development of neuropathic pain resulting from nerve injury or insult. Previous studies have shown the involvement of spinal microglia in the development of neuropathic pain, but their role in chronic pruritus is unclear. Methods: For this study, we constructed a model of chronic pruritus in mice using repeated applications of 2, 4-dinitrofluorobenzene (DNFB) and showed prolonged scratching behavior in treated mice that continued for at least 7 d after the final DNFB treatment. Results: Scratching was accompanied by activation of spinal microglia and both were reduced by an inhibitor of microglial activity. We also showed that microglial activation entailed increased signaling in the p38 MAPK pathway, and treatment with a p38 inhibitor reduced scratching in DNFB-treated mice. We also examined the role of fractalkine/CX3CR1 signaling in the development of DNFB-induced pruritus and showed that intrathecal administration of antiserum against either CX3CR1or FKN inhibited p38 activity and decreased scratching. Conclusion: Our results suggest that microglia are involved in pruritus induced by DNFB via FKN/CX3CR1/p38MAPK pathways similar to those participating in the development of neuropathic pain.

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