Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0033774 (pruritus)
 14,546 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report the case of a patient who, while on long-term hemodialysis (HD), developed nephrogenic fibrosing dermopathy, a newly described sclerosing skin disorder. This disorder is characterized by thickened, hardened skin with brawny hyperpigmentation and raised plaques. The most common patient complaints are pruritus and dysesthesia. The extremities are predominantly involved with sparing of the torso and face. Dysfunction of internal organs has not been described, distinguishing it from other fibrosing conditions such as scleroderma. The skin biopsy is characterized by haphazardly arranged dermal collagen spindle cells in the reticular dermis. Extensive mucin deposits are interposed between collagen bundles and there are an increased number of fibroblast-type cells. In contrast to scleroderma, inflammatory cells are generally absent. Corticosteroid therapy can be tried, but in our patient was of no benefit.
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PMID:Nephrogenic fibrosing dermopathy: an unusual skin condition associated with kidney disease. 1275 92

A 43-year-old Chilean man presented with a 5-month history of progressive hypertrophy of the ears bilaterally. He was seen initially by a dermatologist in Chile for complaints of erythema and swelling of the ears, and had been treated unsuccessfully with topical steroids and antimicrobial ointments. On presentation to our clinic, the hypertrophy had stabilized and the erythema had resolved, but he complained of decreased hearing due to narrowing of the external auditory canal. Associated symptoms included occasional pruritus, but he denied any pain. He also denied a history of sinus problems, respiratory symptoms, ocular pain, chest pain, and arthralgias. Physical examination revealed firm hypertrophy of the collagenous areas of both ears, sparing the ear lobes (Fig. 1). No pain was elicited on palpation. No conjunctivitis was noted and the nasal passages were clear. His chest was clear to auscultation. Histologic examination revealed a minimal perivascular infiltrate of lymphocytes and plasma cells in the dermis with fibrosis of the subcutis (Fig. 2). Blood tests showed a normal complete blood count, antinuclear antibody, and rheumatoid factor. Anti-collagen II antibodies were elevated at 29.2 Eu/ml (normal, 0-20 Eu/ml; borderline, 20-25 Eu/ml; elevated, > 25 Eu/ml).
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PMID:Relapsing polychondritis. 1295 83

Most alpha-hydroxyacids and polyhydroxy acids are physiologic, natural, and nontoxic substances. All members of the group promote normal keratinization and desquamation. Those with multiple hydroxyl groups are moisturizing antioxidants, and are especially gentle for sensitive skin. Alpha-hydroxyacids and polyhydroxy acids can increase biosynthesis of glycosaminoglycans and collagen fibers, and cause substantial skin plumping and increased dermal thickness. Formulation of alpha-hydroxyacids and polyhydroxy acids in combination with pharmaceutical agents can enhance efficacy and diminish or eliminate side effects and drug resistance. N-acetylamino sugars and N-acetylamino acids are two other categories of physiologic substances that can: 1) increase skin thickness; 2) improve wrinkles and photoaged skin; and 3) eradicate itch in senile and eczematous dermatitis.
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PMID:Hydroxycarboxylic acids, N-acetylamino sugars, and N-acetylamino acids. 1467 37

Keloid scars are one of the most challenging problems for physicians and surgeons. These scars have been treated in many ways, with varying success. Verapamil is a widely used calcium channel antagonist, and it has been shown that calcium channel blockers inhibit the synthesis/secretion of extracellular matrix molecules, including collagen, glycosaminoglycans, and fibronectin, and increase collagenase. In this study, we performed total keloid excision in combination with reconstruction with W-plasty or skin grafting and injection of verapamil hydrochloride into the lesions of 21 patients with keloids. Patients were followed for minimum of 2 years, and the treatment outcome was evaluated based on the cosmetic appearances, symptomatic improvements, and the results of microscopic examinations. Also, patient satisfaction was scored with a visual analog scale. Two years after the operations, two patients had keloid in lesser diameter than the original lesions, two patients had lesions that were hypertrophic scars in appearance, and four patients had pruritus. One patient had keloid on the donor site. The rate of patient satisfaction was 6.4 on a scale of 1 to 10. We reviewed the treatment of keloid in this study and obtained one of the lower rates of complication in the literature. We believe that surgical excision with W-plasty or skin grafting and intralesional verapamil injection may be a good alternative in the treatment of keloid.
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PMID:Combination of surgery and intralesional verapamil injection in the treatment of the keloid. 1472 33

Keloids are skin abnormalities that are characterized by excessive deposition of collagen bundles in the dermis. Patients with keloids complain not only about their cosmetic appearance, but also about continuous itching and/or tenderness associated with chronic inflammation. Degradation of extracellular matrix (ECM) may be upregulated, associated with the expansion of keloids into circumferential skin, and high metabolic activity of keloid tissues may be due to increased matrix metalloproteinase (MMP) activity. Based on these hypotheses, we examined differences in expression of MMP-1, MMP-8, and MMP-13 between keloid-derived and normal dermal fibroblasts. Since retinoids are potent inhibitors of MMPs in the treatment of photoaged skin and cancers, we also examined whether or not tretinoin affects MMP expression of keloid-derived fibroblasts. The results of real-time polymerase chain reaction and ELISA demonstrated significant upregulation of MMP-13 and significant downregulation of MMP-1 and MMP-8 in keloid-derived fibroblasts, at both mRNA and protein levels. MMP-1 mRNA expression in the control group was significantly upregulated after the addition of tretinoin, whereas no significant change was observed in the keloid group. MMP-8 mRNA expression in the control group was significantly upregulated by tretinoin, with the peak at 12 h, while no significant change was observed in the keloid-derived fibroblasts. In contrast, the remarkably elevated MMP-13 mRNA expression in the keloid group was significantly suppressed, with the peak suppression at 12 h after addition of tretinoin, while MMP-13 mRNA expression in the control group was not significantly changed. The decrease in MMP-1 and MMP-8 may contribute to accumulation of type I and type III collagen in keloid tissues, and this mechanism may be modulated by molecular interaction with MMP-13. Tretinoin appeared to reverse the abnormal expression profile of MMPs in keloid-derived fibroblasts, such as markedly elevated expression of MMP-13, partly through inactivation of AP-1 pathway. The present results suggest that tretinoin may be clinically useful to improve the chronic inflammation seen in keloids and prevent expansion of keloid tissues into circumferential normal skin.
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PMID:Tretinoin reverses upregulation of matrix metalloproteinase-13 in human keloid-derived fibroblasts. 1475 22

We experienced an unusual case of mycosis fungoides with the clinical and histological features mimicking inflammatory linear verrucous epidermal nevus (ILVEN) in an 11-year-old boy. Localized linear multiple pruritic verrucous confluent papules and plaques appeared on the his left elbow, forearm and hand for 7 months. Skin biopsies showed characteristic findings of mycosis fungoides (e.g. Pautrier's microabscesses, follicular epitheliotropism, wiry bundles of collagen, etc.). T-cell receptor gene rearrangement analysis in the lesional skin demonstrated rearrangement of the gamma chain. RePUVA (systemic PUVA with retinoic acid) therapy improved his skin lesions and pruritus, but these progressed after discontinuation of treatment. Thus, lesions mimicking ILVEN can be an unusual and potentially misleading presentation of mycosis fungoides.
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PMID:Mycosis fungoides mimicking inflammatory linear verrucous epidermal nevus. 1500 11

Aged skin is characterized by rhytides but also by epidermal and dermal atrophy, rough skin texture, irregular pigmentation, telangiectasias, and laxity. Microdermabrasion is an office-based mechanical resurfacing technique alternative to traditional dermabrasion. It has been used in Europe since 1992 with great acceptance. The purpose of this study was to evaluate and quantify the degree of visible improvement in photodamaged skin and fine rhytides following a series of microdermabrasion treatments. A single operator treated 20 patients with varying degrees of photodamage and rhytides with a series of eight microdermabrasion treatments at 1-week intervals; 17 subjects completed the entire study protocol. Standardized photographic documentation was performed before and after each treatment, and a survey questionnaire was completed by each subject. Punch biopsy specimens (3 mm) were collected on treated and matched nontreated control sites and evaluated for histological characteristics. Preprocedure and postprocedure photographs were rated on a 5-point scale by independent blinded observers. A total of 30 blinded observers (16 plastic surgeons and 14 laypersons) rated all photographs. The results showed that all observers rated a significant improvement of hyperchromic discoloration (p = 0.004), while only nonmedical observers observed improvement in fine rhytides. All patients were very satisfied with the results. Common side effects were mild to moderate discomfort occurring on bony areas during the treatment and an itching and tingling sensation for 2 days after treatment. No infections or scars were observed postoperatively. The average epidermal thickness in the untreated samples was 103 +/- 23 microM (mean +/- SD) before treatment compared with 148 +/- 41 microM after treatment (p < 0.001). Histologic analysis of the matched punch biopsy specimens showed an increase in organized collagen in treated versus nontreated sites. Treatment of aged skin using a series of microdermabrasion treatments is an effective, noninvasive method of skin rejuvenation with minimal risk and patient downtime. It is safe and improves skin quality by minimizing certain hyperchromic pigmentations.
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PMID:A prospective controlled assessment of microdermabrasion for damaged skin and fine rhytides. 1506 Mar 59

CASE 1: A 51-year-old woman presented with skin-colored annular lesions on the upper chest, neck, and dorsa of the hands of 1-year duration. The lesions initially started as small papular lesions, which gradually evolved to form large annular and polycyclic lesions. Initially, the lesions were associated with a burning sensation and pruritus. She had no other systemic complaints. Examination revealed 5-6 annular, polycyclic lesions distributed over the upper chest, neck, and dorsa of both hands, varying in size from 1 to 5 cm. All the lesions had a prominent erythematous to skin-colored, irregular, papular border which was firm in consistency (Figs 1 and 2). Central clearing and minimal atrophy were evident in larger lesions. There was no sensory loss or peripheral nerve thickening. Clinical possibilities entertained were granuloma annulare, granuloma multiforme, and annular sarcoid. Routine investigations, including hemogram, renal and liver functions, blood sugar levels, chest X-ray, and urine examination, were within normal limits. A skin biopsy taken from the edge of a lesion revealed foci of collagen degeneration surrounded by an inflammatory infiltrate composed of many histiocytes and multinucleated giant cells. In addition, there were perivascular and periadnexal lymphocytic aggregates. No acid-fast bacilli (AFB) were detected. These findings were consistent with a diagnosis of granuloma multiforme (Fig. 3). CASE 2: A 47-year-old man presented with annular skin-colored lesions associated with a mild burning sensation of 8 months' duration. On examination, 2-3 annular, arciform lesions were distributed over the upper chest and neck. The lesions ranged in size from 2 to 7 cm in diameter, were irregular in shape, and were rimmed by a well-defined raised papular border. Again, there was no sensory loss or peripheral nerve thickening. Histopathology of the skin from the edge of the lesion showed multiple areas of histiocytic granulomas with focal necrobiosis and prominent multinucleated giant cells, findings consistent with granuloma multiforme.
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PMID:Granuloma multiforme. 1691 5

Reactive perforating collagenosis (RPC) in adults commonly manifests in patients with diabetes mellitus. Pruritus and consequent induced scratching have been identified as the bases for the evolution of this skin disease. We present the unusual case of a 55-year-old female diabetic with characteristic umbilicated skin lesions and a long history of scabies. Histology from a crusty nodule revealed transepidermal elimination of collagen. Following antiscabietic treatment, two courses of oral doxycycline demonstrated beneficial effects in controlling the perforating skin disorder.
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PMID:Reactive perforating collagenosis associated with scabies in a diabetic. 1532 2

Tacrolimus ointment (Protopic, Fujisawa) is an effective agent in a class of topical immunomodulators. Its mechanism of action is based on calcineurin inhibition, which results in decreased T-cell activation and inflammatory cytokine release. Tacrolimus ointment is safe and effective for short- and long-term treatment of atopic dermatitis (AD) in pediatric and adult patients. The most common adverse events associated with its use are a transient burning sensation and pruritus at the site of application. Unlike topical corticosteroid agents, tacrolimus ointment does not cause a reduction in collagen synthesis or skin thickness. Because tacrolimus ointment does not cause skin atrophy, it may be safely used for months or years on all skin areas, including the face and intertriginous areas.
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PMID:Tacrolimus ointment (Protopic) for atopic dermatitis. 1555 Sep 92


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