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Sonja Stander - One of the best experts on this subject based on the ideXlab platform.
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Chronic Prurigo: Similar Clinical Profile and Burden Across Clinical Phenotypes
'Frontiers Media SA', 2021Co-Authors: Claudia Zeidler, Manuel Pedro Pereira, Sonja StanderAbstract:Chronic Prurigo is a debilitating skin disease characterized by the presence of chronic pruritus and scratching-related pruriginous lesions. The pruriginous lesions can differ in their clinics what has recently been categorized into different clinical phenotypes. The most common one is chronic nodular Prurigo (syn. Prurigo nodularis); other phenotypes are papular, plaque, umbilicated, and linear Prurigo. A comparison between these phenotypes regarding similarities and differences has not yet been performed. In this explorative analysis, itch characteristics, scratching behavior, and disease burden of the nodular, papular, plaque, and umbilicated Prurigo were investigated in 1,128 patients. Patients with nodular and plaque Prurigo were younger than patients with papular and umbilicated Prurigo. The shortest duration of the underlying pruritus was found in papular and umbilicated Prurigo, the longest in plaque Prurigo. Itch intensity, impairment of sleep, mood and the quality of life did not differ. These findings confirm that the clinical phenotypes of chronic Prurigo belong to a spectrum of one disease with similar disease characteristics and can be categorized under the umbrella term of chronic Prurigo. Future clinical trials should include all phenotypes of chronic Prurigo
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ifsi guideline on chronic Prurigo including Prurigo nodularis
Itch, 2020Co-Authors: Sonja Stander, Claudia Zeidler, Manuel P Pereira, S Bobko, Timothy G Berger, Matthias Augustin, E Brenaut, Suephy C Chen, S Chisolm, Florence DalgardAbstract:Chronic Prurigo (CPG) is a highly burdensome pruritic disease characterized by chronic itch, a prolonged scratching behavior and the development of localized or generalized hyperkeratotic pruriginous lesions. Neuronal sensitization and the development of an itch-scratch cycle contribute to the augmentation of pruritus and the chronicity of the disease. We provide here the first international guideline for a rational diagnostic and therapeutic approach for CPG. Recommendations are based on available evidence and expert opinion. The diagnosis of CPG is made clinically. A detailed medical history together with laboratory and radiological examinations are advised in order to determine the severity of CPG, identify the underlying origin of the itch and assist in the elaboration of a treatment plan. Therapeutically, it is advised to adopt a multimodal approach, including general strategies to control itch, treatment of the underlying pruritic conditions, and of the pruriginous lesions. Topical (corticosteroids, calcineurin inhibitors, capsaicin) and systemic antipruritic agents (eg, gabapentinoids, immunosuppressants, and opioid modulators) as well as physical treatment modalities (phototherapy, cryotherapy) should be employed in a step-wise approach. Psychosomatic or psychological interventions may be recommended in CPG patients with signs of psychiatric/psychological comorbidities.
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diagnostic and treatment algorithm for chronic nodular Prurigo
Journal of The American Academy of Dermatology, 2020Co-Authors: Hartmut Stander, Claudia Zeidler, Sarina B Elmariah, Mary C Spellman, Sonja StanderAbstract:Chronic nodular Prurigo (CNPG) is a subtype of chronic Prurigo, also called Prurigo nodularis, and a chronic skin condition characterized by intensely pruritic nodular lesions. Although the exact cause of CNPG is unknown, it appears to result from a repetitive itch-scratch cycle induced by neuronal sensitization to chronic pruritus. CNPG is associated with an underlying dermatologic condition in about half of patients, and it can also be attributed to systemic, neurologic, psychogenic, or unknown causes. For most patients, multiple underlying causes are identified. Patients with CNPG often experience impaired quality of life, sleep disturbance, anxiety, and depression. To encourage consistent and accurate diagnosis and treatment of CNPG across regions, we are proposing a diagnostic and treatment algorithm that includes initial assessment of core symptoms, detailed dermatologic history and clinical examination, patient-reported outcomes, diagnostic workup, and recommended therapies. This information is supplemented with photographs to illustrate clinical appearance and disease severity. Because CNPG is often multifactorial and it can take months to years for lesions to heal, interdisciplinary cooperation and long-term management are important.
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acquired reactive perforating dermatosis is a variant of Prurigo nodularis
Acta Dermato-venereologica, 2017Co-Authors: Roxaneisabelle Kestner, Sonja Stander, Nani Osada, Dan Ziegler, Dieter MetzeAbstract:Patients with chronic pruritus may develop scratch-induced lesions with elevated borders and central necrosis. This so-called umbilicated type of Prurigo (UP) is rare and is assumed to develop preferentially in the context of metabolic diseases. The aim of this study was to characterize UP in its clinical and histological dimension. Demographic and clinical data were collected from 23 patients with UP. Intensive light microscopical analysis of biopsied lesions was performed. Statistical comparison with previous results for Prurigo nodularis (PN) showed that UP is clearly a subtype of PN. In addition, clinical and microscopic features of epidermal perforation identical to those in acquired reactive perforating dermatosis (ARDP) were observed. Hence, we suggest that ARDP is identical to UP and is therefore a subtype of PN. We assume that reduced wound healing capacities due to underlying systemic disorders, particularly diabetes mellitus and uraemia, underlie the pathomechanism of development of umbilicated skin lesions with a perforating aspect.
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Chronic Prurigo of Nodular Type: A Review
Society for Publication of Acta Dermato-Venereologica, 2017Co-Authors: Claudia Zeidler, Athanasios Tsianakas, Hartmut Stander, Manuel Pereira, Gil Yosipovitch, Sonja StanderAbstract:Prurigo nodularis (PN) is a subtype of chronic Prurigo presenting single to multiple symmetrically distributed, hyperkeratotic and intensively itching papules and nodules. PN evolves along with chronic pruritus in the context of diverse dermatological, systemic, neurological or psychiatric conditions. Permanent scratching is possibly a major trigger of PN, although its exact pathophysiology remains unclear. Current state-of-the-art therapy for PN consists of topical steroids, capsaicin, calcineurin inhibitors, ultraviolet (UV) therapy, systemic administration of gabapentinoids, μ-opioid receptor antagonists, antidepressants or immunosuppressants. Novel treatment concepts, such as inhibitors of neurokinin-1, opioid and interleukin-31 receptors, have been developed and are currently being clinically tested
A Petit - One of the best experts on this subject based on the ideXlab platform.
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atypical presentation of adult t cell leukaemia lymphoma due to htlv 1 Prurigo nodularis lasting twelve years followed by an acute micropapular eruption
Acta Dermato-venereologica, 2010Co-Authors: Arnaud Duval, J Rivet, Isabelle Moulonguet, Olivier Cassar, Felix Agbalika, Daniel Wallach, Antoine Gessain, A PetitAbstract:Prurigo nodularis is a pruritic dermatosis of unknown origin. Human T-cell lymphotropic virus type 1 (HTLV-1) causes adult T-cell leukaemia/lymphoma. HTLV-1 is not considered to be a cause of Prurigo nodularis. A 52-year-old black man, from the French West Indies, who had had Prurigo nodularis for 12 years, presented with a distinct micropapular eruption with the typical pathological picture of epidermotropic T-cell lymphoma. Based on HTLV-1-positive serology and monoclonal integration of HTLV-1 we diagnosed smouldering adult T-cell leukaemia/lymphoma. Re-examination of previous skin biopsies revealed that the disease had been evolving for 12 years. Treatment with alpha-interferon, 3 x 106 units three times a week, associated with zidovudine, 1 g daily, resulted in complete remission within 4 months. When investigating a Prurigo nodularis, we therefore recommend: (i) performing HTLV-1 serology if the patient comes from an endemic area; (ii) if positive, performing CD25 staining and looking for a HTLV-1 clonal integration; and (iii) if positive, using a treatment targeting HTLV-1.
Petit Antoine - One of the best experts on this subject based on the ideXlab platform.
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Atypical presentation of adult T-cell leukaemia/lymphoma due to HTLV-1: Prurigo nodularis lasting twelve years followed by an acute micropapular eruption.
'Acta Dermato-Venereologica', 2010Co-Authors: Duval Arnaud, Rivet Jacqueline, Moulonguet Isabelle, Cassar Olivier, Agbalika Félix, Wallach Daniel, Gessain Antoine, Petit AntoineAbstract:International audiencePrurigo nodularis is a pruritic dermatosis of unknown origin. Human T-cell lymphotropic virus type 1 (HTLV-1) causes adult T-cell leukaemia/lymphoma. HTLV-1 is not considered to be a cause of Prurigo nodularis. A 52-year-old black man, from the French West Indies, who had had Prurigo nodularis for 12 years, presented with a distinct micropapular eruption with the typical pathological picture of epidermotropic T-cell lymphoma. Based on HTLV-1-positive serology and monoclonal integration of HTLV-1 we diagnosed smouldering adult T-cell leukaemia/lymphoma. Re-examination of previous skin biopsies revealed that the disease had been evolving for 12 years. Treatment with alpha-interferon, 3 x 106 units three times a week, associated with zidovudine, 1 g daily, resulted in complete remission within 4 months. When investigating a Prurigo nodularis, we therefore recommend: (i) performing HTLV-1 serology if the patient comes from an endemic area; (ii) if positive, performing CD25 staining and looking for a HTLV-1 clonal integration; and (iii) if positive, using a treatment targeting HTLV-1
Simone Garcovich - One of the best experts on this subject based on the ideXlab platform.
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european academy of dermatology and venereology european Prurigo project expert consensus on the definition classification and terminology of chronic Prurigo
Journal of The European Academy of Dermatology and Venereology, 2018Co-Authors: Manuel P Pereira, Claudia Zeidler, Sabine Steinke, Caroline Forner, Claudia Riepe, M Augustin, S Bobko, Florence Dalgard, Jesper Elberling, Simone GarcovichAbstract:Background The term Prurigo has been used for many decades in dermatology without clear definition and currently used terminology of Prurigo is inconsistent and confusing. Especially itch-related Prurigo remains unexplored regarding the epidemiology, clinical profile, natural course, underlying causes, available treatments and economic burden, although burdensome and difficult to treat. Objective To address these issues, the multicenter European Prurigo Project (EPP) was designed to increase knowledge on chronic Prurigo (CPG). In the first step, European experts of the EADV Task Force Pruritus (TFP) aimed to achieve a consensus on the definition, classification and terminology of CPG. Additionally, procedures of the cross-sectional EPP were discussed and agreed upon. Methods Discussions and surveys between members of the TFP served as basis for a consensus conference. Using the Delphi method, consensus was defined as an agreement ≥75% among the present members. Results Twenty-four members of the TFP participated in the consensus conference. Experts consented that CPG should be used as an umbrella term for the range of clinical manifestations (e.g. papular, nodular, plaque or umbilicated types). CPG is considered a distinct disease defined by the presence of chronic pruritus for ≥6 weeks, history and/or signs of repeated scratching and multiple localized/generalized pruriginous skin lesions (whitish or pink papules, nodules and/or plaques). CPG occurs due to a neuronal sensitization to itch and the development of an itch-scratch cycle. Conclusion This new definition and terminology of CPG should be implemented in dermatology in order to harmonize communication in the clinical routine, clinical trials and scientific literature. Acute/subacute forms of Prurigo are separated entities, which need to be differentiated from CPG and will be discussed in a next step. In the near future the cross-sectional EPP will provide relevant clinical data on various aspects of CPG leading to new directions in the scientific investigation of CGP. This article is protected by copyright. All rights reserved.
Arnaud Duval - One of the best experts on this subject based on the ideXlab platform.
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atypical presentation of adult t cell leukaemia lymphoma due to htlv 1 Prurigo nodularis lasting twelve years followed by an acute micropapular eruption
Acta Dermato-venereologica, 2010Co-Authors: Arnaud Duval, J Rivet, Isabelle Moulonguet, Olivier Cassar, Felix Agbalika, Daniel Wallach, Antoine Gessain, A PetitAbstract:Prurigo nodularis is a pruritic dermatosis of unknown origin. Human T-cell lymphotropic virus type 1 (HTLV-1) causes adult T-cell leukaemia/lymphoma. HTLV-1 is not considered to be a cause of Prurigo nodularis. A 52-year-old black man, from the French West Indies, who had had Prurigo nodularis for 12 years, presented with a distinct micropapular eruption with the typical pathological picture of epidermotropic T-cell lymphoma. Based on HTLV-1-positive serology and monoclonal integration of HTLV-1 we diagnosed smouldering adult T-cell leukaemia/lymphoma. Re-examination of previous skin biopsies revealed that the disease had been evolving for 12 years. Treatment with alpha-interferon, 3 x 106 units three times a week, associated with zidovudine, 1 g daily, resulted in complete remission within 4 months. When investigating a Prurigo nodularis, we therefore recommend: (i) performing HTLV-1 serology if the patient comes from an endemic area; (ii) if positive, performing CD25 staining and looking for a HTLV-1 clonal integration; and (iii) if positive, using a treatment targeting HTLV-1.
