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Sonja Ständer - One of the best experts on this subject based on the ideXlab platform.
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Validation of a Comprehensive Set of Pruritus Assessment Instruments: The Chronic Pruritus Tools Questionnaire PRURITOOLS.
Acta dermato-venereologica, 2019Co-Authors: Emely Verweyen, Sonja Ständer, Christine Blome, Manuel P Pereira, Kiana Kreitz, Inga Höben, Nani Osada, Marvin Gernart, Claudia Riepe, Matthias AugustinAbstract:Few studies have validated standard measurement instruments for evaluation of chronic Pruritus. The Chronic Pruritus Tools Questionnaire PRURITOOLS assembles a set of instruments for the assessment of Pruritus, such as the visual analogue scale (horizontal 100-mm line), numerical rating scale (0-10), verbal rating scale, and information on Pruritus quality and improvement during therapy. This study, with 40 subjects, analysed PRURITOOLS regarding convergent validity and test-retest reliability (60 min), followed by a feasibility questionnaire. Test-retest reliability for PRURITOOLS items was excellent (intraclass correlation coefficient 0.84-1). Strong to very strong correlations between the Pruritus intensity scales indicated convergent validity. The feasibility questionnaire showed an overall acceptance of PRURITOOLS, and the majority of subjects (82.5%) considered it an appropriate questionnaire to measure Pruritus. In conclusion, PRURITOOLS offers validated tools for rapid Pruritus assessment in routine care or endpoints of clinical trials.
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association between itch and cancer in 16 925 patients with Pruritus experience at a tertiary care center
Journal of The American Academy of Dermatology, 2019Co-Authors: Valerie A Larson, Sonja Ständer, Olive Tang, Sewon Kang, Shawn G KwatraAbstract:Background Pruritus has been associated with cancer. However, limited data are available on the types of underlying malignancies associated with Pruritus. Objective We sought to characterize the association between Pruritus and different cancer types, as well as variations by racial group. Methods Cross-sectional study of patients ≥18 years of age seen at the Johns Hopkins Health System during 2013-2017. Patients with Pruritus were compared with patients without Pruritus. Analyses were stratified by race. Results Patients with Pruritus were more likely to have concomitant malignancy than those without Pruritus (odds ratio 5.76, 95% confidence interval 5.53-6.00). Most strongly associated were cancers of the liver, gallbladder and biliary tract, hematopoietic system, and skin. Compared with white patients, black patients more frequently had soft tissue, dermatologic, and hematologic malignancies and less frequently had liver, respiratory, gastrointestinal, and gynecologic malignancies. Limitations The cross-sectional design precludes analysis of the temporal association between Pruritus and malignancy. The study is limited to a single tertiary care center. Conclusion Pruritus is most strongly associated with cancers of the liver, skin, and hematopoietic system. Black patients with Pruritus have a higher likelihood of skin, soft tissue, and hematologic malignancies than white patients, while whites have higher likelihoods of liver, respiratory, gastrointestinal, and gynecologic malignancies.
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Exploratory Study of Intracutaneous Histamine Stimulation in Patient Populations with Chronic Pruritus.
Acta Dermato-venereologica, 2019Co-Authors: Athanasios Tsianakas, Nadine Nippe, Christina Maria Hamper, Anna Friederike Cordes, Claudia Zeidler, Martin Schmelz, Sonja StänderAbstract:Chronic Pruritus can be a diagnostic sign of an underlying disease. In the intracutaneous histamine test, histamine (one of the best-known inducers of Pruritus) may cause different reaction patterns depending on the underlying disease. The aim of this study was to determine if an intracutaneous injection of histamine can differentiate between the causes of chronic Pruritus and thus be used as a diagnostic test in chronic Pruritus of unknown aetiology. A total of 140 subjects with chronic Pruritus with various dermatological, systemic or neurological diseases were included. The intracutaneous histamine test was performed once on each subject. Erythema, wheal and Pruritus intensity were measured and analysed. Significantly greater wheal size was observed in patients with systemic or multifactorial causes. In general, there was a significant correlation between age and wheal size. Also, noticeable differences were found between males and females regarding Pruritus and wheal size. In summary, the exact type of chronic Pruritus could not be clearly determined based on the results of the intracutaneous histamine test. However, the results provide valuable insights into specific reaction patterns to experimental histamine-induced itch, e.g. sex-specific differences in the neurophysiology of Pruritus, which should be considered in future studies.
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medical needs and major complaints related to Pruritus in germany a 4 year retrospective analysis using google adwords keyword planner
Journal of The European Academy of Dermatology and Venereology, 2019Co-Authors: Alexander Zink, Barbara Schuster, Melvin Ruth, Manuel P Pereira, Wolfgang G Philippdormston, Tilo Biedermann, Sonja StänderAbstract:BACKGROUND It is difficult to estimate the prevalence of acute and chronic Pruritus in the population at large due to a lack of affected persons seeking medical assistance. OBJECTIVE To discover the incidence of Pruritus in Germany and determine what the most common related complaints are via an analysis of Google's search volume. METHODS From June 2013 to April 2017, the Google AdWords Keyword Planner was utilized to select and critically assess relevant keywords for 'Pruritus'. RESULTS Among a total of 13 691 470 German language Google searches on the topic of Pruritus, it was found that the most searched for terms included atopic eczema (24.3%) and the layman's term for psoriasis ('Schuppenflechte'; 17.8%), as well as just psoriasis (13.4%). 'Juckreiz', the German word for Pruritus, was determined to be only the sixth most searched for term (2.9%). Anal Pruritus and Pruritus of the entire body comprised the most searched for localizations. The various factors that impact Pruritus, particularly skin conditions and disorders, were established to be among the most searched for terms (72.6%). A decreased monthly search volume was associated with the changing seasons; the summertime had the lowest number of searches for Pruritus. CONCLUSION The Google search engine analysis provided insight for this study into the unexpectedly large number of unmet medical needs of those suffering from Pruritus within Germany, especially that of specific localizations on the body.
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visual analogue scale evaluation of the instrument for the assessment of Pruritus
Acta Dermato-venereologica, 2012Co-Authors: Adam Reich, Monika Heisig, Ngoc Quan Phan, Kenichi Taneda, Kenji Takamori, Satoshi Takeuchi, Masutaka Furue, Christine Blome, Matthias Augustin, Sonja StänderAbstract:The aim of this study was to evaluate the visual analogue scale (VAS) as a method of Pruritus assessment. A total of 310 subjects with pruritic dermatoses (148 Caucasian subjects and 162 Asian subjects) were recruited. The patients assessed Pruritus intensity using the horizontal and vertical VAS, numeric rating scale (NRS) and verbal rating scale (VRS). All scales showed very good reproducibility (intraclass coefficient (ICC) > 0.8). No significant differences were found between the horizontal and vertical VAS (5.3 ± 2.9 vs. 5.3 ± 3.0 points, p = 0.34). Using NRS, patients rated their Pruritus significantly higher than with VAS (5.7 ± 2.6 points, p 0-< 4 points = mild Pruritus, ≥ 4-< 7 points = moderate Pruritus, ≥ 7-< 9 points = severe Pruritus, and ≥ 9 points = very severe Pruritus. In conclusion, the VAS is a valuable method of Pruritus measurement.
Adam Reich - One of the best experts on this subject based on the ideXlab platform.
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visual analogue scale evaluation of the instrument for the assessment of Pruritus
Acta Dermato-venereologica, 2012Co-Authors: Adam Reich, Monika Heisig, Ngoc Quan Phan, Kenichi Taneda, Kenji Takamori, Satoshi Takeuchi, Masutaka Furue, Christine Blome, Matthias Augustin, Sonja StänderAbstract:The aim of this study was to evaluate the visual analogue scale (VAS) as a method of Pruritus assessment. A total of 310 subjects with pruritic dermatoses (148 Caucasian subjects and 162 Asian subjects) were recruited. The patients assessed Pruritus intensity using the horizontal and vertical VAS, numeric rating scale (NRS) and verbal rating scale (VRS). All scales showed very good reproducibility (intraclass coefficient (ICC) > 0.8). No significant differences were found between the horizontal and vertical VAS (5.3 ± 2.9 vs. 5.3 ± 3.0 points, p = 0.34). Using NRS, patients rated their Pruritus significantly higher than with VAS (5.7 ± 2.6 points, p 0-< 4 points = mild Pruritus, ≥ 4-< 7 points = moderate Pruritus, ≥ 7-< 9 points = severe Pruritus, and ≥ 9 points = very severe Pruritus. In conclusion, the VAS is a valuable method of Pruritus measurement.
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Pruritus in the elderly
Clinics in dermatology, 2011Co-Authors: Adam Reich, Sonja Ständer, Jacek C. SzepietowskiAbstract:Pruritus is an unpleasant sensation leading to the desire to scratch. It is the most common symptom in dermatology, and various skin and systemic diseases can be associated with the presence of itching. Pruritus may also be provoked by numerous drugs. Although the exact epidemiologic data are still absent, it is generally accepted that elderly people frequently suffer from Pruritus, and the problem of itching in this population remains a challenge for clinicians. The elderly often complain of numerous comorbidities that complicate the determination of the cause of Pruritus, as well as its treatment. Physical and mental deprivation may complicate proper assessment of Pruritus severity and negatively impair compliance with complex antipruritic therapies. Taking also into account heterogeneity of possible causes of Pruritus, every patient with Pruritus must be handled individually, regarding the diagnostic procedures and antipruritic therapy.
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Drug-induced Pruritus: a review.
Acta dermato-venereologica, 2009Co-Authors: Adam Reich, Sonja Ständer, Jacek C. SzepietowskiAbstract:Pruritus is an unpleasant sensation that leads to scratching. In addition to several diseases, the administration of drugs may induce Pruritus. It is estimated that Pruritus accounts for approximately 5% of all skin adverse reactions after drug intake. However, to date there has been no systematic review of the natural course and possible underlying mechanisms of drug-induced Pruritus. For example, no clear distinction has been made between acute or chronic (lasting more than 6 weeks) forms of Pruritus. This review presents a systematic categorization of the different forms of drug-induced Pruritus, with special emphasis on a therapeutic approach to this side-effect.
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efficacy and tolerance of the cream containing structured physiological lipids with endocannabinoids in the treatment of uremic Pruritus a preliminary study
Acta Dermatovenerologica Croatica, 2005Co-Authors: Jacek C. Szepietowski, Tomasz Szepietowski, Adam ReichAbstract:®® ) and endogenous cannabinoids in controlling Pruritus in patients on maintenance hemodialysis. Twenty-one subjects with uremic Pruritus completed the trial. All patients applied the tested cream twice daily for a period of three weeks. Pruritus was evaluated using two Pruritus scoring methods: standard visual analog scale (VAS) and a questionnaire method. Moreover, all patients had dry skin scored according to the 5-point scale. Global Pruritus and xerosis were examined before the trial, on study visits at weekly intervals, and on follow-up visit performed two weeks of study discontinuation. After 3-week therapy Pruritus was completely eliminated in 8 (38.1%) patients. Pruritus evaluation by both scales revealed significant reduction of Pruritus scores (p<0.0001) during the tested product application. At the beginning of the trial there was no significant correlation between the intensity of dry skin and severity of Pruritus. The 3-week treatment period resulted in complete reduction of xerosis in 17 (81%) patients, while xerosis scores were significantly reduced (p=0.0001) throughout the study period. The test product was very well tolerated by all patients.The test product appeared to be effective in reducing both Pruritus and xerosis in hemodialysis patients. It is very probable that the observed decrease of Pruritus with the test product therapy was not only the result of dry skin improvement but that the addition of endocannabinoids may have also played a role. These preliminary results are encouraging, however, additional controlled studies are needed to clarify the exact usefulness of this product in therapy of uremic Pruritus.
Essam M. Akl - One of the best experts on this subject based on the ideXlab platform.
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Evaluation of serum levels of neurotrophin 4 and brain-derived nerve growth factor in uremic Pruritus patients.
Clinical cosmetic and investigational dermatology, 2019Co-Authors: Neveen E. Sorour, Fatma M. El-esawy, Hala Abd El-mageed Tabl, Mohammed E Ibrahim, Essam M. AklAbstract:Background Pruritus is a common symptom in end-stage renal failure. Many patients suffer from this severe distressing symptom. Although several factors have been postulated to explain uremic Pruritus, there is not any conclusive evidence for one of these factors. Objectives We aimed to evaluate serum levels of brain-derived nerve growth factor (BDNF), neurotrophin-4 (NT-4), serum calcium, phosphors and parathyroid hormone in uremic patients with Pruritus and without Pruritus compared to control subjects. Methods One hundred twenty patients suffering from renal failure and 60 healthy subjects were included in the study. Serum BDNF and NT4 levels were determined by ELISA. The serum calcium, phosphorus, parathyroid hormone and hemoglobin were also evaluated. Results Serum BDNF was significantly higher in uremic patients with Pruritus (P=0.0026) and uremic patients without Pruritus (P=0.0294) than control subjects. In addition, NT-4 levels were significantly elevated in uremic patients with Pruritus (P
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evaluation of serum levels of neurotrophin 4 and brain derived nerve growth factor in uremic Pruritus patients
Clinical Cosmetic and Investigational Dermatology, 2019Co-Authors: Neveen E. Sorour, Hala Abd El-mageed Tabl, Mohammed E Ibrahim, Fatma M Elesawy, Essam M. AklAbstract:Background Pruritus is a common symptom in end-stage renal failure. Many patients suffer from this severe distressing symptom. Although several factors have been postulated to explain uremic Pruritus, there is not any conclusive evidence for one of these factors. Objectives We aimed to evaluate serum levels of brain-derived nerve growth factor (BDNF), neurotrophin-4 (NT-4), serum calcium, phosphors and parathyroid hormone in uremic patients with Pruritus and without Pruritus compared to control subjects. Methods One hundred twenty patients suffering from renal failure and 60 healthy subjects were included in the study. Serum BDNF and NT4 levels were determined by ELISA. The serum calcium, phosphorus, parathyroid hormone and hemoglobin were also evaluated. Results Serum BDNF was significantly higher in uremic patients with Pruritus (P=0.0026) and uremic patients without Pruritus (P=0.0294) than control subjects. In addition, NT-4 levels were significantly elevated in uremic patients with Pruritus (P<0.0001) and uremic patients without Pruritus than control subjects (P=0.0016). There was no significant difference of serum level of BDNF between uremic patients with Pruritus and uremic patients without Pruritus (P=0.1215). However, serum NT-4 was higher in uremic patients with Pruritus vs nonpruritic uremic patients with a significant difference (P=0.0026). There was a positive significant correlation between serum level of NT-4 and severity of Pruritus (P=0.024). Conclusion The present study shows that NT-4 level is increased in the serum of uremic patients with Pruritus and there was a significant correlation between NT-4 and severity of Pruritus suggesting that NT-4 may have a role in uremic Pruritus.
Jacek C. Szepietowski - One of the best experts on this subject based on the ideXlab platform.
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European S2k Guideline on Chronic Pruritus.
Acta dermato-venereologica, 2019Co-Authors: Elke Weisshaar, Joanna Wallengren, Jacek C. Szepietowski, Ulf Darsow, Laurent Misery, Thomas Mettang, Uwe Gieler, Torello Lotti, Julien Lambert, Peter MaiselAbstract:Pruritus is a frequent symptom in medicine. Population-based studies show that every 5th person in the general population has suffered from chronic Pruritus at least once in the lifetime with a 12-month incidence of 7%. In patient populations its frequency is much higher depending on the underlying cause, ranging from around 25% in haemodialysis patients to 100% in skin diseases such as urticaria and atopic dermatitis (AD). Pruritus may be the result of a dermatological or non-dermatological disease. Especially in non-diseased skin it may be caused by systemic, neurological or psychiatric diseases, as well as being a side effect of medications. In a number of cases chronic Pruritus may be of multifactorial origin. Pruritus needs a precise diagnostic work-up. Management of chronic Pruritus comprises treatment of the underlying disease and topical treatment modalities, including symptomatic antipruritic treatment, ultraviolet phototherapy and systemic treatment. Treating chronic Pruritus needs to be targeted, multimodal and performed in a step-wise procedure requiring an interdisciplinary approach. We present the updated and consensus based (S2k) European guideline on chronic Pruritus by a team of European Pruritus experts from different disciplines. This version is an updated version of the guideline that was published in 2012 and updated in 2014 (www.euroderm.org).
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Pruritus in the elderly
Clinics in dermatology, 2011Co-Authors: Adam Reich, Sonja Ständer, Jacek C. SzepietowskiAbstract:Pruritus is an unpleasant sensation leading to the desire to scratch. It is the most common symptom in dermatology, and various skin and systemic diseases can be associated with the presence of itching. Pruritus may also be provoked by numerous drugs. Although the exact epidemiologic data are still absent, it is generally accepted that elderly people frequently suffer from Pruritus, and the problem of itching in this population remains a challenge for clinicians. The elderly often complain of numerous comorbidities that complicate the determination of the cause of Pruritus, as well as its treatment. Physical and mental deprivation may complicate proper assessment of Pruritus severity and negatively impair compliance with complex antipruritic therapies. Taking also into account heterogeneity of possible causes of Pruritus, every patient with Pruritus must be handled individually, regarding the diagnostic procedures and antipruritic therapy.
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Drug-induced Pruritus: a review.
Acta dermato-venereologica, 2009Co-Authors: Adam Reich, Sonja Ständer, Jacek C. SzepietowskiAbstract:Pruritus is an unpleasant sensation that leads to scratching. In addition to several diseases, the administration of drugs may induce Pruritus. It is estimated that Pruritus accounts for approximately 5% of all skin adverse reactions after drug intake. However, to date there has been no systematic review of the natural course and possible underlying mechanisms of drug-induced Pruritus. For example, no clear distinction has been made between acute or chronic (lasting more than 6 weeks) forms of Pruritus. This review presents a systematic categorization of the different forms of drug-induced Pruritus, with special emphasis on a therapeutic approach to this side-effect.
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efficacy and tolerance of the cream containing structured physiological lipids with endocannabinoids in the treatment of uremic Pruritus a preliminary study
Acta Dermatovenerologica Croatica, 2005Co-Authors: Jacek C. Szepietowski, Tomasz Szepietowski, Adam ReichAbstract:®® ) and endogenous cannabinoids in controlling Pruritus in patients on maintenance hemodialysis. Twenty-one subjects with uremic Pruritus completed the trial. All patients applied the tested cream twice daily for a period of three weeks. Pruritus was evaluated using two Pruritus scoring methods: standard visual analog scale (VAS) and a questionnaire method. Moreover, all patients had dry skin scored according to the 5-point scale. Global Pruritus and xerosis were examined before the trial, on study visits at weekly intervals, and on follow-up visit performed two weeks of study discontinuation. After 3-week therapy Pruritus was completely eliminated in 8 (38.1%) patients. Pruritus evaluation by both scales revealed significant reduction of Pruritus scores (p<0.0001) during the tested product application. At the beginning of the trial there was no significant correlation between the intensity of dry skin and severity of Pruritus. The 3-week treatment period resulted in complete reduction of xerosis in 17 (81%) patients, while xerosis scores were significantly reduced (p=0.0001) throughout the study period. The test product was very well tolerated by all patients.The test product appeared to be effective in reducing both Pruritus and xerosis in hemodialysis patients. It is very probable that the observed decrease of Pruritus with the test product therapy was not only the result of dry skin improvement but that the addition of endocannabinoids may have also played a role. These preliminary results are encouraging, however, additional controlled studies are needed to clarify the exact usefulness of this product in therapy of uremic Pruritus.
Ulrich Beuers - One of the best experts on this subject based on the ideXlab platform.
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Advances in Pathogenesis and Management of Pruritus in Cholestasis
Digestive diseases (Basel Switzerland), 2014Co-Authors: Andreas E. Kremer, Ruth Bolier, Remco Van Dijk, Ronald P.j. Oude Elferink, Ulrich BeuersAbstract:Chronic Pruritus is a burdensome feature of numerous hepatobiliary disorders such as primary biliary cirrhosis, primary sclerosing cholangitis, cholangiocarcinoma, inherited forms of cholestasis and intrahepatic cholestasis of pregnancy. Bile salts, μ-opioids, serotonin, histamine and steroids have been controversially discussed in the pathogenesis of cholestatic Pruritus. However, for these substances neither a correlation with itch severity nor a causative link has ever been established. Recent findings indicate that the potent neuronal activator lysophosphatidic acid and autotaxin, the enzyme forming lysophosphatidic acid, may play a key element in the pathogenesis of cholestatic Pruritus. Serum activity of autotaxin correlated with itch intensity and response to antipruritic treatment in patients with cholestatic Pruritus, but not other forms of Pruritus. Autotaxin activity thereby represents the first biomarker for Pruritus and had a positive predictive value of 70% in differentiating cholestatic Pruritus from other forms of Pruritus. Treatment options for patients with cholestatic Pruritus include the anion exchange resin colestyramine, the PXR agonist rifampicin, the μ-opioid antagonist naltrexone, and the serotonin reuptake inhibitor sertraline. These drugs are recommended by evidence-based guidelines as a stepwise therapeutic approach. Patients unresponsive to these drugs should be referred to specialized centers to receive experimental approaches such as UVB phototherapy, albumin dialysis, plasmapheresis or nasobiliary drainage. This review discusses pruritogen candidates in cholestasis, gives novel insights into the neuronal signaling pathway of Pruritus and summarizes evidence-based treatment options for patients suffering from Pruritus in cholestasis.
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Plasma separation and anion adsorption transiently relieve intractable Pruritus in primary biliary cirrhosis
Journal of hepatology, 2006Co-Authors: Thomas Pusl, Gerald Denk, Klaus G. Parhofer, Ulrich BeuersAbstract:Background/Aims Pruritus can be a severely disabling symptom in patients with primary biliary cirrhosis who do not respond to treatment with ursodeoxycholic acid, anion exchangers, enzyme inducers, or opiate antagonists. The aim of this study was to assess the clinical efficacy of plasma separation and anion adsorption in the treatment of intractable Pruritus of cholestasis. Methods Three patients with primary biliary cirrhosis and intractable Pruritus defined by severity of Pruritus ⩾7 on a rating scale between 0 (no Pruritus) and 10 (maximal Pruritus) on at least 4 of 7 days despite medical treatment were treated with plasma separation and anion adsorption on three consecutive days. Fatigue was assessed using the Fisk Fatigue Severity Score and quality of life was assessed by the PBC-40, a disease specific health related quality of life measure. Results Improvement in Pruritus, fatigue, and quality of life was transiently observed in all patients. Serum bile acid levels showed no association with intensity of Pruritus, and the bile acid pattern was not altered. The treatment was well tolerated by all patients. Conclusions Plasma separation and anion adsorption seem to be a safe and effective therapeutic option for patients with primary biliary cirrhosis suffering from intractable Pruritus.
