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Sonja Stander - One of the best experts on this subject based on the ideXlab platform.

  • evaluation of the Antipruritic effects of topical pimecrolimus in non atopic prurigo nodularis results of a randomized hydrocortisone controlled double blind phase ii trial
    Dermatology, 2013
    Co-Authors: Dorothee Siepmann, Ngoc Quan Phan, Thomas A Luger, Tobias Lotts, Christine Blome, Matthias Braeutigam, Trude Butterfassbahloul, Matthias Augustin, Sonja Stander
    Abstract:

    Background: In the treatment of atopic dermatitis, pimecrolimus has high Antipruritic effects. Objective: To investigate the efficacy of 1% pimecrolimus cream in comparison to 1% hydrocortisone cream in non-atopic prurigo nodularis (PN). Methods: A randomized, controlled, double-blind study with intraindividual randomization was done in 30 patients (17 females, 13 males; mean age 58.5 years) with PN. Results: Pruritus intensity decreased significantly (p Conclusion: The results suggest that the non-steroid pimecrolimus is an effective alternative for PN treatment.

  • Antipruritic treatment with systemic μ opioid receptor antagonists a review
    Journal of The American Academy of Dermatology, 2010
    Co-Authors: Ngoc Quan Phan, Jeffrey D Bernhard, Thomas A Luger, Sonja Stander
    Abstract:

    During the past two decades, systemic μ-opioid receptor antagonists (MORA) have been used in the treatment of various forms of chronic pruritus. In a number of case reports, case series, and controlled trials, treatment with MORA has demonstrated considerable Antipruritic effects. In double-blind controlled studies, significant Antipruritic relief has been achieved by MORA in cholestatic pruritus, chronic urticaria, and atopic dermatitis. In case reports and case series, Antipruritic efficacy of MORA has been reported in prurigo nodularis, mycosis fungoides, postburn pruritus, aquagenic pruritus, hydroxyethyl starch-induced pruritus, and pruritus of unknown origin. However, most of the evidence remains anecdotal, the design of these trials varies, and comparison of results is difficult. In this review we aim to present an overview of these reports and to assess the evidence for the Antipruritic action of the drugs naloxone, nalmefene, and naltrexone, which are currently in use for the treatment of chronic pruritus of different origins. We will also evaluate recommendations for the use of MORA in daily medical practice.

  • targeting the neurokinin receptor 1 with aprepitant a novel Antipruritic strategy
    PLOS ONE, 2010
    Co-Authors: Sonja Stander, Dorothee Siepmann, Ilka Herrgott, Cord Sunderkotter, Thomas A Luger
    Abstract:

    Background Chronic pruritus is a global clinical problem with a high impact on the quality of life and lack of specific therapies. It is an excruciating and frequent symptom of e.g. uncurable renal, liver and skin diseases which often does not respond to conventional treatment with e.g. antihistamines. Therefore Antipruritic therapies which target physiological mechanisms of pruritus need to be developed. Substance P (SP) is a major mediator of pruritus. As it binds to the neurokinin receptor 1 (NKR1), we evaluated if the application of a NKR1 antagonist would significantly decrease chronic pruritus. Methods and Findings Twenty hitherto untreatable patients with chronic pruritus (12 female, 8 male; mean age, 66.7 years) were treated with the NKR1 antagonist aprepitant 80 mg for one week. 16 of 20 patients (80%) experienced a considerable reduction of itch intensity, as assessed by the visual analog scale (VAS, range 0 to 10). Considering all patients, the mean value of pruritus intensity was significantly reduced from 8.4 VAS points (SD +/−1.7) before treatment to 4.9 VAS points (SD +/−3.2) (p<0.001, CI 1.913–5.187). Patients with dermatological diseases (e.g. atopic diathesis, prurigo nodularis) had the best profit from the treatment. Side-effects were mild (nausea, vertigo, and drowsiness) and only occurred in three patients. Conclusions The high response rate in patients with therapy refractory pruritus suggests that the NKR1 antagonist aprepitant may indeed exhibit Antipruritic effects and may present a novel, effective treatment strategy based on pathophysiology of chronic pruritus. The results are promising enough to warrant confirming the efficacy of NKR1 antagonists in a randomized, controlled clinical trial.

  • Antipruritic efficacy of a high dosage antihistamine therapy results of a retrospectively analysed case series
    Hautarzt, 2009
    Co-Authors: S Schulz, T. A. Luger, Dorothee Siepmann, Martin Metz, Marcus Maurer, Sonja Stander
    Abstract:

    BACKGROUND AND OBJECTIVES: The causal treatment of chronic pruritus is not always possible or effective necessitating symptomatic Antipruritic therapy. Antihistamines are the only drugs approved for the treatment of chronic pruritus, but they are rarely effective at standard doses. The aim of this investigation was to describe the efficacy and safety of high-dosage antihistamine treatment in patients with chronic pruritus of different origin. PATIENTS: A total of 67 patients with chronic pruritus caused by different skin diseases or chronic pruritus of unknown origin were treated with levocetirizine 10 mg/fexofenadine 360 mg or levocetirizine 10 mg/fexofenadine 360 mg/azelastine 4 mg or desloratadine 20 mg per day. RESULTS: A therapeutic response was achieved in 43.8% of patients with a combination of two antihistamines, 68.4% of patients with three antihistamines and 76.9% of patients with high dosage desloratadine. The average reduction in pruritus was 57.5% (two antihistamines), 67.4% (three antihistamines) and 89% (desloratadine). Adverse drug effects were observed rarely. CONCLUSIONS: The results of this case series suggest a high Antipruritic effect in chronic pruritus by administration of high-dosage, non-sedating antihistamines. These results have to be confirmed in controlled trials. The combination was not more effective than the high dosage monotherapy. The latter one might be preferable due to unknown interactions and addition of side-effects in the combination therapy.

  • treatment of chronic pruritus with the selective serotonin re uptake inhibitors paroxetine and fluvoxamine results of an open labelled two arm proof of concept study
    Acta Dermato-venereologica, 2009
    Co-Authors: Sonja Stander, Thomas A Luger, Barbara Bockenholt, Funda Schurmeyerhorst, Carsten Weishaupt, Gereon Heuft, Gudrun Schneider
    Abstract:

    : Chronic pruritus is difficult to treat and requires the evaluation of new therapeutic modalities. We initiated an open-labelled, two-arm prospective, proof-of-concept study applying two selective serotonin re-uptake inhibitors on a long-term basis. Paroxetine and fluvoxamine were tested in a total of 72 pruritic patients (27 men, 45 women, age range 28-88 years, mean age 59.2 years). The reduction in pruritus was evaluated by analysis of visual analogue scores and determination of the maximal Antipruritic effect (maximal percentual reduction in pruritus). Forty-nine of 72 patients (68.0%) experienced a weak (n=9), good (n=16) or very good (n=24) Antipruritic effect. Statistical analysis proved the efficacy of paroxetine and fluvoxamine with no significant difference. The best response was observed in patients with pruritus due to atopic dermatitis, systemic lymphoma and solid carcinoma. Chronic scratch lesions healed completely in 14/31 patients and partially in 17/31 patients. Adverse drug effects were observed in 70.8% of patients, resulting in discontinuation of treatment in 18 patients. These results support previous reports of high Antipruritic potency of selective serotonin re-uptake inhibitors, which are a good alternative treatment modality in chronic pruritus. This should be confirmed in future double-blind studies.

E. Weisshaar - One of the best experts on this subject based on the ideXlab platform.

  • Pruritus in der Schwangerschaft
    Der Gynäkologe, 2005
    Co-Authors: E. Weisshaar, R. Witteler, T. L. Diepgen, T. A. Luger, S. Ständer
    Abstract:

    Pruritus is the leading dermatological symptom during pregnancy. Besides preexisting or acquired dermatoses, there are a number of pregnancy-specific dermatological diseases such as PEP (polymorphic eruption of pregnancy), Pemphigoid (Herpes) gestationis, Pruritus gravidarum that may be accompanied by severe itching and scratching. Because of potential effects on the fetus, the treatment of pruritus in pregnancy requires prudent consideration of whether the severity of the underlying disease warrants treatment and selection of the safest treatments available. The use of topical and systemic treatments depends on the underlying etiology of pruritus and the stage and status of the skin. In general, emollients, topical Antipruritics and topical corticosteroids appear to be the safest options for localized forms of pruritus in pregnancy whereas systemic treatments and/or UV photo therapy are adequate for generalized pruritus. Systemic corticosteroids and a restricted number of antihistamines may be administered. This paper highlights the major etiologies of pruritus during pregnancy and points out the cornerstones of Antipruritic therapy in recognition of our own clinical experiences and the current literature. Pruritus ist das dermatologische Hauptsymptom in der Schwangerschaft. Neben bereits bestehenden oder neu erworbenen Dermatosen gibt es eine Reihe von Schwangerschaftsdermatosen wie z. B. PEP (polymorphe Exantheme der Schwangerschaft), Pemphigoid (Herpes) gestationis und Pruritus gravidarum, welche von starken Juckempfindungen und Kratzen begleitet sind. Durch mögliche fetale Schädigungen muss die Indikation und Auswahl der antipruritogenen Therapie in der Schwangerschaft vorsichtig abgewogen und die sicherste Therapieform gewählt werden. Der Einsatz topischer und systemischer Therapien hängt daher von der zugrunde liegenden Ursache, dem Stadium und dem individuellen Zustand der Haut ab. Für lokalisierte Formen des Pruritus können topische Antipruriginosa und Glukokortikosteroide eingesetzt werden, während bei generalisiertem Pruritus zumeist systemische Therapien und/oder eine UV-Therapie nach sorgfältiger Abwägung durchgeführt werden. Systemische Glukokortikosteroide und eine limitierte Anzahl von Antihistaminika können in schweren Fällen eingesetzt werden. In dieser Arbeit werden die Hauptursachen des Pruritus in der Schwangerschaft und die Eckpunkte der antipruritogenen Therapie dieser herausfordernden Patientengruppe unter Berücksichtigung eigener klinischer Erfahrungen und der aktuellen Literatur dargestellt.

  • Pruritus in der Schwangerschaft
    Der Hautarzt, 2005
    Co-Authors: E. Weisshaar, R. Witteler, T. L. Diepgen, T. A. Luger, S. Ständer
    Abstract:

    Pruritus is the leading dermatological symptom during pregnancy. Besides preexisting or acquired dermatoses, there are a number of pregnancy-specific dermatological diseases such as PEP (polymorphic eruption of pregnancy, previously named PUPPP), pemphigoid (herpes) gestationis, and pruritus gravidarum that are accompanied by severe itching and scratching. Because of potential effects on the fetus, the treatment of pruritus in pregnancy requires prudent consideration. The use of topical and systemic treatments depends on the underlying aetiology of pruritus and the stage and status of the skin. In general, emollients, topical Antipruritics and topical corticosteroids appear to be the safest options for localised forms of pruritus in pregnancy whereas systemic treatments and/or UV phototherapy are adequate for generalized pruritus. Systemic corticosteroids and a restricted number of antihistamines may be administered in severe cases. This paper highlights the major aetiologies of pruritus during pregnancy and points out the cornerstones of Antipruritic therapy in recognition of our own clinical experiences and the current literature. Pruritus ist das dermatologische Hauptsymptom in der Schwangerschaft. Neben bereits bestehenden oder neu erworbenen Dermatosen gibt es eine Reihe von Schwangerschaftsdermatosen, wie z. B. PEP (polymorphe Exantheme der Schwangerschaft), Pemphigoid (Herpes) gestationis und Pruritus gravidarum, die von starken Juckempfindungen und Kratzen begleitet sind. Durch mögliche fetale Schädigungen muss die Indikation und Auswahl der antipruritogenen Therapie in der Schwangerschaft vorsichtig abgewogen werden. Der Einsatz topischer und systemischer Therapien hängt von der zugrunde liegenden Ursache, dem Stadium und dem individuellen Zustand der Haut ab. Für lokalisierte Formen des Pruritus können topische Antipruriginosa und Glukokortikosteroide eingesetzt werden, während bei generalisiertem Pruritus zumeist systemische Therapien und/oder eine UV-Therapie nach sorgfältiger Abwägung durchgeführt werden. Systemische Glukokortikosteroide und eine limitierte Anzahl von Antihistaminika können in schweren Fällen eingesetzt werden. In diesem Beitrag werden die Hauptursachen des Pruritus in der Schwangerschaft und die Eckpunkte der antipruritogenen Therapie dieser Patientengruppe unter Berücksichtigung eigener klinischer Erfahrungen und der aktuellen Literatur dargestellt.

  • Antipruritic effects of two different 5 ht3 receptor antagonists and an antihistamine in haemodialysis patients
    Experimental Dermatology, 2004
    Co-Authors: E. Weisshaar, Nadine Dunker, Friedrichwilhelm Rohl, Harald Gollnick
    Abstract:

    :  Pruritus is the most distressing symptom in haemodialysis (HD) patients. Its aetiology has not yet been delineated, and thus there are no good therapeutical options. Case reports and series attribute Antipruritic potency to the serotonin receptor antagonists of the 5-HT3 type in renal pruritus. It was the aim of this study to investigate the Antipruritic effect of two different 5-HT3 receptor antagonists and an antihistamine in 11 patients undergoing HD. Pruritus was induced by iontophoresis with serotonin and histamine and recorded before and after HD. These data were compared to those obtained after oral pretreatment with the 5-HT3 receptor antagonists tropisetron 5 mg and ondansetron 8 mg and the antihistamine cetirizine 10 mg. Ten healthy volunteers served as a control group. Vasocutaneous parameters (wheal and flare), skin temperature and alloknesis were also determined. Itching in HD patients and controls was not significantly diminished by oral pretreatment with the serotonin receptor antagonists. In controls, but not in HD patients, cetirizine significantly reduced itching, skin temperature and vasocutaneous parameters. Our data additionally demonstrate that there are no significant differences in vasocutaneous parameters, itching and alloknesis in HD patients before and after dialysis. We conclude that 5-HT3 receptor blockers such as tropisetron and ondansetron and the antihistamine cetirizine do not sufficiently reduce serotonin- and histamine-induced itching in haemodialyis patients.

  • can a serotonin type 3 5 ht3 receptor antagonist reduce experimentally induced itch
    Inflammation Research, 1997
    Co-Authors: E. Weisshaar, B Ziethen, Harald Gollnick
    Abstract:

    Background: Serotonin type 3 (5-HT3) receptor antagonists have been reported to be a novel therapeutic principle for the treatment of cholestatic and uremic pruritus.¶Objective: To determine the Antipruritic effect of a 5-HT3 receptor antagonist (tropisetron) on histamine and serotonin-induced itch under experimental conditions in comparison to native skin and after pretreatment with an orally applied antihistamine (cetirizine).¶Methods: Histamine and serotonin were iontophoretically applied in 10 healthy volunteers. Wheals and flares were planimetrically evaluated. Itching and burning sensations were entered on a scale over 24 min. The examination also comprised alloknesis, elicitation of perifocal itch sensation by usually non-itching (e.g. mechanical) stimuli.¶Results: Tropisetron did not have any significant influence on histamine-induced reactions but could significantly reduce serotonin-induced flares. Cetirizine led to a significant reduction of all histamine-induced parameters and abolished serotonin-induced wheals.¶Conclusions: Serotonin has an own pruritic potency and does not only act over histamine containing mast cells. The Antipruritic effect of tropisetron reported in cholestatic and uremic pruritus could not be verified in healthy persons under experimental conditions.

V R Sinha - One of the best experts on this subject based on the ideXlab platform.

  • antidepressants as Antipruritic agents a review
    European Neuropsychopharmacology, 2018
    Co-Authors: Randeep Kaur, V R Sinha
    Abstract:

    Pruritus is a concomitant symptom of various underlying disorders viz. dermatological, systemic and psychiatric disorders that provoke the person to scratch the skin. Many natural as well as, Antipruritic therapies are usually practiced in the treatment of pruritus including general preventive measures, topical therapies such as cooling agents, antihistamines, anesthetics, capsaicin, corticosteroids, immunomodulators and; systemic therapies including administration of antihistamines, opioid antagonists/agonists, antiepileptic drugs/neuroleptics (e.g., gabapentin and pregabalin), antidepressants (e.g., doxepin, amitriptyline, paroxetine, fluvoxamine, sertraline, escitalopram and mirtazapine) (Patel and Yosipovitch, 2010; Reich et al., 2011; Martin and Padilla, 2015; Eskeland et al., 2016). Topical therapies are the mainstay of treatment of delicate and localized pruritus while other systemic drug therapies are used to treat stern and generalized pruritus. The reported Antipruritic activity of some antidepressant drugs has intrigued this review to focus on the types of pruritus, pruritus mechanism, the Antipruritic mechanism of antidepressants and to comprehend the role of antidepressants in the management of pruritus.

Thomas A Luger - One of the best experts on this subject based on the ideXlab platform.

  • evaluation of the Antipruritic effects of topical pimecrolimus in non atopic prurigo nodularis results of a randomized hydrocortisone controlled double blind phase ii trial
    Dermatology, 2013
    Co-Authors: Dorothee Siepmann, Ngoc Quan Phan, Thomas A Luger, Tobias Lotts, Christine Blome, Matthias Braeutigam, Trude Butterfassbahloul, Matthias Augustin, Sonja Stander
    Abstract:

    Background: In the treatment of atopic dermatitis, pimecrolimus has high Antipruritic effects. Objective: To investigate the efficacy of 1% pimecrolimus cream in comparison to 1% hydrocortisone cream in non-atopic prurigo nodularis (PN). Methods: A randomized, controlled, double-blind study with intraindividual randomization was done in 30 patients (17 females, 13 males; mean age 58.5 years) with PN. Results: Pruritus intensity decreased significantly (p Conclusion: The results suggest that the non-steroid pimecrolimus is an effective alternative for PN treatment.

  • Antipruritic treatment with systemic μ opioid receptor antagonists a review
    Journal of The American Academy of Dermatology, 2010
    Co-Authors: Ngoc Quan Phan, Jeffrey D Bernhard, Thomas A Luger, Sonja Stander
    Abstract:

    During the past two decades, systemic μ-opioid receptor antagonists (MORA) have been used in the treatment of various forms of chronic pruritus. In a number of case reports, case series, and controlled trials, treatment with MORA has demonstrated considerable Antipruritic effects. In double-blind controlled studies, significant Antipruritic relief has been achieved by MORA in cholestatic pruritus, chronic urticaria, and atopic dermatitis. In case reports and case series, Antipruritic efficacy of MORA has been reported in prurigo nodularis, mycosis fungoides, postburn pruritus, aquagenic pruritus, hydroxyethyl starch-induced pruritus, and pruritus of unknown origin. However, most of the evidence remains anecdotal, the design of these trials varies, and comparison of results is difficult. In this review we aim to present an overview of these reports and to assess the evidence for the Antipruritic action of the drugs naloxone, nalmefene, and naltrexone, which are currently in use for the treatment of chronic pruritus of different origins. We will also evaluate recommendations for the use of MORA in daily medical practice.

  • targeting the neurokinin receptor 1 with aprepitant a novel Antipruritic strategy
    PLOS ONE, 2010
    Co-Authors: Sonja Stander, Dorothee Siepmann, Ilka Herrgott, Cord Sunderkotter, Thomas A Luger
    Abstract:

    Background Chronic pruritus is a global clinical problem with a high impact on the quality of life and lack of specific therapies. It is an excruciating and frequent symptom of e.g. uncurable renal, liver and skin diseases which often does not respond to conventional treatment with e.g. antihistamines. Therefore Antipruritic therapies which target physiological mechanisms of pruritus need to be developed. Substance P (SP) is a major mediator of pruritus. As it binds to the neurokinin receptor 1 (NKR1), we evaluated if the application of a NKR1 antagonist would significantly decrease chronic pruritus. Methods and Findings Twenty hitherto untreatable patients with chronic pruritus (12 female, 8 male; mean age, 66.7 years) were treated with the NKR1 antagonist aprepitant 80 mg for one week. 16 of 20 patients (80%) experienced a considerable reduction of itch intensity, as assessed by the visual analog scale (VAS, range 0 to 10). Considering all patients, the mean value of pruritus intensity was significantly reduced from 8.4 VAS points (SD +/−1.7) before treatment to 4.9 VAS points (SD +/−3.2) (p<0.001, CI 1.913–5.187). Patients with dermatological diseases (e.g. atopic diathesis, prurigo nodularis) had the best profit from the treatment. Side-effects were mild (nausea, vertigo, and drowsiness) and only occurred in three patients. Conclusions The high response rate in patients with therapy refractory pruritus suggests that the NKR1 antagonist aprepitant may indeed exhibit Antipruritic effects and may present a novel, effective treatment strategy based on pathophysiology of chronic pruritus. The results are promising enough to warrant confirming the efficacy of NKR1 antagonists in a randomized, controlled clinical trial.

  • treatment of chronic pruritus with the selective serotonin re uptake inhibitors paroxetine and fluvoxamine results of an open labelled two arm proof of concept study
    Acta Dermato-venereologica, 2009
    Co-Authors: Sonja Stander, Thomas A Luger, Barbara Bockenholt, Funda Schurmeyerhorst, Carsten Weishaupt, Gereon Heuft, Gudrun Schneider
    Abstract:

    : Chronic pruritus is difficult to treat and requires the evaluation of new therapeutic modalities. We initiated an open-labelled, two-arm prospective, proof-of-concept study applying two selective serotonin re-uptake inhibitors on a long-term basis. Paroxetine and fluvoxamine were tested in a total of 72 pruritic patients (27 men, 45 women, age range 28-88 years, mean age 59.2 years). The reduction in pruritus was evaluated by analysis of visual analogue scores and determination of the maximal Antipruritic effect (maximal percentual reduction in pruritus). Forty-nine of 72 patients (68.0%) experienced a weak (n=9), good (n=16) or very good (n=24) Antipruritic effect. Statistical analysis proved the efficacy of paroxetine and fluvoxamine with no significant difference. The best response was observed in patients with pruritus due to atopic dermatitis, systemic lymphoma and solid carcinoma. Chronic scratch lesions healed completely in 14/31 patients and partially in 17/31 patients. Adverse drug effects were observed in 70.8% of patients, resulting in discontinuation of treatment in 18 patients. These results support previous reports of high Antipruritic potency of selective serotonin re-uptake inhibitors, which are a good alternative treatment modality in chronic pruritus. This should be confirmed in future double-blind studies.

  • Antipruritic effect of cyclosporine microemulsion in prurigo nodularis results of a case series
    Journal Der Deutschen Dermatologischen Gesellschaft, 2008
    Co-Authors: Dorothee Siepmann, Thomas A Luger, Sonja Stander
    Abstract:

    Summary Background: Prurigo nodularis shows intense itching nodules, which are often persistent and therapy refractory. Histological alterations include fibrosis of collagen fibers and presence of inflammatory infiltrate, which partly explains the clinical persistence of lesions. Inflammatory cells may directly contribute to induction and maintenance of pruritus at nerve fibers. Cyclosporine microemulsion (ME) suppresses the migration and proliferation of inflammatory cells and may thereby interfere with pathogenesis of prurigo nodularis. The aim of this investigation was to assess the Antipruritic efficiency of cyclosporine ME in therapy of prurigo nodularis. Patients and methods: 14 patients with prurigo nodularis of diverse origin and failure to previous therapy were treated with oral cyclosporine ME (3 to 5 mg per kg daily). Blood pressure, liver enzymes, renal function and differential blood count were monitored. Results: In 13 of 14 prurigo patients (92.9 %) there was a significant response to monotherapy with cyclosporine ME. The maximal Antipruritic effect occurred after 2 weeks to 12 months. Prurigo nodules also healed during therapy. Seven patients (50.0 %) described side effects. In one case the therapy was stopped. Conclusions: Oral cyclosporine ME is an effective therapy for prurigo nodularis of diverse origin. It appears to function by inhibiting dermal inflammatory cells.

Howard I Maibach - One of the best experts on this subject based on the ideXlab platform.