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

An 80-year-old woman being treated with anti-hypertensive drugs developed eruption and itching of the skin. High fever and lymph node enlargement subsequently developed in spite of discontinuing all antihypertensive drugs, and she was admitted to our hospital. At the initial examination, multiple papules were noted over the entire body, and the skin showed thickening and lichenification with scratch marks. There was also generalized enlargement of the superficial lymph nodes. From these findings, her condition was diagnosed as chronic prurigo due to drug allergy. Laboratory tests showed inflammatory findings, anemia and a high serum level of IgE. Analysis of the surface marker of peripheral lymphocytes revealed no abnormalities. Bacteriologic cultures of blood revealed methicillin-resistant Staphylococcus aureus (MRSA). Histologic examination of the lymph nodes revealed chronic reactive lymphadenitis with a follicular pattern. She was strongly suspected of having MRSA septicemia, and so combination chemotherapy with vancomycin, minocycline and cefoperazone/sulbactam was started. However, 1 month after initiation of chemotherapy, the low-grade fever, eruption and moderate inflammatory findings persisted, and culture of the eruptions revealed MRSA. The prurigo was therefore considered to be the source of the septicemia, and daily application of diflucortolone ointment containing 3% acetic acid was started. Thereafter, the clinical and laboratory findings showed a rapid improvement. MRSA infections usually occur in compromised patients who are receiving antibiotics during prolonged hospitalization. The present case, who did not have any underlying disease, indicates that old-age is also an important factor for the development of MRSA septicemia.
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PMID:[Septicemia due to methicillin-resistant Staphylococcus aureus from chronic prurigo in an elderly woman]. 939 25

In a study on the dose-response relationship for longwave UVA (UVA1; 340-400 nm) carcinogenesis in hairless mice scratch marks appeared after months of daily exposure as an unwanted side effect. Tumor induction in the highest of the 4 tested dose groups (receiving a daily dose of 430 kJ/m2 of 365-nm radiation) could not be determined because extensive scarification occurred prior to the development of any tumors. The induction of scratch marks could be scored and quantified in all 4 dose groups tested. The UVA1 dose-dependencies for the induction of tumors and scratch marks were compared. We found that the induction of scratch marks depended mainly on the cumulative UVA1 exposure, whereas tumor induction showed a lesser dose-dependency. An attempt was made to prevent the apparent pruritogenic effect of UVA1 irradiation and to understand its mechanism. The influence of ketanserin, a serotonin/histamine antagonist, on the UVA1 induction of scratch marks was tested in groups of 8 mice daily irradiated with 430 kJ/m2. No difference was found between treated and untreated animals. Histological examination of skin biopsies from irradiated mice from the 430-kJ/m2 dose group from the UVA1 carcinogenic experiment, showed no changes in numbers of mast cells or other inflammatory features when compared to skin biopsies from unirradiated control mice. This indicated that UVA1-induced scratching is not mediated through mast cell release of serotonin and/or histamine. An adequate therapeutic treatment which can prevent UVA1-induced scratching would enable us to test tumor induction with UVA1 over a larger dose range, and may provide additional insight in how this radiation damages the skin. It remains conjectural whether there exists an analogous UVA-induced pruritus in human skin.
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PMID:Chronic UVA (365-nm) irradiation induced scratching in hairless mice: dose-time dependency and the effect of ketanserin. 941 16

Among the various dermatologic abnormalities that can be associated with advanced chronic renal failure and dialysis therapy, pruritus is certainly the most disturbing disorder. Pruritus is an unpleasant, vexing sensation that provokes an intense desire to scratch. In the past the pruritus was considered from the neurophysiologic point of view as a submodality of pain, but more recent research showed that pain and pruritus are sensations which are carried through different populations of primary sensory neurons. The causes of pruritus in uremic patients are still unknown: xerosis, intradermic microprecipitation of divalent ions, hyperparathyroidism, peripheral neuropathy, allergic reactions and hypersensitivity, histamine and others have been considered as pathogenetic factors. The uncertainty on the causes is in part responsible for the different approach and results, unsatisfactory in many cases. In this paper we will review the neurophysiology, the pathogenesis and the possible therapeutic approaches to uremic pruritus.
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PMID:[Uremic pruritus]. 943 34

Atopic dermatitis patients often complain of intense itching and excessive scratching. Apart from standard therapies of antihistamines with sedative side effects, there are patients who appear not to respond satisfactorily to standard medical treatments. As itching can be a skin manifestation of psychological disturbance, these patients may benefit from behaviour treatment of scratch behaviour which can have a beneficial effect on the course of atopic eczema. The scratch response is considered a classical conditioned habit and special attention was given to the function of behaviour. Two patients, a man of 27 and a girl of 11, were suffering from intractable atopic eczema. The first patient was required to record his own scratching in a diary which is part of awareness training regarding scratch situations. In the second patient impaired parent-child relationships were the main discriminative stimuli to provoke scratch behaviour. It was shown that behaviour therapy helps patients who scratch repeatedly to exercise voluntary control over it.
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PMID:[Scratching for the itch in eczema; a psychodermatologic approach]. 955 Jul 61

Eczema cannot be cured, but much can be done both to prevent and alleviate its symptoms in children. Emollients--available as bath oils, soap substitutes and moisturisers--have a vital role in treating dry, scaly skin and tackling the scratch/itch cycle. They should be used daily, and can be administered alongside topical steroids and other treatments.
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PMID:Know how treatment for childhood eczema. 983 64

Itching reflects a distinct quality of cutaneous nociception elicited by chemical or other stimuli to neuronal receptors at the superficial layers of the skin and muco-cutaneous orifices. Although recent experimental studies of the conduction and perception of itch have yielded deeper insight into the physiology of this sensory quality, little is known about the neuromechanisms involved in pruritus accompanying many inflammatory skin diseases, in particular, in atopic eczema. Previous case-control studies of our research group with patients suffering from atopic eczema (AE) revealed significantly diminished itch perception after iontophoretic application of different doses of histamine as well as substance P (i.c. injected). Further experiments using acetylcholine (ACh, i.c.) clearly demonstrated that ACh elicits pruritus instead of pain in patients with AE. The first part of the present review deals with the results of our most recent case-control studies on histamine-induced itch perception in atopics devoid of eczema as well as in patients with urticaria or psoriasis compared to atopics with or without manifest eczema. We demonstrated that both focal itch and perifocal alloknesis (i.e., itch elicited by a slight mechanical, otherwise non-itching stimulus) were significantly reduced in eczema-free atopics yet were normal in non-atopics suffering from urticaria or psoriasis. In further studies using ACh i.c. injected into the uninvolved skin of patients with AE, lichen ruber, psoriasis, type IV contact eczema, or non-specific nummular eczema (n = 10/each group), all the atopics and 6/10 psoriatics felt itch instead of burning pain, but none of the others did. Different doses of vasoactive intestinal peptide (VIP) i.c. applied to the controls and the atopics with or without eczema did not markedly increase the intensity of nociceptive sensations. However, ACh induced pain in the controls, pure pruritus in the atopics with acute eczema, and a 'mixture' of pain and itch in the atopics just free from eczema. Obviously, the quality of sensations evoked by ACh and VIP depends on the inflammatory or non-inflammatory state of the atopic skin. In a placebo-controlled, double blind study on histamine-induced focal itch and alloknesis with healthy subjects (n = 15) using naltrexone (opioid receptor antagonist) and cetirizine (H1-blocking agent), naltrexone was found to significantly reduce both itching and alloknesis. Cetirizine reduced focal itch but failed to influence the alloknesis phenomenon. The wheal and flare reaction was suppressed only by cetirizine. These different effects point to a mainly CNS-based activity of naltrexone but a peripheral level effect of cetirizine. Due to long-lasting experience with group sport as a supporting adjuvant for inpatients with AE, we evaluated, by clinical, psychometric, and physiological studies, the therapeutic efficacy of controlled physical exercise in addition to otherwise equal anti-eczematous therapy for both voluntary participants and non-participants in sports by performing several case-control studies, one followed-up to 6 months after the patients' discharge from the hospital. Regular moderate exercises neither deteriorated nor impeded the recovery from AE, ameliorated the participants' scratch controlling ability and significantly their depressed emotional mood. The non-participants failed to achieve these aims. Sweating-induced itch was inhibited in almost all participants if simple skin care (clearing by warm shower, ointment) and short-term rest were used by informed patients. In conclusion, there are several indications that itching is elicited in individuals inclined to cutaneous atopy, regardless of their eczematous or just eczema-free state, by a different physiological pathway from that in non-atopic individuals. Therefore, antipruritic agents influencing the centrally altered nociception of atopics are needed and may be expected in near future. (ABSTRACT TRUNCATED)
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PMID:Recent studies of cutaneous nociception in atopic and non-atopic subjects. 1009 77

An association between pruritus and eating disorders has been suggested. This study examined changes in pruritus during weight restoration in a homogeneous group of women with severe anorexia nervosa (n = 19), using a structured questionnaire, visual analogue scale, clinical examination and a range of serological markers. We demonstrated that itching is a clinical feature of anorexia nervosa, associated with low weight and resolving on weight restoration. Some 58% of the sample suffered pruritus at low weight in a stable hospital environment. There was a significant association between changes in body mass index and severity of pruritus (P = 0.033), with reduced itching on weight restoration. Pruritus occurred in the absence of abnormalities in thyroid, renal and hepatic function, serum androgens, oedema, dermatoses or compulsive washing. Scratching was manifest as 'scratch prurigo' in five cases. Where itching was present, it was experienced as severe. We discuss a variety of possible explanations, including psychopathology, endocrine factors, regional blood flow variation, eczema and the role of central opioid and serotonergic activity. We argue that anorexia nervosa should be considered in all patients at low weight presenting with pruritus, and pruritus should be considered to be a physical symptom of anorexia nervosa.
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PMID:Scratching and fasting: a study of pruritus and anorexia nervosa. 1058 44

Updating our clinical concept of atopic dermatitis (AD) evolves from the better understanding of all the immunologic aberrations expressed by the polygenic combinations and permutations associated with the atopic diathesis. Recognizing the immunopathologic features of AD readily underscores that AD without "atopy" is an oxymoron. Appreciating "pruritus" as the impetus to scratch, which isomorphically gives rise to the "eczema," shifts the goal of management from suppressing inflammation to avoiding the triggers of pruritus. Recognizing the full spectrum of dermatologic findings in AD endorses the preferred label as a dermatitis, rather than the inferred restrictive label, atopic eczema. As our knowledge of immunology evolves, our criteria for the diagnosis and management of the atopic diathesis are sure to change.
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PMID:The clinical spectrum of atopic dermatitis. 1048 59

This study consists of two parts. In the first we recorded 1696 scratch marks seen on 69 pruritic patients. The scratch marks followed a consistent pattern on the skin, which was independent of the cause of the itching. The most striking feature was a longitudinal alignment on the limbs. Next we tried to relate our findings to experimental work that suggests that itching is extinguished most effectively by counterstimuli applied within the same dermatomal segment. If this is the case, sufferers from itchy skin diseases might be expected to scratch itchy points on their skin using strokes directed along dermatomal lines, thereby gaining maximal relief. We used the data obtained during the first part of our study to test this possibility. Fifty-one percent of the scratch marks analyzed ran at an angle of less than 20 degrees to the nearest interdermatomal line (significantly higher than the 22.5% expected by chance). However the tendency for scratch marks to run along dermatomal lines was confined to the limbs. In addition, the preferred scratch directions of a group of nonitchy subjects, not driven by the need to alleviate actual itching, coincided closely with the pattern of scratch marks seen on the itchy patients. The direction of scratch marks may therefore be determined as much by mechanical factors affecting the ease of scratching as by the distribution of dermatomes.
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PMID:Some observations on the direction of scratch marks. 1057 Mar 96

Itch is one of the major symptoms of skin disease although it remains poorly studied. Little is known about its mediators or the neurological processes involved in either the detection of an itch stimulus or the induction of the main response to itch, scratch. This lack of knowledge may be due to the subjective nature of the sensation itself and the related difficulties in quantifying it, and is compounded by the absence of a convincing animal model. Defining itch as that sensation which provokes the desire to scratch provides two approaches to measurement, that of itch itself, and the behavioural response, scratch. The measurement of itch itself traditionally involves the use of questionnaires or visual analogue scale, both of which rely on the dubious assumption that the subject is able to relate their experiences accurately. By contrast experimental induction of itch and measurement of areas of allokinesis around application sites may provide a more reliable and repeatable method of itch quantification. Recent advances in two areas that may prove relevant are discussed: new technological improvements in movement meters and compatible software; and some recently described animal models.
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PMID:Pruritus: more scratch than itch. 1060 57


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