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PubMed2006

[Clinical effects of olopatadine hydrochloride on pruritus in skin diseases].

OBJECTIVE: The clinical effects of second generation antihistamines on pruritus caused by various skin diseases were examined by keeping a daily record of their effects. METHODS: Five mg of olopatadine hydrochloride (Allerock) was administered to the subjects twice daily. The severity of the pruritus and the scratch scars were scored before, and then 2 weeks and 4 weeks after, commencement of treatment. The severity of the pruritus during the day and night was measured by using a visual analogue scale (VAS), and a daily 'itch score' was recorded in an 'itch diary.' RESULTS: The itch scores for both day and night, as well as the scratching scores, the VAS values and the 'itch score,' significantly decreased after administration of olopatadine. The VAS value was significantly correlated with the itch scores and patient responses in the medical interview. Statistical analysis showed that there was a prompt alleviation of the pruritus in urticaria a day after administration, followed by asteatotic dermatitis and atopic dermatitis, in the order of improvement, within the next several days. CONCLUSION: The VAS value for pruritus was highly correlated with the itch score, showing that the VAS value was suitable for evaluating daily changes in the severity of pruritus. These results suggest that second generation antihistamines like olopatadine hydrochloride, which showed a prompt response to histamine, are effective against pruritus in urticaria, and that continuous use of these antihistamines is effective against pruritus in other forms of skin disease, such as asteatotic dermatitis and atopic dermatitis in which other chemical mediators besides histamine may be the triggers for pruritus.

Adult↗
PubMed1987

[Beneficial effect of zinc supplementation on pruritus in hemodialysis patients with special reference to changes in serum histamine levels].

Persistent pruritus is one of the most common symptoms in hemodialysis patients. The cause of pruritus is not known, and conventional treatment for pruritus is rarely helpful. Some authors thought that release of histamine from increased mast cells in uremic patients was the cause of pruritus. On the other hand, there have been a number of reports suggesting that uremic patients are zinc deficient. In vitro as well as in vivo studies have demonstrated that zinc has an inhibitory effect on various functions of some cells, such as histamine release from mast cells. In this study, we examined the serum zinc and histamine levels in 19 hemodialysis patients with persistent pruritus and the effect of zinc supplementation on the pruritus. In patients with pruritus, the serum zinc level decreased and serum histamine level increased, showing a negative correlation between them. Oral zinc sulfate, 445 mg daily for two months, relieved pruritus subjectively in 53% of the patients. After treatment, serum histamine levels decreased significantly, as well as serum zinc levels increased significantly. These findings suggest that zinc deficiency participates in increased histamine levels in dialysis patients, and subsequently in the development of uremic pruritus.

Administration, Oral↗
PubMed1994

Methionine-enkephalin concentrations correlate with stage of disease but not pruritus in patients with primary biliary cirrhosis.

OBJECTIVE: Opiate antagonist agents ameliorate pruritus in some patients with cholestatic liver disease, suggesting that endogenous opioids may mediate pruritus in cholestasis. However, the endogenous opioids potentially responsible for pruritus remain unknown. Methionine-enkephalin is an endogenous opioid synthesized in numerous tissues including the gastrointestinal tract, and released into the portal circulation. Serum methionine-enkephalin concentrations are elevated in patients with chronic liver disease, making this opioid a candidate for opioid-mediated pruritus in cholestatic liver disease. The aim of our study was to determine whether elevated circulating methionine-enkephalin concentrations are associated with pruritus. METHODS: Serum concentrations of methionine-enkephalin were measured in 54 consecutive, untreated patients with primary biliary cirrhosis and 20 healthy controls. There was a direct correlation between methionine-enkephalin concentrations and total serum bilirubin (r = 0.42, p < 0.05) and the Mayo risk score (r = 0.5, p < 0.005). Methionine-enkephalin concentrations were significantly higher in histological stages 3 and 4 (48 +/- 4 pg/ml, n = 44), compared with stages 1 and 2 (29 +/- 12 pg/ml, n = 10, p < 0.05). Methionine-enkephalin concentrations in both histological groups were significantly higher than those in 20 healthy controls (16 +/- 4 pg/ml, p < 0.005). RESULTS: There was no significant correlation between methionine-enkephalin concentrations and the presence of pruritus (46 +/- 25 pg/ml with pruritus vs. 40 +/- 22 pg/ml without pruritus, n = 20). CONCLUSIONS: Increased serum methionine-enkephalin concentrations in patients with primary biliary cirrhosis were not associated with pruritus.

Bilirubin↗
PubMed1993

Pruritus in continuous ambulatory peritoneal dialysis and hemodialysis patients.

To study the prevalence and pathogenesis of uremic pruritus, CAPD and HD patients were asked to complete a questionnaire. The replies were quantitated based on numerical scales, and the results were compared with various hematological and biochemical parameters, underlying disease, and duration of dialysis. There were 113 CAPD patients (63 males and 50 females), mean age 60 (range 20-84) years, average time on CAPD 20 (range 1-163) months and 76 HD patients (44 males and 32 females) mean age 57 (range 23-81) years, mean time on HD 44 (range 2-242) months. Replies to questions were evaluated and graded by the same investigator who did not know the patients. Pruritus was present in 70 (62%) CAPD patients (64% in females and 60% in males p = NS) and in 41 (54%) HD patients (69% in females and 43% in males, p = 0.025). Before starting dialysis pruritus was present in 30% CAPD patients and 28% HD patients. Pruritus was graded as mild, moderate and severe; the distribution was 58.6%, 34.3%, and 7.1% (CAPD) and 43.9%, 41.5%, and 14.6% (HD), respectively. Dry skin was reported by 73% CAPD patients and 72% HD patients. This xeroderma was correlated with the severity of pruritus and was also present in 65% CAPD and 48.5% HD patients without pruritus. Patients with pruritus were older than those without pruritus both for CAPD (63 vs 54 years, p = 0.004) and HD (61 vs 51 years, p = 0.003). A significant correlation was observed only between pruritus score and age for CAPD patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2004

An approach to the treatment of anogenital pruritus.

The anogenital area is a common location for pruritic complaints. Specific terms for chronic itch in this location have included pruritus vulvae, pruritus ani, lichen simplex chronicus, and neurodermatitis. A male counterpart to pruritus vulvae, pruritus scroti, is less common. Acute anogenital pruritus is usually caused by infections or contact dermatitis. In chronic pruritus, inflammatory dermatoses and malignancies must be ruled out. In idiopathic anogenital pruritus or neurodermatitis, the skin findings should be limited to lichenification and excoriations. Skin findings may be entirely absent. When treating anogenital pruritus, topic irritants and potential sensitizers must be eliminated. Cleansing and toilet habits must be addressed. A short course of a high-potency topical steroid should bring moderate to complete relief. Sedating antihistamines may limit nighttime symptoms. In some patients, psychotropic agents are required to achieve adequate sedation. Antidepressants may be required in patients refractory to treatment or with underlying psychiatric disorders.

Female↗
PubMed1988

Pruritus in psoriasis. A prospective study of some psychiatric and dermatologic correlates.

Among 82 inpatients with psoriasis, 67% (55 patients) reported moderate or severe pruritus. The degree of depressive psychopathology discriminated between the mild, moderate, and severe pruritus groups at admission. Prospectively, the change in depression scores correlated with the change in pruritus pretreatment to posttreatment. Pruritus severity did not correlate significantly with stress due to life events, age at onset, ethyl duration of psoriasis, age, sex, marital status, and average reported daily alcohol (ethanol) consumption. Among the objective dermatologic measures, including extent and severity of lesions, only the degree of perilesional irritation discriminated between the mild, moderate, and severe pruritus groups at admission, and prospectively, change in this measure correlated with the change in pruritus pretreatment to posttreatment. This finding was most likely related to the self-excoriation associated with pruritus. Intrapsychic factors (eg, the severity of depression) rather than external psychosocial or well-defined dermatologic factors, were the most significant correlates of pruritus in psoriasis.

Adult↗
PubMed2002

Chronic pruritus associated with Helicobacter pylori.

BACKGROUND: Helicobacter pylori is an established cause of gastritis and has been implicated in extradigestive diseases. OBJECTIVE: To investigate the role of H. pylori in patients with unexplained refractory pruritus. METHODS: Ten patients with severe pruritus unresponsive to conventional therapy were evaluated for active H. pylori infection by H. pylori serology followed by either esophagogastroduodenoscopy (EGD) or urea breath test. Of the 10 patients, 8 were found to have active infection. All 10 received anti-H. pylori antibiotic therapy and were reevaluated for relief of pruritus. RESULTS: Of 8 patients with active H. pylori infection, 87.5% (7/8) had some type of pruritus relief after triple therapy. Of these, 62.5% (5/8) had complete relief and 25% (2/8) had temporary relief of pruritus. The remaining 12.5% (1/8) did not respond. Two control patients without active H. pylori infection had no relief of pruritus with therapy. CONCLUSIONS: We have identified a population of patients with refractory pruritus and active H. pylori infection whose pruritus resolved after eradication of H. pylori.

Adult↗
PubMed1993

Subhypnotic doses of propofol relieve pruritus associated with liver disease.

BACKGROUND: Pruritus is a severe and troublesome symptom in patients with cholestasis and is often difficult to treat. Propofol was recently shown to be efficient in relieving pruritus secondary to spinal morphine administration. The efficacy of propofol was therefore investigated in patients with pruritus associated with liver disease. METHODS: In a prospective, randomized, double-blind, crossover, placebo-controlled study, 10 patients received 2 doses of propofol (1.5 mL = 15 mg) and 2 doses of placebo (1.5 mL of Intralipid, Kabi-Pharm., Helsinki, Finland) during a 4-day study period. Pruritus was assessed by a verbal rating score from 0 (no pruritus) to 10 (most severe pruritus imaginable). Treatment success was defined as a decrease of pruritus of at least 4 points in the verbal rating score. RESULTS: Treatment success was achieved in 85% of the patients receiving propofol and in 10% of those receiving Intralipid (P < 0.01). Discomfort on injection (15%) and slight dizziness (10%) were observed with propofol treatment. CONCLUSIONS: This study shows that subhypnotic doses of propofol are effective for the short-term symptomatic relief of pruritus associated with liver disease. At the dose used, side effects were rare and minor.

Adult↗
PubMed2003

Effects of homeopathic treatment on pruritus of haemodialysis patients: a randomised placebo-controlled double-blind trial.

Pruritus is a frequent and difficult to treat problem in haemodialysis. This double-blind placebo-controlled randomised clinical trial assessed the role of homeopathic treatment in this situation. The code was held by the pharmacist who dispensed the medications. Pruritus was evaluated using a previously published scale. Only patients with initial values above 25% of maximum pruritus score were entered. Data were analysed after partial code break, separating the two groups of patients, but with no awareness of which one received verum or placebo. Patients were classified as responders if they had >50% reduction of pruritus score. Twenty-eight patients (16M/12F, 51 +/- 11 years of age) were entered and 20 (12M/8F, 52 +/- 8 years of age) remained for final analysis: 11 in the verum group, 9 in placebo. At entry, the mean pruritus score was 65 +/- 25% for the treated patients and 70 +/- 27% for placebo. After 15, 30, 45, and 60 days of follow-up, pruritus score were respectively: 46 +/- 29, 41 +/- 30, 42 +/- 29, and 38 +/- 33 for the treated patients and 61 +/- 29, 67 +/- 31, 64 +/- 35, and 57 +/- 39 for placebo. Reduction was statistically significant (P<0.05) at every point of observation. According to the patients' own assessment, at the end of the study period, the homeopathic treatment reduced the pruritus score by approximately 49%. Responders were more frequent in the treated group with statistical significance at 30 days (0% vs 45%, P=0.038). Homeopathic treatment may represent a worthwhile alternative to relieve pruritus in patients undergoing haemodialysis.

Adult↗
PubMed1996

Randomised crossover trial of naltrexone in uraemic pruritus.

BACKGROUND: Most dialysis patients develop pruritus, for which current treatment is unsatisfactory. Endogenous opioids may be involved in this pruritus. We studied the effect of the opioid antagonist naltrexone on the pruritus of haemodialysis patients. METHODS: Naltrexone 50 mg per day by mouth was given to 15 haemodialysis patients with severe resistant pruritus in a randomised, double-blind, placebo-controlled crossover trial. The naltrexone or placebo periods lasted 7 days each with a 7-day washout between the two periods. Pruritus was assessed by the patients on a visual analogue scale from 0 (no pruritus) to 10 (maximum), and mean daily scores were calculated. Plasma histamine and beta-endorphin levels were measured, and spontaneous and stimulated basophil histamine-release were determined. FINDINGS: The median pruritus scores at the end of the naltrexone treatment were 2.1 (interquartile range 1.5-2.15) for the naltrexone-placebo sequence and 1.0 (0.4-1.15) for the placebo-naltrexone sequence. The respective values before naltrexone was given were 9.9 (9.85-9.95) and 9.9 (9.3-10.0). Plasma beta-endorphin levels were normal and remained unchanged during the study. Plasma histamine levels were high (mean 2.32 [SD 0.11] ng/mL, normal < 1.0) and decreased after naltrexone (to 1.8 [0.09], p < 0.01). Basophils from haemodialysis patients stimulated by interleukin-3 plus IgE antibodies released high amounts of histamine. The increase was 78.3 (19.3)% compared with 26.6 (16.3)% for five normal controls (p < 0.01). Incubation of the basophils with naloxone, another opioid antagonist, prevented this effect. INTERPRETATION: Our data suggest short-term efficacy with few side-effects for the amelioration of uraemic pruritus with naltrexone.

Cross-Over Studies↗
PubMed2002

Efficacy and safety of oral naltrexone treatment for pruritus of cholestasis, a crossover, double blind, placebo-controlled study.

BACKGROUND/AIMS: To assess the efficacy and safety of naltrexone for the short and long term treatment of pruritus of cholestasis. METHODS: Twenty patients with pruritus and cholestasis were included. A baseline pruritus score was obtained over 1 week. Patients were then randomized to receive 50 mg/day of naltrexone or placebo for 2 weeks. Subsequently, a 1-week washout period ensued and patients were crossed over to the other therapy for 2 additional weeks. Pruritus was assessed daily with a visual analogue scale (VAS) from 0 to 10. Patients whose pruritus decreased >50% of basal with naltrexone received naltrexone 50 mg/day for 2 additional months. RESULTS: Mean basal VAS was similar in both groups. VAS showed greater and more significant changes with naltrexone than with placebo (P<0.0003). In nine out of 20 patients (45%) receiving naltrexone, pruritus decreased >50% compared to basal value, including five whose pruritus disappeared completely. No significant changes were observed in serum biochemistry. Most of the adverse events that occurred during the first 48 h of naltrexone therapy were consistent with opioid withdrawal-like phenomena and spontaneously disappeared 2 days after starting treatment. CONCLUSIONS: Naltrexone can be considered as an alternative option to treat pruritus of cholestasis. In the current study, side effects were transient and did not require specific medication.

Administration, Oral↗
PubMed1988

Variations in aquagenic pruritus and treatment alternatives.

We report our experience in the treatment of two patients with aquagenic pruritus of the elderly and two patients with aquagenic pruritus. Our findings confirm previous reports by others indicating that aquagenic pruritus is not one homogenous entity but rather is composed of two similar but distinct entities, each of which responds to a different treatment. Patients with aquagenic pruritus were helped by adding sodium bicarbonate to the bath water while patients with aquagenic pruritus of the elderly responded to emollients. It is suggested that aquagenic pruritus and aquagenic pruritus of the elderly are two similar but distinct entities. Separating these two entities provides the key to successful treatment, because each of them responds to a different treatment without crossover. This report is only the second report indicating the effectiveness of sodium bicarbonate baths in patients with aquagenic pruritus. It is clear that further examples are needed to confirm these findings.

Adult↗
PubMed1997

UVB phototherapy is an effective treatment for pruritus in patients infected with HIV.

BACKGROUND: Pruritus in patients positive for HIV may be debilitating. OBJECTIVE: Our purpose was to evaluate the efficacy of UVB therapy in the treatment of pruritus in patients positive for HIV. METHODS: Twenty-one male HIV-positive patients with intractable pruritus (14 with eosinophilic folliculitis and 7 with primary pruritus) were treated three times weekly with UVB phototherapy. Pruritus was quantified with use of a subjective score of 0 (none) to 10 (severe). RESULTS: Mean CD4 counts at the initiation of therapy were 91.0 +/- 31.9 cells/microliter. Pruritus scores before and after treatment were 8.6 +/- 0.4 and 2.2 +/- 0.5, respectively (p < 0.001). The mean number of treatments to achieve maximal improvement was 20.7 +/- 2.3, with a cumulative UVB dose of 3399.1 +/- 597.4 mJ/cm2. No significant difference was found between the group with eosinophilic folliculitis and the group with primary pruritus. CONCLUSION: UVB phototherapy can produce significant relief of pruritus and improvement in the quality of life in patients positive for HIV.

Adult↗
PubMed1988

Pathophysiology of pruritus.

In spite of the research that has been performed, pruritus remains a poorly understood sensation. It is important to remember that the majority of information presented here is derived from observations of human subjects. One can only speculate as to how much of this information can be extrapolated to pruritus in animals. Pruritus is closely intertwined with pain and touch. Pain and pruritus sensations are carried on A delta and C fibers, ascend on the lateral spinothalamic tract, and terminate in various brain centers, including the thalamus and the cortex. The gate control theory of pain and pruritus describes the substantia gelatinosa cells as "swinging gates" to modify peripheral input and result in stimulation of higher centers. Central factors reduce or amplify the perception of these cutaneous sensations. Histamine is the classic mediator of pruritus, although it is still unknown whether a final common mediator of pruritus exists. Numerous other mediators include proteases, peptides, substance P, opiate peptides, prostaglandins, and leukotrienes. These may have pruritic properties directly, or may act as histamine liberators to cause pruritus.

Animals↗
PubMed2000

Ondansetron therapy for uremic pruritus in hemodialysis patients.

Pruritus is a distressing symptom affecting up to 90% of dialysis patients. Conventional treatment with antihistamines is often ineffective and may have unacceptable side effects. Serotonin (5-hydroxytryptamine type 3 [5-HT(3)]) is known to enhance pain perception and pruritic symptoms through receptors on sensory nerve endings. Antagonism of 5-HT(3) receptors may be of use in treating uremic pruritus. We randomly assigned 16 hemodialysis patients with persistent pruritus to treatment with the 5-HT(3)-receptor antagonist, ondansetron (8 mg), or placebo three times daily for 2 weeks each in a prospective, placebo-controlled, double-blind crossover study. Patients scored their intensity of pruritus daily on a 0-to-10 visual analogue scale (0 = no pruritus, 10 = maximal pruritus), and daily use of antihistamines as escape medication was recorded. The median daily pruritus score did not change significantly during active or placebo treatment (preondansetron, 5. 3; interquartile range [IQR], 3.4 to 6.3; during ondansetron, 3.9; IQR, 2.7 to 5.0; P = not significant; preplacebo, 3.7; IQR, 3.0 to 4. 6; during placebo, 3.6; IQR, 2.4 to 4.8; P = not significant). The median daily percentage of escape medication use decreased from 21% (IQR, 9 to 61) to 9% (IQR, 0 to 33) with ondansetron (P = not significant) and from 53% (IQR, 0 to 88) to 5% (IQR, 0 to 31) with placebo (P = not significant). There was no difference in predialysis biochemistry test results or dialysis efficacy during treatment phases. Ondansetron does not improve pruritus in hemodialysis patients. Use of antihistamines decreased with both ondansetron and placebo.

Adult↗
PubMed1997

Pruritus in chronic hepatitis C: association with high serum bile acids, advanced pathology, and bile duct abnormalities.

Pruritus is a common symptom of chronic cholestatic liver diseases but is considered rare in chronic hepatitis. We observed pruritus to be an unusually common complaint in patients with advanced chronic hepatitis C. We reviewed the records of 175 chronic hepatitis C patients to identify patients with severe, diffuse, unexplained pruritus; 12 consecutive prospective patients undergoing liver biopsy for chronic hepatitis C served as controls. Assessment included laboratory biochemical tests and assessment of liver pathology by stage, grade, hepatic activity index, and a bile duct score. Pruritus was present in nine (5.1%) patients. Serum AST, ALT, alkaline phosphatase, GGTP, total bilirubin, and ferritin were similar in pruritics and controls. Pruritics had higher serum bile acids (2028.4 +/- 223.1 mmol/liter vs 423.1 +/- 194.3, P < 0.001), higher transferrin saturation (57.5 +/- 6.8% vs 33.2 +/- 3.3, P < 0.01), and lower HCV RNA by bDNA (24.5 +/- 12.7 x 10(5) vs 172.7 +/- 54.1 x 10(5), P < 0.05). Pathology revealed cirrhosis in 6/9 (66.6%) pruritics vs 1/12 (8.3%) controls (P < 0.01). Pruritics had higher pathologic stage (3.7 +/- 0.2 vs 2.2 +/- 0.4, P < 0.01), grade (4.4 +/- 0.2 vs 2.1 +/- 0.2, P < 0.001), activity index (14.3 +/- 1.9 vs 8.6 +/- 1.9, P < 0.025), and bile duct score (7.6 +/- 0.6 vs 4.7 +/- 0.4, P < 0.01). Of eight pruritics treated with IFN-alpha2b, two had complete ALT response and one relapsed. Pruritus followed a relapsing course and only three patients partially responded despite a variety of interventions. In conclusion, pruritus is a common complication of advanced CHC. Its presence is associated with high serum bile acids, advanced pathology and bile duct abnormalities. The clinical course of pruritus is relapsing and response to therapy is inconsistent. These features suggest that pruritus in CHC has a pathogenesis that may vary from that of chronic cholestatic diseases.

Antiviral Agents↗
PubMed2003

[Pruritus without skin manifestation--what kind of state of the art nursing intervention?].

The search for evidence based information and its evaluation for planning the care of a woman with pruritus without visible signs on her skin is exemplified and described in this article. Literature was sought with the key words "itch", "pruritus", and "elderly" in medline, Cinahl and the Cochrane library. Retrieved studies were appraised by the criteria for valid information of evidence based nursing. Most pruritus studies were about pruritus with skin rash or about pruritus connected to liver or renal failure. Randomised controlled trials about the treatment of pruritus were characterised by small sample sizes or were done with only men or women. The little knowledge found in these studies did not help resolve the complex individual situation of the patient. Treatment suggestions from the studies: to assess the causes and exacerbating factors of pruritus; to wash the skin with water only, e.g. without soap; to emulsify the skin with Vaseline or oil at least once daily; to prevent too much heat by covering the patient just enough for him or her to feel no cold; prescribing Atarax, a histamin inhibitor of the first generation at night time; to try the antidepressant drug Doxepin; and emulsification with alcohol, menthol and cool water. There is no evidence to predict results of any one of these suggested interventions. Further research regarding the pathophysiology and the effectiveness of interventions against pruritus is needed.

Aged↗
PubMed1997

Chloroquine-induced pruritus in malaria fever: contribution of malaria parasitaemia and the effects of prednisolone, niacin, and their combination, compared with antihistamine.

AIMS: Chloroquine treatment of malaria fever, results in a generalized pruritus of unknown mechanism in up to 60% of adult Africans, by contrast pruritus is unusual in Caucasians following chloroquine use. METHODS: We conducted a double-blind, randomized, parallel group study to examine and compare the antipruritic effects of promethazine, niacin, prednisolone and their combination on pruritus induced by chloroquine, in 28 historical itching patients with parasitologically proven malaria fever. We also evaluated the role of the antecedent malaria parasite density in the severity of chloroquine pruritus intensity. RESULTS: The concurrent administration of chloroquine (2.1 g base total dose) with prednisolone caused a statistically significant reduction in the pruritus AUC (0, 72 h) (P < 0.001 ANOVA) compared with the antihistamine promethazine alone. The areas under the pruritus intensity-time curve were promethazine 105 +/- 28 (units h), niacin 76 +/- 22, prednisolone 28 +/- 24, and prednisolone and niacin 34 +/- 17 (P < 0.001 ANOVA). The 95% confidence interval for the difference in the pruritus AUC between prednisolone and promethazine was 8.4 to 145.6 units h. There was a statistically significant and positive correlation between the pruritus intensity (AUC 0, 72 h) and the malaria parasite load in the itching subjects, not receiving prednisolone (n = 9) (r = 0.73, P = 0.026 ANOVA). CONCLUSION: A single oral dose of prednisolone (10 mg) may be preferable to the antihistamine promethazine (25 mg) as an antipruritic agent for concurrent prescription with chloroquine in individuals predisposed to severe itching. Malaria parasite clearance and clinical amelioration were unaffected by any of the treatments.

Adult↗