UMLS:C0033774 - FACTA Search

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Query: UMLS:C0033774 (pruritus)
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Tacrolimus is an ascomycin macrolactam derivative with immunomodulatory and anti-inflammatory activity that belongs to the class of calcineurin inhibitors. Tacrolimus in its topical formulation has been established as a safe and effective alternative to topical corticosteroids because of its mild side effects and its minimal systemic absorption. Topical tacrolimus has been approved for the treatment of atopic dermatitis in two concentrations, 0.03 and 0.1%. In a thorough research of literature the authors review all of the available data regarding the off-label uses of the medication in other dermatoses. It seems that compared to pimecrolimus, tacrolimus has proved to be a more effective treatment. There is no causal relationship that has been established between tacrolimus and carcinogenesis. Furthermore, the authors believe that, without any evidence, the theoretical concerns are not enough to produce warnings. Tacrolimus ointment 0.1% may be recommended as a first-line choice for seborrheic dermatitis of the face and trunk, facial and intertriginous psoriasis and probably for allergic contact dermatitis and Zoon's balanitis. It has been ineffective in numerous dermatoses such as alopecia areata, necrobiosis lipoidica, internal pruritus and in thick hyperkeratotic plaques of psoriasis when administered as the commercially available formulation without occlusion. There is yet unexploited therapeutic potential regarding the use of topical tacrolimus in dermatology. Isolated cases of successful administration of the medication in various cutaneous conditions require further large-scale studies to clarify the actual effectiveness.
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PMID:Assigning new roles to topical tacrolimus. 1768 74

Perceived stress has long been allied with disturbances of the dynamic equilibrium established between the nervous, endocrine and immune systems, thus triggering or aggravating disease manifestation. Several common skin diseases are now acknowledged to be worsened by psychological stress, particularly immunodermatoses such as atopic dermatitis, psoriasis, seborrheic eczema, prurigo nodularis, lichen planus, chronic urticaria, alopecia areata and pruritus sine materia. Itch (pruritus) is perhaps the most common symptom associated with a majority of these inflammatory skin diseases, and acute as well as chronic stress perceptions are recognized to trigger or enhance pruritus. A wealth of mediators released systemically or locally in the skin in response to stress increase sensory innervation, upregulate the production of other pruritogenic agents, perpetuate (neurogenic) inflammation and lower the itch threshold. In the present review, we explore recent frontiers in both stress and pruritus research and portray the perpetuation of chronic skin inflammation and itch as a neuroendocrine-immune 'misalliance'. We argue that key candidate molecules of the stress response with strong pruritogenic potential, such as nerve growth factor, corticotropin-releasing hormone and substance P, and mast cells, which may be considered as 'central cellular switchboards of pruritogenic inflammation', need to be further explored systematically in order to develop more effective therapeutic combination strategies for itch management in chronic, stress-vulnerable inflammatory skin diseases.
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PMID:From the brain-skin connection: the neuroendocrine-immune misalliance of stress and itch. 1770 57

Pimecrolimus cream 1% has shown to be effective in patients with a variety of inflammatory cutaneous disorders. And it might be a useful modality in the treatment of seborrheic dermatitis. This prospective study was aimed at assessing the efficacy and tolerability of pimecrolimus cream 1% in the treatment of facial seborrheic dermatitis. Twenty patients were instructed to apply pimecrolimus cream 1% for 4 consecutive weeks. Assessment of the disease severity was performed at baseline and at week 1, 2, and 4. Clinical assessments of erythema, scaling, and pruritus were measured using a 4-point scale (0-3). Global assessments of the disease severity by patients and investigators were performed at each visit. Mean clinical scores of erythema, scaling, and pruritus significantly improved by 87.4%, 91.9%, and 91.5% respectively at week 4 (p<0.001). Improvements in the global assessment of disease severity determined by patients and investigators also showed excellent results. No specific adverse events other than transient burning and tingling sensations were noted. The relapse of facial seborrheic dermatitis was mostly observed between 3 to 8 weeks after the discontinuation of pimecrolimus. We suggest that the topical application of pimecrolimus cream 1% can be an effective and safe alternative for treatment of facial seborrheic dermatitis.
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PMID:Treatment of facial seborrheic dermatitis with pimecrolimus cream 1%: an open-label clinical study in Korean patients. 1798 37

Darier's disease is a rare disorder of keratinization of the epidermis, nails, and mucous membranes. Patients usually present with pruritus and pain along with multiple small, red-brown papules on the seborrheic areas. Other cutaneous signs include punctate keratotic pits of the palms and soles and dystrophy of the nails. Darier's disease is the result of a mutation in the ATP2A2 gene. A case which was difficult to diagnose because its presentation resembled more commonly seen skin conditions is reported. The patient was misdiagnosed with acne, eczema, and seborrheic dermatitis, and was treated without improvements. This case highlights the fact that skin disorders that do not respond to conventional therapy should lead physicians to suspect an uncommon or even serious cutaneous disorder. The diagnosis of Darier's disease, based on family history, clinical appearance, and histopathology, expedited the appropriate treatment.
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PMID:Darier's disease: a commonly misdiagnosed cutaneous disorder. 1845 21

Dandruff is a common scalp disorder affecting almost half of the postpubertal population of any ethnicity and both genders. It may, however, represent a stubborn esthetical disturbance often source of pruritus. Skin biocenosis, in particular the Malassezia spp. flora, plays a key aetiologic role, in combination with the unusual capacity of some corneocytes to be coated by these yeasts. Substantial evidence indicates that keratinocytes play an active role in the generation and expression of immunopathological reactions. This is probably the case in dandruff. Upon stimulation of a critical colonization of corneocytes by Malassezia yeasts, the release of pro-inflammatory mediators is increased. This could lead to the subclinical microinflammation present in dandruff. In seborrheic dermatitis, local deposits of immunoglobulins and the release of lymphokines are responsible for the recruitment and local activation of leukocytes leading to the eventual amplification of the inflammatory reaction. Some ancillary non-microbial causes of dandruff may operate through physical or chemical irritants. Many methods have been described for rating dandruff. Our favourite tools are clinical examination and squamometry. Dandruff can precipitate telogen effluvium and exacerbate androgenic alopecia. Antidandruff formulations exhibiting some direct or indirect anti-inflammatory activity can improve both dandruff and its subsequent hair cycle disturbance.
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PMID:Revisiting dandruff. 1848 95

Hair shedding and hair thinning have been reported to be affected by dandruff and seborrhoeic dermatitis. The present study was conducted in 150 men presenting with telogen effluvium related to androgenic alopecia associated with dandruff. They were randomly allocated to three groups receiving each one of the three shampoos in the market containing either 1% ketoconazole (KTZ), 1% piroctone olamine (PTO) or 1% zinc pyrithione (ZPT). Shampoos had to be used 2-3 times a week for 6 months. Hair shedding during shampoo was evaluated semiquantitatively. Hair density on the vertex was evaluated on photographs using a Dermaphot. Trichograms were used for determining the anagen hair percentage and the mean proximal hair shaft diameter using computerized image analysis. The sebum excretion rate (SER, mug cm(-2) h(-1)) was also measured using a Sebumeter. The three treatments cleared pruritus and dandruff rapidly. At end point, hair density was unchanged, although hair shedding was decreased (KTZ: -17.3%, PTO: -16.5%, ZPT: -10.1%) and the anagen hair percentage was increased (KTZ: 4.9%, PTO: 7.9%, ZPT: 6.8%). The effect on the mean hair shaft diameter was contrasted between the three groups of volunteers (KTZ: 5.4%, PTO: 7.7%, ZPT: -2.2%). In conclusion, telogen effluvium was controlled by KTZ, PTO and ZPT shampoos at 1% concentration. In addition, KTZ and PTO increased the mean hair shaft thickness while discretely decreasing the sebum output at the skin surface.
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PMID:Nudging hair shedding by antidandruff shampoos. A comparison of 1% ketoconazole, 1% piroctone olamine and 1% zinc pyrithione formulations. 1849 17

Aging skin undergoes progressive degenerative change. Structural and physiologic changes that occur as a natural consequence of intrinsic aging combined with the effects of a lifetime of ongoing cumulative extrinsic damage and environment insult (e.g. overexposure to solar radiation) can produce a marked susceptibility to dermatologic disorders in the elderly. As skin ages, the vasculature progressively atrophies. The supporting dermis also deteriorates, with collagen and elastin fibers becoming sparse and increasingly disordered. These changes leave the elderly increasingly susceptible to both vascular disorders such as stasis dermatitis and skin injuries such as pressure ulcers and skin tears, with a steadily decreasing ability to effect skin repair. A parallel erosion of normal immune function produces higher levels of autoimmune skin disorders such as bullous pemphigoid, benign mucous membrane pemphigoid, paraneoplastic pemphigoid, and pemphigus vulgaris. Lichen sclerosus, an autoimmune disorder often occurring in the genital area in older women, is not common but is an important development because of the potential for substantial discomfort as well as serious complications. The prevalence of polypharmacy in this population increases the risk for autoimmune drug reactions, and diagnosis should be undertaken with an awareness that polypharmacy in this population creates a greatly increased susceptibility to drug eruptions that can mimic other cutaneous disorders. Immunologic senescence in the elderly also sets the stage for potential reactivation of the Varicella zoster virus, in which initial dermatologic involvement expands into the major sensory ganglia. Known as shingles, this disorder can be excruciatingly painful with the potential to cause blindness if the optic nerve becomes involved. Dermatoses such as xerosis, pruritus, and eczema are also widespread in the elderly, create substantial suffering in those afflicted, and often prove recalcitrant to treatment. Individual susceptibility to specific types of contact dermatitis changes over the lifetime, and seborrheic dermatitis is substantially more prevalent in the elderly. It is not uncommon for older patients to have multiple impairments, with the potential for cognitive dysfunction as well as impaired vision, hearing, or mobility. In addition, they may not have adequate housing or nutrition, or the financial resources necessary for adequate compliance. Physicians must take into consideration the patient's physical ability to comply with the recommended therapy as well as socioeconomic factors that may impact on compliance. Simple topical regimens are preferable wherever possible in order to maximize compliance and, therefore, efficacy. Extra effort may be necessary to ensure that instructions are accurately followed and that ongoing compliance with the regimen prescribed is actually achieved. Management of dermatologic disorders in the elderly is often less than optimal, due to the fact that the special needs and limitations of this population are not adequately considered. Treatments should consider the intrinsic differences between younger and older patients that may impact on diagnosis and therapy choice. The aged patient is often afflicted with numerous co-morbidities that can influence the choice of therapy. Skin integrity in the elderly is compromised, and safety concerns are increased with the long-term use of any medication prescribed. In addition, the prevalence of polypharmacy in the aged population substantially increases the risk of cutaneous drug reactions, which can profoundly complicate accurate diagnosis of dermatologic disorders. The aged population also needs to be more closely monitored because of increased fragility of the skin and the physical limitations that may hinder compliance with prescribed regimens.
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PMID:Clinical implications of aging skin: cutaneous disorders in the elderly. 1922 48

Sertaconazole (Dermofix, Ertaczo, Ginedermofix, Monazol, Mykosert or Zalain), an imidazole antifungal agent, inhibits the synthesis of ergosterol, an essential cell wall component of fungi. It is indicated in the EU for the treatment of superficial skin mycoses such as dermatophytosis (including tinea corporis, tinea cruris, tinea manus, tinea barbae and tinea pedis), cutaneous candidiasis, pityriasis versicolor and seborrhoeic dermatitis of the scalp, and in the US for tinea pedis only. Sertaconazole has broad-spectrum antifungal activity against dermatophytes of the Trichophyton, Epidermophyton and Microsporum genera, and yeasts of the genera Candida and Cryptococcus; additionally, it is effective against opportunistic filamentous fungi and Gram-positive bacteria. Moreover, the antifungal activity of sertaconazole is maintained in clinical isolates of dermatophytes that show reduced susceptibility to other azoles. While the drug has good dermal penetration, this is not associated with systemic absorption. In clinical trials in patients with superficial mycoses, 2% sertaconazole cream applied twice daily was effective in the eradication of a range of dermatophytoses, and a significantly greater proportion of patients were cured compared with those receiving 2% miconazole cream twice-daily treatment. In patients with vulvovaginal candidiasis, sertaconazole as a single-dose ovule or tablet was effective in the eradication of Candida spp., and achieved both a more rapid and a higher cure rate compared with a triple dose of econazole. Both as a topical cream and suppository preparation, sertaconazole was generally well tolerated. Sertaconazole is a well established antifungal agent, which is now available in a variety of formulations, and remains a useful treatment option particularly in patients with fungal infections resistant to other azoles. Like other azoles, sertaconazole inhibits the synthesis of ergosterol, an essential component of fungal cell walls, resulting in disruption of mycelial growth and replication. However, at higher concentrations, sertaconazole binds directly to nonsterol lipids in the fungal cell wall, which leads to increased permeability and subsequent lysis of the mycelium. Thus, depending on the concentration, sertaconazole may exhibit both fungistatic and fungicidal activities. Sertaconazole shows good in vitro fungistatic activity against a broad range of dermatophytes of the Trichophyton, Epidermophyton and Microsporum genera, and yeasts of the genera Candida and Cryptococcus. The geometric minimum inhibitory concentration (MIC) of sertaconazole ranged from 0.06 to 1 microg/mL against a variety of dermatophyte isolates (n = 456), which included 114 isolates with reduced susceptibility to fluconazole (MICs > or = 16 microg/mL). Similarly, against a variety of Candida spp., MIC values at which 90% of cultures were inhibited (MIC(90)) for sertaconazole were < or = 0.1-4 microg/mL compared with MIC(90) of 0.1 to >100 microg/mL for fluconazole. Furthermore, fungicidal activity of sertaconazole was apparent against a variety of Candida spp., with minimum fungicidal concentration values of 0.5-64 microg/mL. Additionally, sertaconazole showed antibacterial activity with a geometric MIC of 0.88 microg/mL against 21 isolates of Gram-positive bacteria. When applied topically in experimental models of inflammation, sertaconazole showed some evidence of anti-inflammatory action. Only 4% of 250 clinical isolates of dermatophytes and Scopulariopsis brevicaulis from Spanish hospitals showed resistance to sertaconazole, and continuous culture of Candida spp. in sertaconazole-containing media failed to induce resistance. Following application of sertaconazole as a topical cream or vaginal suppository, plasma levels of the drug remained undetectable in healthy volunteers. In randomized, double-blind, multicentre trials of 3-6 weeks' duration (n = 127-383), a significantly greater number of patients with tinea of the glabrous skin and tinea pedis receiving topical 2% sertaconazole cream once or twice daily achieved a successful mycological cure compared with recipients of a placebo cream. Moreover, the clinical cure rate and the mycological cure rate of 2% sertaconazole cream twice daily was significantly higher than that of 2% miconazole cream twice daily in patients with a range of cutaneous mycoses (n = 631) in a randomized, double-blind, multicentre, phase III, comparator trial of 35 days' duration. Furthermore, a greater proportion of patients receiving sertaconazole achieved the category of clinically cured at a significantly earlier timepoint than recipients of miconazole. An open-label, noninferiority trial of 28 days' duration in 313 patients with tinea corporis, tinea pedis or a corresponding candidiasis showed that sertaconazole as a 2% solution was as effective as treatment with a 2% cream preparation. Sertaconazole as a single-dose 300 mg vaginal ovule or 500 mg tablet was successful in the eradication of Candida spp. in 65-100% of patients with vaginal candidiasis in trials that evaluated clinical and mycological cure rates up to 1 year after the last treatment application (n = 37-327). Furthermore, the clinical cure rate and the mycological cure rate of single-dose sertaconazole 500 mg tablet was significantly greater than that of triple-dose econazole 150 mg in the eradication of Candida albicans and also achieved a more rapid response rate in patients with vaginal candidiasis (n = 37). Sertaconazole was generally well tolerated in patients with dermatological and gynaecological mycoses. Adverse events associated with topical application of sertaconazole cream were mostly cutaneous-related and included contact dermatitis, dry or burning skin, application-site reaction, eczema, itch and skin tenderness. However, the frequency of adverse events did not differ from that of the placebo vehicle treatment arm. Furthermore, sertaconazole showed no evidence of a sensitizing action in causing contact dermatitis in healthy volunteers. Sertaconazole administered as a vaginal suppository was generally associated with an absence of adverse events and, where reported, included only local irritation after insertion.
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PMID:Sertaconazole: a review of its use in the management of superficial mycoses in dermatology and gynaecology. 1927 77

Malassezia-positive smears can be recognized from otitis externa, however, there are few references in the literature to the relation between Malassezia and otitis externa. Therefore, the bacterial and clinical characteristics of 72 cases (63 patients) with otitis externa were investigated at the Department of Otorhinolaryngology, Takinomiya General Hospital to analyze this. Thirty-seven cases were bacterial otitis externa, 20 cases were fungal otitis externa, and 15 cases were etiological agents unknown in this study. The causative organisms in fungal otitis externa were the genera Aspergillus (10 cases), Malassezia (5) and Candida (5), respectively. We suspected that 5 cases were caused by Malassezia because Malassezia cell counts were greater than 10 per field (x 400), and a large number of Malassezia were isolated from all cases. In these cases, many squamous epithelial cells were observed by direct examination, and cells from the middle or basal layer of the ear canal were also recognized in three cases. Therefore, accelerated turnover of epidermal cells of the ear canal was suggested. The main symptoms were itching and fullness in the ear, with observations of redness and erosion in objective deterioration, and we felt that these conditions were similar to seborrheic dermatitis (SD). In addition, these five cases were confirmed as fungus-related otitis externa by their improvement with antifungal agents.
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PMID:[A study of otitis externa associated with Malassezia]. 1943 Jan 86

A 3-years-old Iranian cross-breed ram with history of repeated local sweating, severe pruritus of body surface was referred to the veterinary clinic. On clinical examination wetness, warmness, pruritus and thickness of affected area were observed. In affected area, hair coat was staring and draggy. Body temperature, heart and respiratory rates were 40.4 degrees C, 120 beat min(-1) and 40 min(-1), respectively. Hematologic indices including packed cell volume, total and differential white blood cell (WBC) and total red blood cell (RBC) were normal. Laboratory examinations of skin scrapings confirmed infestation with Psoroptes ovis. Histopathologic findings included dilation of sweat glands, hyperplasia of sebaceous glands, hyperkeratosis, ulcer and scab formation and eosinophilic dermatitis. History and clinical findings association with the skin scraping and histopathologic findings indicated localized seborrhoeic dermatitis with hyperhidrosis. After treatment with ivermectin at the dose rate of 0.2 mg kg(-1), all clinical signs subsided. This confirmed that the cause of seborrhic dermatitis and hyperhidrosis was mite infestation and other possible causes were ruled out. So this is the first report of localized seborrhoeic dermatitis with hyperhidrosis due to mite infestation in animals.
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PMID:Localized seborrhoeic dermatitis with hyperhidrosis due to mite infestation in an Iranian cross-breed ram. 1957 43

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