General Medical Emergencies
Anthony FT Brown, Michael D Cadogan in Emergency Medicine, 2020
Causes of pruritus with skin disease: Scabies, pediculosis, insect bites, parasites (roundworm).Eczema and psoriasis.Contact dermatitis.Urticaria.Lichen planus (pruritic, planar, purple, polygonal papules with chronic oral mucous membrane involvement).Pityriasis rosea (upper respiratory infection preceding ‘herald’ patch, followed after 7–14 days by a pink or red, flaky, oval-shaped rash).Drugs, which may cause any of the conditions (ii)–(vi) above.Dermatitis herpetiformis (chronic itchy, papulovesicular eruptions, usually distributed symmetrically on extensor surfaces, associated with gluten sensitivity).
Dermatologic diseases and pregnancy
Hung N. Winn, Frank A. Chervenak, Roberto Romero in Clinical Maternal-Fetal Medicine Online, 2021
The onset of pustular psoriasis of pregnancy is usually during the last trimester of pregnancy, but it may occur as early as the third month. Skin lesions begin as circinate erythematous macules or plaques, with 1 to 3 mm pustules advancing along the peripheral edge, preferentially occurring in intertriginous areas. It may spread to mucous membranes as well as to the entire integument, sparing only the face, hands, and feet. Pruritus is usually not present or very mild. The lesions heal with non-scarring post-inflammatory hyperpigmentation. Systemic symptoms are common including fever, chills, malaise, nausea, diarrhea, and arthralgias. Rarely does the patient present with tetany, delirium, and seizures secondary to hypocalcemia. Other potential lab abnormalities include leukocytosis with neutrophilia, elevated erythrocyte sedimentation rate, hypoalbuminemia, and iron deficiency anemia (70–72).
The patient with acute renal problems
Peate Ian, Dutton Helen in Acute Nursing Care, 2020
Holistic assessment of the patient is important when renal impairment is suspected as the inability of the body to excrete waste products can affect all organs. We have already noted how the patient’s level of consciousness may be impaired by the accumulation of urea; the higher the concentration of this substance in the blood, the more likely the patient will become comatose. Individuals with deteriorating renal function can develop uraemic encephalopathy, which occurs when high levels of urea in the blood impair neurotransmission. Similarly, visual inspection of the skin is important, not just for an estimate of the patient’s fluid status, but to determine whether or not the uraemia is worsening. The skin can take on a yellow tinge, as can the mucous membranes, as the urea accumulates. The patient may subsequently complain of intense pruritus and this may lead to an increased risk of infection through skin trauma. As the gut is also affected by rising urea levels in the blood, the patient may have signs of gastrointestinal illness such as persistent hiccupping, vomiting and diarrhoea (O’Callaghan 2017).
Recognizing skin conditions in patients with cirrhosis: a narrative review
Published in Annals of Medicine, 2022
Ying Liu, Yunyu Zhao, Xu Gao, Jiashu Liu, Fanpu Ji, Yao-Chun Hsu, Zhengxiao Li, Mindie H. Nguyen
Pruritus is a sensation that induces persistent or intermittent itching and involuntary scratching. It can affect the whole body or be confined to the limbs, especially the footplate and palm, where more intensive itchiness may occur. It is one of the most common skin abnormalities that occur in liver disease, particularly in patients with cholestatic liver disease. As a frequent concomitant symptom without visible lesions of liver cirrhosis, pruritus is usually linked to cholestasis in PBC, primary sclerosing cholangitis, obstructive gallstone disease and carcinoma of the bile duct. It can also be the most prominent symptom in certain pregnancy-associated liver conditions such as intrahepatic cholestasis of pregnancy [60]. Viral hepatitis-related cirrhosis can lead to intense pruritus, accompanied by solid crusty nodules, which are called prurigo nodularis (Figure 3(d)). Usually distributed in the extremities, especially between the knee and ankle and forearm, the lesion is associated with the topical deposition of an immune complex consisting of HBV/HCV in the skin [1]. Data from a large cohort of patients with chronic liver disease (n = 1631) suggest that the overall prevalence of pruritus was about 40% overall, higher among those with cirrhosis and as high as 50% in those with PBC and 60% in those with autoimmune overlap syndrome [61].
The NK1 receptor antagonist serlopitant for treatment of chronic pruritus
Published in Expert Opinion on Investigational Drugs, 2019
Sonja Ständer, Mary C. Spellman, Paul Kwon, Gil Yosipovitch
Chronic pruritus is a common symptom associated with multiple potential underlying causes. Current treatment options are limited, and most provide only short-term relief. The NK1 receptor pathway is involved in the transmission of itch signals in the peripheral and central nervous systems, and studies indicate that targeting this pathway with NK1 receptor antagonists could be an effective strategy for the treatment of pruritus. Serlopitant is an NK1 receptor antagonist that has demonstrated good tolerability and reduced pruritus in patients with chronic pruritus, PN, and psoriatic itch in well-controlled clinical studies. Efficacy and safety of serlopitant is under further evaluation in robust clinical safety and efficacy studies in patients with pruritus associated with various underlying conditions and CPUO.
Emerging drugs for the treatment of epidermolysis bullosa
Published in Expert Opinion on Emerging Drugs, 2020
Matthias Titeux, Mathilde Bonnet des Claustres, Araksya Izmiryan, Helene Ragot, Alain Hovnanian
Pain and pruritus are major concerns for all EB types with marked impacts on quality of life. Pain can be caused by skin ulcerations, oropharyngeal blistering and erosions, corneal erosions and anal fissures. Pain management involves a combination of non-opioids and opioid analgesics, and sometimes non-steroidal anti-inflammatory drugs. Pregabalin, gabapentin and tricyclic antidepressants (amitriptyline) can be used in case of neuropathic pain. Pruritus also has multiple possible causes including wound healing and inflammation. It is only partially relieved by topical (skin hydration, topical mid-potency corticosteroids, etc) and systemic treatments such as sedating antihistamines (e.g. hydroxyzine), tricyclic antidepressants, pregabalin or gabapentin. Recently cannabinoids have been used in some countries to alleviate pain in EB patients and reduce opioids regimen dependency [22]
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