Treatment of itch.
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Administration, Cutaneous↗
Biomedical subjects
C F Wahlgren
Publications and source records attributed to C F Wahlgren.
Occurrence and clinical features of sensitization to Pityrosporum orbiculare and other allergens in children with atopic dermatitis.
One hundred and nineteen consecutive cases of children with atopic dermatitis aged 4-16 years (73 girls) from a pediatric dermatology outpatient clinic were included in a study of atopic sensitization. Structured interviews and clinical investigations were performed. IgE antibodies to common inhalant allergens, Pityrosporum orbiculare, Candida albicans, Tricophyton rubrum and Staphylococcus aureus were detected. Specific IgE antibodies frequently occurred to pollens, animal epithelia, C. albicans, house dust mites and moulds, whereas specific IgE antibodies to potential skin allergens were less prevalent. Twenty-six children (21.8%) had IgE antibodies to P. orbiculare, 14 (11.8%) to T. rubrum and 3 (2.5%) to S. aureus. Atopic dermatitis in children with one or several RAST positivities was worse, with a more chronic course, higher total eczema score, more frequent distribution in the head-neck-face regions and more itch compared to the children without serum detectable IgE antibodies. Severe itch disturbing nightly sleep was the only clinical feature that characterised P. orbiculare-positive cases. Allergy to P. orbiculare appears to be of little importance in early childhood atopic dermatitis but is likely to carry a poor prognosis.
Adolescent↗
[Exotic tinea. Increased occurrence among children in the district of Stockholm].
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Adolescent↗
Influence of calcitonin gene-related peptide on histamine- and substance P-induced itch, flare and weal in humans.
Recent data have shown both synergistic and inhibitory effects between calcitonin gene-related peptide (CGRP) and substance P (SP) on inflammation and flare responses. The modulatory effects of CGRP on the itch, flare and weal responses following intracutaneous injections of SP and histamine were studied in 10 healthy volunteers. The only change in itch responsiveness observed was a significant prolongation of itch latency following SP when preceded 10 min earlier by a CGRP injection. No influence on flare and weal was observed.
Adult↗
Clinical, light and electron microscopic features of recessive ichthyosis congenita type III.
The recessively inherited congenital ichthyoses have ultrastructural features which indicate abnormal epidermal lipid metabolism. The ultrastructural markers of the three recessive congenital ichthyosis groups are lipid droplets in horny layers (type I), cholesterol clefts (type II) and membrane structures (type III). We describe six patients from five families belonging to the last group. The variable clinical phenotype alone does not allow the delineation of this disease, but together with the ultrastructural characteristics the subtype is unequivocal. In addition to the membrane structures, half of the cases showed abnormal keratinosomes and vesicular complexes. Membrane-bound vacuoles and needle-like slits were exceptionally found. The onset of the ichthyosis was variable, in contrast to other patients described under the heading recessive congenital ichthyosis.
Adult↗
Some methods for evaluating clinical itch and their application for studying pathophysiological mechanisms.
Research on itch has been hampered by difficulties in measuring the itch sensation. A microcomputer-based system, where the patients themselves record their symptoms on portable data loggers can be used for quantitative measurements of clinical itch and for the detection of antipruritic effects of drugs. By using this system we have found that itch in atopic dermatitis is not inhibited by antihistamines but by cyclosporin A, a drug inhibiting cytokine production. Thus histamine is not a major pruritogen in atopic dermatitis. A hypothesis is proposed that cytokines are involved in itch in atopic dermatitis.
Administration, Topical↗
Pathophysiology of itching in urticaria and atopic dermatitis.
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Dermatitis, Atopic↗
Inhibitory effect of loratadine and clemastine on histamine release in human skin.
The inhibitory effect of the two H1 antagonists clemastine and loratadine on histamine release in human skin was studied in 15 volunteers. The antihistamines and placebo were administered orally (clemastine 2 mg twice a day, loratadine 10 mg once a day) for 5 days according to a double-blind, crossover design. Clemastine caused a significant sedation in comparison with placebo, whereas there was no difference between loratadine and placebo in this respect. After 5 days' medication, flare reaction was induced by intradermal injection of histamine and the histamine liberator compound 48/80. The antihistamine dosages were approximately equipotent and inhibited the flare response induced by histamine to about the same extent, whereas the flares induced by compound 48/80 were still more inhibited by both drugs. The results indicate that clemastine and loratadine not only inhibit histamine effects at H1 receptor level, but have additional suppressive effects, probably due to inhibition of mast cell degranulation. The simple, virtually noninvasive, in vivo technique described in this paper does not require chemical analysis of the released mediators and could be used to screen 'mast cell stabilizing' effects of various antihistamines.
Adolescent↗
Perception of histamine-induced itch elicited in three different skin regions.
In order to investigate whether any regional difference in itch perception exists in experimentally induced pruritus, various concentrations of histamine (1, 3.3, 10, 33 and 100 micrograms/ml) were injected intradermally in three different skin regions in 15 healthy subjects. The regions were 1) the volar aspect of the forearm, 2) the lateral aspect of the upper arm and 3) the upper back at scapular level. Itch perception (itch latency, itch duration, maximal itch intensity, 'total itch index') and flare reactions were studied. A significant dose-response relationship was shown in each of the three regions for all itch variables, except itch latency, and for the flare reactions. However, no significant regional difference in itch perception was observed. The flare reaction showed a regional variation, with significantly smaller flares on the forearm than in the other two regions.
Adolescent↗
Itch and atopic dermatitis: clinical and experimental studies.
The aims of the study were to develop and evaluate methods for quantitative measurement of itch, to investigate the perception of itch in patients with atopic dermatitis (AD), and to measure itch in such patients during treatment with H1-receptor antagonists or cyclosporin A, thereby exploring possible mechanisms in the pathogenesis of itch in AD. In a double-blind, randomized, placebo-controlled, cross-over study of 30 AD patients using a potent, topical, antipruritic corticosteroid, two methods for measuring itch both successfully detected the itch-relieving effect of the corticosteroid. The two methods comprised new portable data-loggers (Pain-Track) for continuous recording of itch, and conventional visual analogue scale (VAS) forms for retrospective recording. The main advantages of the Pain-Track method are possibilities for frequent sampling, surveillance of compliance, and analysis of a large amount of data. Induction and measurement of experimental histamine-induced itch were studied in 38 healthy subjects. It was shown that pruritic stimuli should be presented in a random order so as to avoid systematic errors in the perception of itch. Two rating scales, a seven-stepped non-verbal scale on a Pain-Track logger, and a 100-mm VAS on a potentiometer, were found valid for continuous recording of itch. The perception of experimental itch was studied in 32 AD patients and 32 healthy controls. The itch responses provoked by wool fibres were significantly stronger in AD patients than in controls, whereas the histamine-induced dose-response curves for itch did not differ significantly between the two groups, who discriminated equally well between weak and strong histamine stimuli. No increased skin mast cell releasability was shown in vivo to compound 48/80 in AD patients. Their itch responses to the different pruritic stimuli did not correlate with clinical itch intensity, eczema score or serum IgE-level. In a double-blind, randomized, placebo-controlled, cross-over study of 25 AD patients, the effect on clinical itch of a sedative (clemastine) and of a non-sedative (terfenadine) antihistamine did not differ from that of placebo, although both drugs had a pronounced H1-receptor-antagonizing effect in the skin and clemastine was significantly sedative. These findings support the view that histamine is not the major pruritogen in AD, and that sedation is not necessarily associated with itch relief. In a double-blind, randomized, placebo-controlled, cross-over study of 10 AD patients, 10 days' treatment with cyclosporin A (CSA), 5 mg/kg/day, significantly reduced itch intensity, eczema score and the number of peripheral blood eosinophils.(ABSTRACT TRUNCATED AT 400 WORDS)
Adolescent↗
Patients' perception of itch induced by histamine, compound 48/80 and wool fibres in atopic dermatitis.
Itch and flare responses were investigated in 32 patients with atopic dermatitis (AD) and in 32 healthy controls. Itch was induced chemically by intradermal injections of histamine (1, 3.3, 10 and 100 micrograms/ml) and compound 48/80 (10 micrograms/ml) into non-lesional skin and mechanically by wearing a woollen sweater. Continuous recording of itch intensity allowed the calculation of itch duration (ID), maximal itch intensity (Imax) and a "total itch index" (Tii). The itch responses were significantly increased in AD patients compared with controls for wool fibres and one of the histamine concentrations (10 micrograms/ml), but not for the remaining three histamine concentrations or compound 48/80. Conversely, the flare response was significantly smaller in AD patients than in controls for the two strongest histamine solutions and compound 48/80. Significant dose-response relationships were found between histamine concentration and each of ID, Imax, Tii and flare in both patients and controls. The slope of the flare-regression line was significantly steeper in controls than in AD patients, whereas the slopes of the itch-regression lines did not differ significantly between the two groups, i.e. their ability to discriminate between weak and strong histamine concentrations did not differ significantly. No increased skin mast cell releasability in vivo to compound 48/80 was shown in AD patients compared with controls. The itch and flare responses of AD patients did not correlate significantly with clinical itch intensity, eczema score or serum IgE level.
Adolescent↗
[Lichen sclerosus et atrophicus in children can be misinterpreted as sexual abuse].
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Child↗
Chronic urticaria and cancer: an epidemiological study of 1155 patients.
To evaluate the possible association of malignant disease with chronic urticaria 1155 consecutive cases with chronic urticaria were reviewed. The Swedish Cancer Registry, Stockholm, was searched for records reporting malignancies in the study population (1958-84), and the expected number of malignancies was calculated on the basis of age- and sex-standardized incidence data. A malignancy was diagnosed in 36 patients with urticaria and the expected number of malignancies was 41. In 23 patients the malignancy appeared during the same year as the onset of urticaria or later. The expected number was 25.6. We conclude that chronic urticaria is not statistically associated with malignancy in general.
Adolescent↗
The antipruritic effect of a sedative and a non-sedative antihistamine in atopic dermatitis.
A double-blind, randomized, cross-over study was carried out on the effect of a sedative and a non-sedative antihistamine on 25 adults with atopic dermatitis. Intensity of itch was recorded using a computerized method for self-assessment (Pain-Track) and using conventional visual analogue scales. The antipruritic effect of 3 days of treatment with the non-sedative H1 antagonist terfenadine (60 mg b.i.d.) and with the sedative antihistamine, clemastine (2 mg b.i.d.) did not differ from that found with the placebo. Our findings support the view that histamine is not of importance in the pathogenesis of itch in atopic dermatitis.
Adolescent↗
Chronic urticaria associated with internal malignancy.
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Adenocarcinoma↗
Antipruritic effect of oral cyclosporin A in atopic dermatitis.
The effect of ten days' treatment with cyclosporin A, 5 mg/kg/day, in 10 adults with atopic dermatitis was investigated using a double-blind, randomized, placebo-controlled, cross-over design. Evaluation was based on itch recording, clinical scoring and immunohistochemical examination of skin biopsy specimens. Cyclosporin A significantly reduced the itch intensity, the eczema score and the consumption of topical hydrocortisone. A significant decrease in serum magnesium and in the total number of blood eosinophils was seen. No other laboratory abnormalities were observed. In lesional skin, Cyclosporin A induced a relative decrease of CD3+ T cells in 5/10 patients, of HLA-DR+ cells in 6/10, and of interleukin-2-receptor positive (CD25+) cells in 4/10. However, these changes in phenotype expression did not seem necessary for itch relief. Relapse of clinical symptoms was seen within 2-30 days of completion of the Cyclosporin A course. The mechanism of the antipruritic effect remains unclear, but the present findings may support the hypothesis that 'pruritogenic cytokines', whose production is inhibited by Cyclosporin A, may be important in the pathogenesis of itch in atopic dermatitis.
Administration, Oral↗
Influence of grenz rays and psychological factors on experimental pruritus induced by histamine and compound 48/80.
The interaction between grenz rays and experimentally induced pruritus was evaluated in 14 healthy subjects. Grenz rays were administered once weekly for 4 weeks on restricted areas of the upper arms. Pruritus was evoked by intradermal injection of histamine and the histamine liberator compound 48/80. The results were compared with unconditioned values and with those obtained following a placebo treatment procedure. The influence of psychosocial and psychosomatic factors was also evaluated. Grenz-ray therapy reduced itch but not flare responses. The influence of grenz rays was, however, not statistically different from that observed after placebo treatment. Psychosocial and psychosomatic factors were good predictors of individual skin responsiveness. The results indicate that grenz rays do not interfere with experimental histamine-induced pruritus more than placebo and emphasize the importance of knowing individual characteristics and coping strategies.
Adult↗
Some aspects of the experimental induction and measurement of itch.
Two different rating scales--a visual analogue scale (VAS) connected to a chart-recorder, and Pain-Track, a micro-computerized system with a 7-step-graded, fixed-point, non-verbal scale (FPNVS)--were evaluated for their capacity to assess experimental, histamine-induced itch continuously in 38 healthy subjects. The consequences for itch perception of using different injection sequences of various histamine concentrations were also investigated. A linear dose-response relationship was shown with random injection order for all subjective variables studied (itch latency and duration, maximal itch intensity, 'total itch index') with the VAS, but only for itch duration and 'total itch index' with the FPNVS. Using the VAS and injecting histamine solutions with increasing concentration, a significant dose-response curve was obtained for maximal itch intensity and 'total itch index', but when the same histamine stimuli were presented in the reverse (i.e. decreasing) order, there was no dose-response relationship. This indicates that central nervous system interaction may be unequally activated, depending on the order of different injected histamine stimuli. The objective variable flare was unaffected by the injection sequence. It is concluded that random injection order should be used in the assessment of itch sensation, in order to avoid systematic errors. The fact that the FPNVS did not discriminate as well as the VAS could indicate that our experimental stimuli were too weak to be properly discriminated with a 7-step-graded scale.
Adult↗