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Allergic and Immunologic Reactions
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Saira N. Agarwala, Aspen R. Trautz, Sylvia Hsu
Clinical presentation: Clinical signs of long-standing pruritus include excoriations, ecchymoses, lichen simplex chronicus, or prurigo nodularis. The exact clinical presentation of pruritus depends on its etiology. Three different clinical groups of pruritus have been proposed: pruritus on diseased or inflamed skin, pruritus on nondiseased skin, and pruritus with secondary scratch lesions.
Chronic erythematous rash and lesions on trunk and limbs
Published in Richard Ashton, Barbara Leppard, Differential Diagnosis in Dermatology, 2021
Richard Ashton, Barbara Leppard
Prurigo is a rash which is caused by the patient scratching and picking his skin. Sometimes just excoriations are seen, but often numerous discrete intensely itchy pink, mauve or brown excoriated papules or nodules occur (nodular prurigo). They heal to leave white scars, which sometimes have very obvious follicular openings within them. Prurigo can sometimes be associated with eczema.
Polymorphous Light Eruption
Published in Henry W. Lim, Nicholas A. Soter, Clinical Photomedicine, 2018
The familial photosensitivity rash with autosomal dominant inheritance that is common among Native Americans (16–18) has been considered a unique variant of polymorphous light eruption. However, there are many differences, such as primary eczematous and prurigo lesions, cheilitis, and pterygia formation that help to differentiate this condition as a separate entity (17,19,20). This peculiar rash closely resembles actinic prurigo (21,22), a disease that is clearly different from polymorphous light eruption.
Therapeutic potential of biologics in prurigo nodularis
Published in Expert Opinion on Biological Therapy, 2022
Svenja Müller, Thomas Bieber, Sonja Ständer
Omalizumab is the only recombinant humanized anti-IgE monoclonal antibody that is regulatory-agency approved for the indications of chronic spontaneous urticaria (CSU) and asthma [58]. Few case reports show a significant improvement of pruritus and healing of pruritic skin lesions in nodular and papular-plaque-type chronic prurigo, even if the underlying mechanisms are largely unknown [83,84]. Ito et al. suggest a central role of basophils in the pathogenesis of CNPG as CNPG patients presented higher activated basophils in blood (measured by higher cell surface CD203c expression level in flow cytometry) than in healthy controls, whereas basophils were additionally elevated in CNPG skin lesions (measured immunohistochemically using basophil-specific BB1 antibody) [85]. Ugajin et al. described the case of a Japanese male patient with chronic papular-plaque-type prurigo who clinically presented with disseminated erythematous macules, papules, nodules and scratch marks [84]. In the immunohistochemical examination of papular and nodous skin lesions, basophils were found in both lesions, but seemed to be higher expressed in the papule [84]. However, basophils in blood and IgE levels were within the reference range [84]. The patient was treated with omalizumab 300 mg sc every for weeks and showed a skin and pruritus improvement within 10 days after the first injection which accords with the life span of basophils [84]. Two months later, skin changes were almost healed; hence, the administration of omalizumab was stopped [84].
Novel drugs for the treatment of chronic pruritus
Published in Expert Opinion on Investigational Drugs, 2018
Manuel P. Pereira, Sonja Ständer
Nalbuphine was recently developed for the treatment of CP. It acts both as a mu-opioid receptor antagonist and as a kappa-opioid receptor agonist. In a large RCT including 373 hemodialysis patients, nalbuphine given orally in high dose (120 mg), but not in low dose (60 mg), led to a significant improvement of itch intensity [55]. In a previous smaller pharmacokinetics study promising effects of nalbuphine in uremic pruritus had already been shown [56]. The anti-pruritic efficacy of nalbuphine has also been tested for chronic prurigo of nodular type (NCT02174419). In a phase II RCT, nalbuphine 180 mg administered for 8 weeks led to a significantly higher proportion of patients achieving a pruritus relief of at least >50% compared to placebo. A subsequent phase II/III RCT on chronic prurigo patients with a treatment duration of 52 weeks (including the open-label extension period (PRISM Study, NCT03497975)) is planned to start in the near future.
Tachykinin upregulation in atopic dermatitis
Published in Immunopharmacology and Immunotoxicology, 2019
Louise Lönndahl, Aram Rasul, Sol-Britt Lonne-Rahm, Mikael Holst, Björn Johansson, Husameldin El-Nour, Diana Radu Djurfeldt, Klas Nordlind
In AD, pruritus is a characteristic symptom. Substance P has been suggested to be an important pruritic mediator in humans [6] and mice [7] and treatment with an NK-1R antagonist, BIIF 1149 CL, inhibits the scratching behavior in NC/Nga atopic-like mice [8]. However, in another murine (ADJM) model, the NK1-R antagonist aprepitant (EmendR) had no significant inhibitory effect on the scratching behavior [9]. In humans promising results have been shown for aprepitant when treating different pruritic skin disorders, including patients with prurigo and atopic diathesis [10]. We were, however, not able to show an inhibitory effect by aprepitant in human AD, when comparing aprepitant and local treatment with local treatment per se [11].