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Query: UMLS:C0033774 (pruritus)
 14,546 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Herpes zoster (HZ; shingles) results from reactivation of varicella-zoster virus that has been dormant in the spinal and cranial sensory ganglia following primary infection with varicella (chickenpox), usually during childhood. In developed countries more than 95% of the adult population are seropositive for varicella-zoster virus and are therefore at risk of developing HZ. Reactivation can occur at any age, but it is associated with an age-related decline in cell-mediated immunity and therefore occurs more frequently in older adults. Thus, HZ affects up to 25% of individuals during their lifetime, but approximately 50% of those aged 80 years or more. Whilst the disease is rarely life-threatening, it is associated with a number of acute symptoms such as a vesicular rash and pain. Longer-term complications include visual disturbances and postherpetic neuralgia (PHN), which is potentially the most troubling problem of all, and is associated with severe itching and allodynia. These can combine to negatively impact the day-to-day functioning and quality of life of the patient. Hospitalization associated with HZ and PHN is frequent in older individuals and a significant cost to healthcare providers. Current management of HZ with antiviral drugs and analgesics produces reasonable results in younger patients, in whom the disease is usually milder, and is effective against acute pain and skin rash. However, it is much less effective against PHN, which occurs more commonly and more severely in older patients. Once PHN has developed, current treatments offer only limited benefit and adverse effects are common. Management is challenging and often unsatisfactory (<50% of patients gain 50% relief of pain). With the older adult population steadily growing in size, the number of patients presenting with HZ is also likely to increase and this will place a greater burden on healthcare systems. Prevention strategies, such as vaccinating those at greatest risk, may offer the best option for the future.
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PMID:Herpes zoster and postherpetic neuralgia. 2019 14

Zoster is a localised, generally painful cutaneous eruption that occurs most frequently among older adults and immunocompromised persons. It is caused by reactivation of latent varicella zoster virus (VZV). A common complication of zoster is postzosteric neuralgia (PZN), a chronic, often debilitating pain condition that can last months or even years. The risk for PZN in patients with zoster is 10 % - 20 %. Another complication of zoster is eye involvement, which occurs in 10- 25 % of zoster episodes and can result in prolonged or permanent pain, severe itch, facial scarring, and loss of vision etc. Prompt treatment with the oral antiviral agents acyclovir, valacyclovir, brivudine or famciclovir decreases the severity and duration of zoster-associated pain (ZAP). Additional pain control can be achieved by supplementing antiviral agents with analgesics, tricyclic antidepressants, and other agents, e. g., gabapentin. Efficacy of the therapy depends on its early initiation. Because zoster starts with unspecific symptoms, specific treatment starts late, as a rule 3 - 7 days after the beginning of virus replication, responsible for complications. A licensed zoster vaccine is a preparation of a live, attenuated strain of VZV, the same strain used in the varicella vaccines. However, its minimum potency is at least 14-times higher than the potency of single-antigen varicella vaccine. In a large clinical trial, zoster vaccine was more than 50 % efficacious for preventing zoster. It is also efficacious in reducing the severity and duration of pain and preventing PHN. Therefore zoster vaccination is recommended for elderly persons.
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PMID:[Skin involvement in zoster]. 2049 Sep 89

The purpose of these case reports is to describe treatment of three consecutive patients with post-herpetic neuralgia using a bioelectronical device (SCENAR). The instrument is approved as a Class II device in the United States. The electrode of the device was stroked gently over the involved skin area for up to 15 minutes per session. No more than 5 sessions over a 3-week period was required. All patients experienced substantial relief of pain from the first treatment. One patient required only 1 treatment lasting 10 minutes. The other 2 patients required 4 to 5 treatments over a 3-week period. One patient required a treatment for skin itch after one year with a follow up period of 6 months to 24 months. An electronic biofeedback device (SCENAR) may be successfully utilized in the management of post-herpetic neuralgia.
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PMID:The use of electronic biofeedback for the management of post-herpetic neuralgia--a report of 3 cases. 2087 66

Herpes zoster is a skin disease encountered commonly in dermatologic practice. While post-herpetic neuralgia (PHN) is a familiar side effect of this condition, it is not the only neuropathic symptom that can result. Post-herpetic itch (PHI) is less well known, but should be considered when evaluating a patient after an occurrence of zoster. Gabapentin has been successfully used to treat cutaneous pain and pruritus in a variety of conditions. The authors describe a case of PHI successfully treated with a course of gabapentin and propose that this agent be considered for use in patients who present with PHI.
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PMID:A case of post-herpetic itch resolved with gabapentin. 2119 29

Neurogenic pain and pruritus are the common chief complaints at dermatology office visits. Unfortunately, they are also notoriously difficult conditions to treat. Topical capsaicin used as a single therapy or as an adjuvant offers a low-risk option for patients who do not achieve control on other therapies. This chapter presents the evidence behind topical capsaicin use in dermatologic conditions characterized by neurogenic pain or pruritus, including postherpetic neuralgia, notalgia paresthetica, brachioradial pruritus, lichen simplex chronicus, prurigo nodularis, pruritus ani, pruritus of hemodialysis, aquagenic pruritus, apocrine chromhidrosis, lipodermatosclerosis, alopecia areata, and psoriasis. It presents the most common capsaicin formulations, dosages, and durations of treatment for each condition. Additionally, the chapter addresses various adverse effects and limitations in the use of topical capsaicin in dermatology.
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PMID:The role of capsaicin in dermatology. 2494 74

Frequent causes of morbidity secondary to herpes zoster include acute pain, secondary infection, and postherpetic neuralgia. A less documented complication is pruritus, which can be either acute or postinfectious when it persists more than 3 months after the rash has healed. We discuss a case of severe, acute neuropathic pruritus and pain secondary to active herpes zoster that was unresponsive to standard medical therapy, including oral antihistamines, topical lidocaine, oral gabapentin, and local wound care. Modest control of the pruritus and pain was achieved with continued multimodal therapy and the addition of topical 2% amitriptyline/0.5% ketamine gel.
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PMID:Amitriptyline/Ketamine as therapy for neuropathic pruritus and pain secondary to herpes zoster. 2568 5

Risk factors for postherpetic neuralgia (PHN) include: increasing age; a prodrome of pain before rash onset; the degree of spread of the rash, particularly if it extends beyond a single dermatome; and severity of pain during the acute attack. Forty per cent of patients over 50 and 75% of those over 75 develop PHN following resolution of the rash. Patients develop persistent pain classified as PHN 120 days following rash onset. It can be either constant or paroxysmal and is commonly described as burning, stabbing or itching and located in the same dermatomal distribution as the shingles rash. Pain can lead to sleep disturbance, anorexia, reduced socialisation and reactive depression. Paracetamol should be tried initially for mild to moderate pain, either alone or in combination with codeine but there is no evidence to support the use of NSAIDs. Compared with other antidepressants, tricyclic antidepressants are the most likely to confer benefit in neuropathic pain. In frail elderly patients nortriptyline appears to be tolerated best. Both gabapentin and pregabalin can reduce pain and improve sleep patterns in patients with PHN. Patients with severe pain or those whose condition is affecting their daily activities and function should be referred to a specialist in pain management.
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PMID:Diagnosis and management of postherpetic neuralgia. 2572 17

We present the case of a 49-year-old woman with trigeminal trophic syndrome (TTS), also known as trophic trigeminal neuralgia, trigeminal neurotrophic ulceration, and/or trigeminal neuropathy with nasal ulceration. Our case represents an uncommon report of intractable itching and chronic pain associated with TTS. Emphasis was placed on skin biopsy histology, which revealed no neuronal innervation of the affected scalp despite reports of intractable itching and chronic pain. Trigeminal trophic syndrome of the V1 branch of the trigeminal nerve secondary to herpes zoster (HZ) with correlated histology is described. This article provides a discussion of TTS and correlated histology as well as a brief discussion of intractable itching and postherpetic neuralgia.
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PMID:Trigeminal trophic syndrome with histopathologic correlation. 2584 91

Background. Herpes zoster infection is a painful worldwide disease. Inappropriate and delayed treatment causes prolongation of the disease with debilitating symptoms and postherpetic neuralgia. Method. A cross-sectional study evaluated shingles cases admitted in a teaching hospital with one-year followup in north of Iran from 2007 to 2013. Results. From 132 patients, 60.4% were male. Head and neck involvement occurred in 78 people (59.1%), thoracoabdominal region in 37 cases (28%), and extremities in 16 cases (12.1%), and one case (0.8%) got multisites involvement. 54 cases (40.9%) had predisposing factors including diabetes mellitus in 26 cases (19.7%), malignancy in 15 (11.4%), immunosuppressive medication in 7 (5.03%), HIV infection in 3 (2.3%), radiotherapy in 2 (1.5%), and tuberculosis in one patient (0.8%). The most common symptoms were pain (95.5%), weakness (56%), fever (31.1%), headache (30.3%), ocular complaints (27.3%), itching (24.2%), and dizziness (5.3%). 21 cases (15.9%) had bacterial superinfection on blistering areas and overall 18 cases (13.6%) had opium addiction. 4 cases (3.03%) died during admission because of comorbidities. Postherpetic neuralgia was reported in 56 patients (42.5%) after three months and seven cases (5%) in one-year followup. Conclusion. Shortening interval between skin lesion manifestation and starting medication can accelerate lesion improvement and decrease disease course, extension, and complication.
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PMID:Clinical manifestations of herpes zoster, its comorbidities, and its complications in north of iran from 2007 to 2013. 2589 16

Small fiber neuropathies (SFNs) are a subgroup of sensory neuropathies that almost exclusively affect thinly myelinated A-delta or unmyelinated C-nerve fibers. Patients with SFN typically report acral burning pain, paresthesias, and dysesthesias, and sometimes itch manifesting particularly at toes and feet. Although neurological examination and standard neurophysiological assessment are normal to only marginally abnormal, special small nerve fiber tests may show functional, electrical, and morphological small fiber pathology. Interestingly, the application of small nerve fiber assessment tools has revealed similar findings also in other painful and nonpainful disorders, such as the complex regional pain syndrome, postherpetic neuralgia, or fibromyalgia syndrome. The diversity in clinical presentation, however, already implies that different pathophysiological mechanisms underlie small nerve fiber degeneration and regeneration in these disorders. This review aims at presenting current knowledge on small nerve fiber research and at intensifying the awareness for SFN vs small fiber pathology as a chance to learn about small nerve fiber pathophysiology.
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PMID:Small fiber pathology--a culprit for many painful disorders? 2841 5


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