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Transient Receptor Potential Channels and Itch
Published in Tian-Le Xu, Long-Jun Wu, Nonclassical Ion Channels in the Nervous System, 2021
Mahar Fatima, Jingyi Liu, Bo Duan
Patients with chronic renal failure and undergoing hemodialysis suffer from severe uremic pruritus (37). The serum concentration of β2-MG, a subunit of major histocompatibility complex class I antigen, is elevated in patients undergoing hemodialysis (38). Cheek injections of β2-MG in mice evoke scratching responses. Selective blockade of TRPV1 inhibits β2-MG-elicited itch (39), suggesting TRPV1 channels may play an important role in uremic pruritus.
Phototherapy with Ultraviolet B
Published in Henry W. Lim, Nicholas A. Soter, Clinical Photomedicine, 2018
Serge A. Coopman, Robert S. Stern
It is well established that pruritus associated with a variety of causes can be improved by phototherapy (Table 2). The most extensive experience has been accumulated in the treatment of uremic pruritus in patients with chronic renal failure (72–74). Patients are usually treated 1–3 times per week for about 1 month and the improvement rate and length of remission seem to be dependent on the total dose of UVB rather than the particular protocol design. Not all patients experience improvement with this therapy, but a beneficial response seems to be unaffected by the presence of secondary hyperparathyroidism. The therapeutic action mechanism is not known, but it is hypothesized that circulating substances, responsible for the pruritus, are inactivated by UVB. This theory is supported by the observation that bilateral improvement occurs after treatment of one body half. A phototherapeutic trial can also be considered for the relief of pruritus of other internal origins such as primary biliary cirrhosis, either alone or in combination with cholestyramine (75). Twenty patients with extensive and symptomatic pityriasis rosea were treated with unilateral UVB phototherapy in a bilateral comparison study (76). Erythemogenic exposure on 5 consecutive days resulted in substantially reduced pruritus and extent of disease compared to the untreated side in 50% of the patients. Therapy seemed to be most beneficial to patients receiving treatment within the first week of eruption.
Thalidomide
Published in Sarah H. Wakelin, Howard I. Maibach, Clive B. Archer, Handbook of Systemic Drug Treatment in Dermatology, 2015
Elaine Agius, Robert P.E. Sarkany
Thalidomide is only licensed in Europe for the treatment of multiple myeloma. It is widely used to treat leprosy reactions (erythema nodosum leprosum) and licensed for this indication in the USA. It has also been reported to be of benefit in a range of inflammatory skin diseases including: Actinic prurigo.Cutaneous lupus erythematosus.Erythema nodosom leprosum.Nodular prurigo.Pyoderma gangrenosum.Severe apthous stomatitis and Behçet’s syndrome.Graft-versus-host disease.Cutaneous sarcoidosis.Erythema multiforme.Kaposi’s sarcoma.Lichen planus.Uraemic pruritus.Systemic mastocytosis.
An evaluation of difelikefalin as a treatment option for moderate-to-severe pruritus in end stage renal disease
Published in Expert Opinion on Pharmacotherapy, 2021
Zoe M. Lipman, Gil Yosipovitch
Chronic pruritus is defined as itch lasting 6 weeks or more [1,2]. Stemming from a wide variety of causes ranging from primary dermatologic to secondary effects of underlying medical conditions, chronic pruritus can be a debilitating condition that significantly decreases quality of life and affects mood, sleep, personal relationships, and self-esteem [3]. Chronic kidney disease-associated pruritus (CKD-aP), or uremic pruritus, is a frequently underdiagnosed but severely distressing condition that occurs in greater than 60% of patients undergoing dialysis [4–6]. With between 20 and 40% of patients reporting intense, generalized systemic itching in the moderate-to-severe range, CKD-aP has been associated with depression, worsened sleep quality, increased risk of infection, decreased quality of life, and an increased risk of death [4,5,7–10].
Therapeutic effect of intravenous sodium thiosulfate for uremic pruritus in hemodialysis patients
Published in Renal Failure, 2020
Yu-Huan Song, Si-Yang Wang, Jia-Hui Lang, Yue-Fei Xiao, Guang-Yan Cai, Xiang-Mei Chen
Uremic pruritus may be due to an allergy to the tubing, dialyzer, or other elements associated with dialysis [2,28]. The literature has shown associations between demographic and clinical characteristics of patients and the severity of pruritus, such as aluminum level [29], secondary hyperparathyroidism, elevated blood urea nitrogen level [30], hypercalcemia and hyperphosphatemia [31], the duration of dialysis [32], low Kt/V and sex. For example, males had 1.5-fold greater adjusted odds of having moderate or severe pruritus than females [33]. HD patients with AVF are less likely to develop pruritus [34]. Our study results were consistent with these previous findings. Comorbid conditions such as diabetes mellitus, cardiovascular disease, hypertension, and neurological disease were found to be associated with pruritus in CKD patients [33,35]. Our study showed no association between pruritus and hs-CRP levels, but such an association was reported in several studies [36].
Vegetarian diet may ameliorate uremic pruritus in hemodialysis patients
Published in Renal Failure, 2018
Chun-Yang Tseng, Tai-Te Wu, Chia-Wen Lai, Hsuan-Jen Lin, Che-Yi Chou, Chiz-Tzung Chang, Hung-Chih Chen
Pruritus is a common and bothersome symptom among end-stage renal disease (ESRD) patients under hemodialysis (HD) treatment. While previous studies have shown that uremic pruritus (UP) can be present in up to 40% of hemodialysis patients [1], the pathophysiology of UP is incompletely understood. Dialysis clearance, metabolic factors, especially uremic hyperparathyroidism, iron deficiency anemia, neuropathy, medication, and skin xerosis have long been known as risk factors of UP [2–4]. Uremic pruritus has also been known to a systemic disorder associated with inflammation. High sensitivity C-reactive protein (hs-CRP) for example, is an inflammatory marker and has been associated with UP both in hemodialysis and peritoneal dialysis patients [5,6]. Recently, serum interleukin 2 (IL-2), has also been found to be elevated in hemodialysis patients with UP [7].