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PubMed1995

Long-term treatment with interferon-alpha 2b for severe pruritus in patients with polycythaemia vera.

Pruritus is a major clinical problem in patients with polycythaemia vera (PV). Conventional symptomatic treatment is unsatisfactory. Recently, a favourable effect of interferon-alpha on pruritus in patients with PV has been reported. Also, interferon-alpha suppresses the increased haemopoiesis in PV. However, long-term treatment with interferon-alpha may be hampered by side-effects and the inconvenience of chronic subcutaneous injection therapy. We conducted a long-term study (median follow-up 13 months) of the efficacy and tolerability of interferon-alpha in 15 patients (mean age 68 years) with PV and severe pruritus. Six patients were evaluable after 1 year. Pruritus significantly improved in 12/15 patients. Haematological control improved, as evidenced by a decreased number of phlebotomies from a mean of 4.3 in the year before the study to 1.8 while on interferon-alpha. Leucocyte and platelet numbers also decreased significantly. Five patients (33%) did not tolerate interferon-alpha. The effects of interferon-alpha could not be ascribed to an inhibitive effect on histamine production or to the disappearance of the abnormal erythroid progenitor clone, because erythropoietin-independent erythroid colony formation persisted during interferon-alpha treatment. We conclude that long-term interferon-alpha treatment is feasible and effectively relieves pruritus in patients with PV, but side-effects are an important concern. The optimal dose regimen that is well tolerated, relieves pruritus, and offers satisfactory haematological control at the same time remains to be established.

Aged↗
PubMed1987

Generalized pruritus as a presenting symptom in Nigeria.

In a retrospective study of 4000 consecutive dermatologic patients seen at the Lagos University Teaching Hospital Skin Clinic, 268 patients (6.7%) had generalized pruritus without obvious skin diseases. Filariasis was responsible for the pruritus in 57% of these patients; 21% was bath-related pruritus, and the reasons for this were highlighted. In 6% of cases, pruritus was thought to be due to intolerance to environmental heat; 9.7% was due to miscellaneous causes. Pruritus from systemic diseases accounted for 3.7%. Causes for the pruritus were not elicited in 2.6% of the patients.

Humans↗
PubMed2004

Endogenous opioids, mu-opiate receptors and chloroquine-induced pruritus: a double-blind comparison of naltrexone and promethazine in patients with malaria fever who have an established history of generalized chloroquine-induced itching.

AIMS: Chloroquine induces a severe generalized pruritus, in predisposed Black African patients, during treatment of malaria fever, and also in some Caucasian patients treated for rheumatological diseases. We have previously shown that chloroquine may release endogenous opioids and/or interact with micro-opiate receptors in rats, and that both histamine and malaria parasite blood density, contribute to the itching severity in malaria fever in humans. The aim of our present study was to assess and compare the antipruritic efficacy of the micro-opiate receptor antagonist, naltrexone, and the antihistamine, promethazine, in chloroquine treated patients with malaria fever. METHODS: A double-blind, randomized, parallel group comparison of the chloroquine-induced pruritus intensity and time profile in patients with parasitologically proven malaria fever, who were pretreated with a single dose of either naltrexone 50 mg or promethazine 25 mg orally (six patients each). All patients had an established history of severe pruritus following chloroquine treatment of malaria fever. A self-assessed itching severity score was undertaken at 0, 6, 12, 24, 48 and 72 h after initial chloroquine dosing, and the areas under the pruritus-intensity time curve AUCP0-72 h was determined in each patient and correlated to the malaria parasite density in blood. RESULTS: Both naltrexone and promethazine subjectively reduced itching severity compared with prior historical experience. One patient on naltrexone and two on promethazine never experienced any itching. There was no statistically significant treatment effect, but a significant time effect (P = 0.001, F = 4.77 d.f. 5) by two-way repeated measures ANOVA. The AUCP for naltrexone was 82 +/- 25 units/h, and 57 +/- 34 units/h for promethazine [95% confidence interval for the difference being -73 to 123]. However, the malaria parasite density in the naltrexone group (740 +/- 178 microl(-1)) tended to be higher than in the promethazine group 314 +/- 69 microl(-1) (P = 0.056, 95% confidence interval for the difference being -15 to 866 microl(-1)). Correction of the AUCP for malaria parasite density (parasite pruritogenic index, AUCP. units/h/parasites/microl blood) tended to be lower with naltrexone 9.1 +/- 2.6 than with promethazine 12.2 +/- 7.0 There was a highly significant and positive correlation between the malaria parasite density and the AUCP0-72 h, on naltrexone (r2 = 0.78, P = 0.040) and promethazine (r2 = 0.93, P = 0.008). However, comparison of regressions revealed that the slope of the regression was significantly steeper with promethazine 0.48 than naltrexone 0.12 (P = 0.006, t = 4.2), with the intercepts showing a trend to a difference (P = 0.086). CONCLUSION: Naltrexone exerted an antipruritic action, at least to a similar extent to promethazine in patients with chloroquine-induced itching in malaria fever. However, the relationship between parasite density and resultant pruritus was significantly different between naltrexone and promethazine. Thus, micro-opiate receptors/and or endogenous opioids may contribute to chloroquine itching in malaria fever, in humans, in accord with animal experimental findings. Malaria parasite density in blood is a strong determinant of itching severity in patients predisposed to chloroquine-induced pruritus.

Administration, Oral↗
PubMed2006

Rifampin is safe for treatment of pruritus due to chronic cholestasis: a meta-analysis of prospective randomized-controlled trials.

OBJECTIVES: To determine the safety and efficacy of rifampin for treatment of pruritus associated with cholestasis due to chronic liver disease. METHODS: Medical literature was searched systematically using keywords as rifampicin, rifampin, rifamycin, cholestasis, pruritus, itching, and liver disease. Trials that compared the efficacy of rifampin with placebo/alternative for treatment of pruritus due to chronic cholestasis were selected for analysis. Primary outcomes were resolution of pruritus and development of side effects. Association was measured with the odds ratio (OR). Breslow-Day method was used to treat for homogeneity under null hypothesis that OR was consistent across all the trials. Corrected Mantel-Haenszel chi(2) test was used to test if OR differed systematically from value of 1. RESULTS: Five prospective randomized-controlled cross-over trials with 61 patients were identified. Treatment with rifampin led to complete or partial resolution of pruritus in 47 (77%) patients as compared with 12(20%) treated with placebo or alternative (OR 15.2, 95% confidence interval 5.2-45.6, P=0.001). Four (7%) patients treated with rifampin suffered side effects, which resolved after its discontinuation. There was no incidence of hepatotoxicity. Test of heterogeneity for primary end points among the trials was not significant (P=0.16). CONCLUSION: This meta-analysis suggests that rifampin is safe and effective for treatment of pruritus due to chronic cholestasis. This analysis also suggests that use of rifampin for short duration is associated with a low risk of hepatotoxicity.

Cholestasis↗
PubMed1992

Uremic pruritus and skin mast cells.

The number of mast cells in the skin was evaluated in 25 patients with end-stage renal failure on different treatment modality (conservative, hemodialysis and peritoneal dialysis). According to the presence of pruritus, uremic patients were divided into two groups: group A, 13 patients with diffuse pruritus, and group B, 12 patients without pruritus. Controls were 6 age- and sex-matched healthy subjects. In comparison with patients without pruritus, patients with pruritus had mainly degranulated, diffusely spread and more numerous mast cells in the skin; significantly higher levels of plasma middle molecular weight substances, serum histamine and PTH and significantly lower serum iron levels. However, no differences were noted in observed parameters between groups on different treatment modalities. Favorable therapeutic effects in patients with pruritus were achieved either with iron supplementation in those with hypoferremia or with antihistamines, mast cell membrane stabilizers and high-permeability membranes.

Humans↗
PubMed1994

Thalidomide for the treatment of uremic pruritus: a crossover randomized double-blind trial.

Our observation that thalidomide administration to a dialysis patient with leprosy alleviated his pruritus led us to conduct this short-term study to assess the efficacy of the drug in this regard. From 210 hemodialysis patients, 29 cases of refractory uremic pruritus were entered into the study. Patients were instructed to score their symptoms from 0 to 3, three times a day and assigned to receive thalidomide or placebo at bed time for 7 days. After a washout period of 7 days, drugs were crossed over. Response was defined as a reduction of at least 50% in the pruritus scoring. Eighteen patients finished the study. In the first phase, 55% of patients responded showing a mean reduction in their pruritus scoring of 78% (p < 0.05 vs. placebo); no response to placebo was observed. A similar proportion of patients responded to thalidomide in the second phase with a mean reduction in their pruritus scoring of 81%. In conclusion, thalidomide can be a precious tool in the handling of uremic pruritus unresponsive to available therapy.

Aged↗
PubMed2000

Frequency of pruritus in Plasmodium vivax malaria patients treated with chloroquine in Thailand.

Chloroquine-induced itch in black-skinned African malaria patients is common and frequently leads to poor compliance or treatment defaulting.To assess the frequency and severity of chloroquine-induced pruritus in an Asian population, we reviewed case records of 1189 Plasmodium vivax malaria patients treated with chloroquine (25 mg/kg over 3 days) at the Bangkok Hospital for Tropical Diseases from 1992 through 1997. The majority of patients were Thais or ethnic Burmese (light brown skin), referred from the western border of Thailand. Overall, there were 23 patients (1.9%) with complaints of pruritus during chloroquine therapy. Of these, 12 (52%) had palm and sole involvement, eight (35%) had generalized pruritus including the palms and soles, and three (13%) had palm itching only. One patient developed pruritus on the palms and soles on two consecutive admissions. The pruritus did not interfere with daily activity, was reduced in intensity by anti-histamine therapy, and did not affect the patient's willingness to complete the chloroquine regimen. Therapeutic responses in the 23 patients with chloroquine itch was similar to those without itch. Among the itch patients, there was no association with gender or level of parasitaemias. Our findings indicate that the frequency of chloroquine-induced pruritus in Asian patients treated with chloroquine for P. vivax malaria is low in comparison with black-skinned Africans.This may be related to pharmacogenetic factors, the infective Plasmodium species, drug metabolism or drug-parasite interactions, or a lower affinity of chloroquine for less pigmented skin.

Adolescent↗
PubMed1990

Pruritus. Current concepts in pathogenesis and treatment.

Pruritus is an unpleasant sensation that provokes an urge to scratch. Many stimuli (notably histamine) are able to induce pruritus. The neural conduction of the itch sensation from the free unmyelinated nerve endings to the central nervous system mainly occurs on unmyelinated C fibres and the anterolateral spinothalamic tract. Pruritus is a common symptom in many skin or systemic diseases, but very little is known about the mechanism of the condition. Treatment evaluation is difficult; many methods do not evaluate the pruritus, but only the scratching, which is a consequence of pruritus. A number of asymptomatic treatments are only partially effective and we know little about their mechanism of action. Antihistamines remain the treatment of first choice for pruritus without known cause, but generally give incomplete relief. Whenever possible it is best to treat the underlying disease.

Antipruritics↗
PubMed2000

Oral guar gum, a gel-forming dietary fiber relieves pruritus in intrahepatic cholestasis of pregnancy.

BACKGROUND: Guar gum is a gel-forming fiber, which increases fecal elimination of bile acids. It may therefore be beneficial in the treatment of intrahepatic cholestasis of pregnancy. METHODS: Forty-eight patients with intrahepatic cholestasis of pregnancy were randomized double-blind to receive either guar gum or placebo until delivery. Serum bile acid concentration was measured. Pruritus was assessed by both the investigator and the patient. RESULTS: At baseline, the intensity of pruritus and the serum bile acid concentration were significantly related. Guar gum diminished or prevented worsening of pruritus, while in the placebo group pruritus was enhanced (p<0.05). In the placebo group serum bile acid concentration increased significantly, whereas in the guar gum group it remained unchanged (p<0.05 between the groups). Guar gum treatment-induced changes of the pruritus score and serum bile acid concentrations were significantly related (p<0.01). CONCLUSIONS: Guar gum relieved the intensity of pruritus without any side effects and prevented the rise in serum bile acid concentration in this placebo-controlled and double-blind study of patients with intrahepatic cholestasis of pregnancy.

Administration, Oral↗
PubMed2003

Pruritus: a review.

The history, neurophysiology, clinical aspects and treatment of pruritus are reviewed in this article. The different forms of pruritus in dermatological and systemic diseases are described, and the various aetiologies and pathophysiology of pruritus in systemic diseases are discussed. Lack of understanding of the neurophysiology and pathophysiology of pruritus has hampered the development of adequate therapies. Nevertheless, the discovery of primary afferent neurons and, presumably, second-order neurons with typical histamine responses mediating pruritic sensations can be regarded as a breakthrough in our understanding of the mechanisms behind pruritus. The number of experimental and therapeutic studies has greatly increased during the past few years, reflecting an increased interest in this topic. However, further effort is needed to develop new therapeutic concepts and clarify some confusion arising from promising case reports and uncontrolled clinical studies. A precise work-up for evaluating patients with pruritus is proposed, which may help the physician to identify the underlying causes and thus to treat the patient appropriately.

Female↗
PubMed2003

Pruritus.

Pruritus is a common manifestation of dermatologic diseases, including xerotic eczema, atopic dermatitis, and allergic contact dermatitis. Effective treatment of pruritus can prevent scratch-induced complications such as lichen simplex chronicus and impetigo. Patients, particularly elderly adults, with severe pruritus that does not respond to conservative therapy should be evaluated for an underlying systemic disease. Causes of systemic pruritus include uremia, cholestasis, polycythemia vera, Hodgkin's lymphoma, hyperthyroidism, and human immunodeficiency virus (HIV) infection. Skin scraping, biopsy, or culture may be indicated if skin lesions are present. Diagnostic testing is directed by the clinical evaluation and may include a complete blood count and measurement of thyroid-stimulating hormone, serum bilirubin, alkaline phosphatase, serum creatinine, and blood urea nitrogen levels. Chest radiography and testing for HIV infection may be indicated in some patients. Management of nonspecific pruritus is directed mostly at preventing xerosis. Management of disease-specific pruritus has been established for certain systemic conditions, including uremia and cholestasis.

Cholestasis↗
PubMed1991

Chloroquine-induced pruritus: its impact on chloroquine utilization in malaria control in Dar es Salaam.

To confirm reports that chloroquine-induced pruritus might have a negative impact on chloroquine utilization on malaria control in Dar es Salaam, a precoded questionnaire was administered to 300 malaria patients and the respondents were then followed up at their homes during the period of their malaria treatment. It was found that 45% of the study population had suffered from chloroquine-induced pruritus at some time in their life and 27% complained of it during the study. Chloroquine-induced pruritus was found to have a significant negative impact on chloroquine utilization on malaria control in Dar es Salaam, Tanzania (P less than 0.001). The defaulting rate attributable to chloroquine-induced pruritus was 64%. The high defaulting rate (91%) among the patients with chloroquine-induced pruritus is suspected to be among the factors that contribute to the emergence and spread of resistant malaria parasites in Dar es Salaam. However, studies are needed to confirm this point. Studies are also needed to determine if there may be familial predisposition to chloroquine-induced pruritus as hypothesized in this study.

Chloroquine↗
PubMed1991

The efficacy of piriton on chloroquine-induced pruritus in patients with malaria.

The efficacy of chlorpheniramine in the prevention of choroquine-induced pruritus was assessed in a trial involving 132 malaria patients with a history of chloroquine-induced pruritus. Patients who gave informed consent were randomized into either placebo or treatment group. 70 were randomized into chlorpheniramine group and 62 into placebo group. Of the 70 patients put on chloroheniramine, 52 (74%) did not develop pruritus while only 15 (24.2%) of the 62 patients put on placebo did not develop pruritus. Chlorpheniramine was significantly more efficacious in preiritus prevention than placebo (X2 = 31; p less than 0.001). The protection rate of chlorpheniramine against chloroquine-induced pruritus was 67%. The number of patients who terminated treatment prematurely was significantly higher in placebo group than in piriton group. The possibility of recommending the drug into malaria treatment schedules for individuals with known history of chloroquine-induced pruritus is discussed.

Chloroquine↗
PubMed1993

[Persistent pruritus after hydroxyethyl starch infusions. Retrospective long-term study of 266 cases].

In 266 patients receiving hydroxyethyl starch (HES) for otological indications, we retrospectively analysed the incidence of pruritus and its relationship to clinical and therapeutic parameters. We found that 32% of the patients developed pruritus, which characteristically appeared as pruritic crises. In 55% of pruritic patients onset after the HES medication had already been discontinued was reported. The symptoms persisted on average for 8.8 weeks. Pruritus was generalized, but with a predilection for the trunk and genitalia. Coincidental atopic disease or higher age did not promote pruritus. However, the incidence of pruritus correlated well with the cumulative dosage and also depended on the type and molecular weight of HES given (6% or 10%, mol.wt. 40 or 200 kDa). Light and electron microscopic assessment showed deposits of HES, especially within dermal macrophages and endothelial cells and adjacent to nerve fibres. Pathogenetically a histamine-independent pathway is probably responsible for the induction of pruritus. Hence, classic antihistaminic drugs had no therapeutic effect in our patients.

Adolescent↗
PubMed1994

Pruritus in end stage renal disease.

In end stage renal disease (ESRD) clients, pruritus can be so severe and intractable, despite scratching, that sleep deprivation and contemplation of suicide can result. The exact etiology of pruritus in ESRD is unknown, but several possible etiologies have been proposed. Assessment tools are available to nurses and clients to grade the severity, frequency, distribution, and sleep deprivation experienced with the itching. Various treatments have been used to manage pruritus in ESRD with limited success. This article reviews the anatomy and physiology of the skin, describes the pathophysiology of pruritus, discusses proposed etiologies, reviews an assessment for an ESRD client with pruritus, and discusses the collaborative management of pruritus in ESRD.

Humans↗
PubMedDate not supplied

Inhibition of epidural morphine-induced pruritus by intravenous droperidol. The effect of increasing the doses of morphine and of droperidol.

BACKGROUND AND OBJECTIVES: Because the mechanism of inhibition of epidural morphine-induced pruritus by droperidol is not clear, this study was undertaken to determine the effects of larger doses of droperidol or morphine, or both. METHODS: A double-blind study was performed in 210 ASA I or II patients undergoing cesarean delivery, who were randomly assigned to six groups. All patients received epidural anesthesia with 0.5% bupivacaine containing 1:200,000 epinephrine, to which 2 mg (groups 1, 2, and 3) or 4 mg (groups 4, 5, and 6) morphine sulfate was added. Just after delivery, 2.5 mg droperidol was given intravenously to groups 2 and 5, and 5 mg was given to groups 3 and 6. During the postoperative period, the patients were assessed for the occurrence and severity of pruritus (classified as absent, mild, moderate, or severe) or other untoward symptoms. The groups were compared for the incidence of pruritus by the Mann-Whitney nonparametric test. RESULTS: The incidence of pruritus was significantly reduced only when the control group. (no droperidol) was compared with the group that received 2.5 mg droperidol, both when 2 mg and when 4 mg morphine was used. A 5-mg dose of droperidol had no inhibitory effect. There was no difference in the incidence of pruritus between use of 2 mg and 4 mg morphine. Other untoward effects of morphine either could not be observed or occurred with an incidence unaffected by either dose of droperidol. CONCLUSION: Pruritus caused by epidural use of 2 or 4 mg of morphine is inhibited by the intravenous use of 2.5 mg droperidol but not by a larger dose.

Adjuvants, Anesthesia↗
PubMed1997

[Uremic pruritus].

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.

Cations↗
PubMed1998

Bullous pemphigoid presenting as generalized pruritus: observations in six patients.

BACKGROUND: Bullous pemphigoid is a chronic immunobullous disease of the elderly. Classically, tense, pruritic blisters develop on normal or erythematous skin. These may be preceded by a prodromal pruritic, urticarial, or eczematous eruption. Occasionally, patients may develop generalized pruritus without blisters as a prodrome of bullous pemphigoid. METHODS: The records of the patients were reviewed. Biopsy specimens were studied by light and immunofluorescence microscopy. Serum specimens were studied by indirect immunofluorescence techniques including the salt-split skin technique. RESULTS: We studied six elderly patients presenting with generalized pruritus as the dominant or single presenting feature of early bullous pemphigoid. Two of the six had rare vesicles at presentation. All had excoriations and one each presented with minimal urticarial or eczematous papules. Routine skin biopsies were largely nonspecific. All patients had confirmation of their diagnosis by either indirect or direct immunofluorescence testing or both. All six patients had their disease completely controlled by their treatment. CONCLUSIONS: The clinical presentation of the six patients in our series and the eight previously reported patients should be regarded as an unusual prodromal manifestation of bullous pemphigoid characterized by generalized pruritus without primary skin lesions. This presentation could be described as "pruritic pemphigoid," because it joins the remarkable clinical finding of generalized pruritus with the underlying diagnosis of bullous pemphigoid. Elderly patients with severe or persistent unexplained generalized pruritus merit immunofluorescence testing to exclude bullous pemphigoid as the cause of the generalized pruritus. Establishing an early diagnosis permits the prompt institution of effective therapy with dapsone or systemic corticosteroids with an excellent prognosis for complete control of the disease.

Aged↗