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At least 145 records · Page 8Linked to original sources
PubMed1999

Scratching and fasting: a study of pruritus and anorexia nervosa.

An association between pruritus and eating disorders has been suggested. This study examined changes in pruritus during weight restoration in a homogeneous group of women with severe anorexia nervosa (n = 19), using a structured questionnaire, visual analogue scale, clinical examination and a range of serological markers. We demonstrated that itching is a clinical feature of anorexia nervosa, associated with low weight and resolving on weight restoration. Some 58% of the sample suffered pruritus at low weight in a stable hospital environment. There was a significant association between changes in body mass index and severity of pruritus (P = 0.033), with reduced itching on weight restoration. Pruritus occurred in the absence of abnormalities in thyroid, renal and hepatic function, serum androgens, oedema, dermatoses or compulsive washing. Scratching was manifest as 'scratch prurigo' in five cases. Where itching was present, it was experienced as severe. We discuss a variety of possible explanations, including psychopathology, endocrine factors, regional blood flow variation, eczema and the role of central opioid and serotonergic activity. We argue that anorexia nervosa should be considered in all patients at low weight presenting with pruritus, and pruritus should be considered to be a physical symptom of anorexia nervosa.

Adult↗
PubMed1998

Oral guar gum treatment of intrahepatic cholestasis and pruritus in pregnant women: effects on serum cholestanol and other non-cholesterol sterols.

BACKGROUND: Our aim was to investigate whether intestinal binding of bile acids by guar gum, a dietary fibre, relieves cholestasis and pruritus in intrahepatic cholestasis of pregnancy. METHODS: Forty-eight pregnant women with cholestasis and pruritus were randomized double-blind to guar gum and placebo until the time of delivery, and 20 healthy pregnant women were used as control subjects. The pruritus score and serum bile acids, lipids and non-cholesterol sterols were measured at baseline, at least 2 weeks after treatment, just before delivery and up to 4 weeks after delivery. RESULTS: The increase in serum bile acids and worsening of pruritus were prevented by guar gum in relation to placebo (P < 0.05). Serum cholesterol was unchanged, but increased cholesterol precursor sterol values suggested that cholesterol synthesis was increased by guar gum. Serum cholestanol proportion, an indicator of cholestasis, was related to pruritus but was unaffected by guar gum. CONCLUSION: We conclude that in intrahepatic cholestasis of pregnancy and pruritus, guar gum treatment is beneficial in relieving pruritus, even although indicators of cholestasis are only partially reduced.

Administration, Oral↗
PubMed2003

[Therapy of pruritus associated with skin diseases with the serotonin receptor antagonist ondansetron].

BACKGROUND: Pruritus is often a stressing symptom and a therapeutic challenge. We report our experience with the serotonin receptor antagonist ondansetron in the symptomatic treatment of pruritus accompanying various skin diseases. PATIENTS AND METHODS: The influence of ondansetron (8-12 mg orally per day) on pruritus was assessed in twelve patients with various skin disorders. The intensity of pruritus was quantitated daily by a visual analogue scale over the time period of one week before, during, and one week after treatment. RESULTS: Ondansetron decreased pruritus intensity in prurigo simplex (four patients), asteatotic eczema (two patients), parapsoriasis en plaques, and pruritus of unknown origin (one patient each). One of two patients with atopic dermatitis experienced relief, whereas no benefit was observed in urticaria factitia and notalgia paraesthetica (one patient each). CONCLUSIONS: Ondansetron may ameliorate the concomitant pruritus of some dermatologic diseases.

Administration, Oral↗
PubMedDate not supplied

Ondansetron for treatment of intrathecal morphine-induced pruritus after cesarean delivery.

BACKGROUND AND OBJECTIVES: Pruritus induced by intrathecal morphine is a concern in many obstetric patients after cesarean delivery and may detract from the benefit of postoperative pain relief. This study was performed to investigate the efficacy of ondansetron (5-HT3 receptor antagonist) in treatment of pruritus following intrathecal morphine. METHODS: Eighty parturients developing moderate to severe pruritus following intrathecal morphine were randomly allocated into 2 groups. One group received 4 mg ondansetron while the other group received placebo (normal saline). The improvement of pruritus and other adverse effects such as pain scores, nausea, vomiting, sedation, hallucination, and respiratory depression were determined at 30 minutes after study drugs' administration. RESULTS: The treatment success rate was higher in the ondansetron group than in the placebo group (80% v 36%, P < .001). Among the successfully treated patients, the recurrence rates of moderate to severe pruritus within 4 hours after administration of ondansetron and placebo were 12% and 70%, respectively (P < .001). The number of patients with decreased nausea and vomiting score was also higher in the ondansetron group (11 v 1, P < .006). CONCLUSION: Ondansetron treats intrathecal morphine-induced pruritus after cesarean delivery, particularly in patients suffering from both nausea/vomiting and pruritus.

Adult↗
PubMed2003

[Pathogenesis and treatment of pruritus in patients with cholestasis].

The pathogenesis of initiating the pruritus in patients with cholestasis is still not completely understood. One hypothesis is, that the cause for initiating the pruritus in patients with cholestasis is the activation of nerves in the skin. The activating substances are unknown, probably they are substances who accumulate in patients with cholestasis. Therefore one of the conventional approaches to treat pruritus is to remove pruritogenic substances from the body. Examples of this approach include the administration of anion exchange resins as cholestyramine or the administration of hepatic enzyme-inducing drugs such as rifampicin or phenobarbital. None of these drugs has been conclusively shown to be efficacious. A new hypothesis is the association of pruritus with altered central neurotransmission. Altered opioid concentrations probably play a central role in the pathogenesis of pruritus. This hypothesis is corroborate by the possibility of treating pruritus in patients with cholestasis with opiate antagonists such as naloxone or nalmefene. The treatment with ondansetron may also have effects on the pruritus of patients with cholestasis. A completely new treatment strategy is the application of dronabinol (r-9-tetrahydrocannabinol).

Brain↗
PubMed2000

[Pruritus during treatment with an estrogen-gestagen combination].

HISTORY AND CLINICAL FINDINGS: A 51 year old female patient complained about marked pruritus of the whole integument. Since seven years she had been taking a two phase combination of estrogens and gestagen because of climacteric symptoms. 24 years ago severe pruritus occurred especially at the hands during the last trimenon of her first pregnancy whereas 7 years later during the subsequent pregnancy pruritus was absent. Physical examination revealed multiple excoriations over the whole body. No other relevant pathological findings were noted. INVESTIGATIONS: Laboratory findings, chest X-ray and abdominal sonography were normal. TREATMENT AND COURSE: Neither oral administration of an antihistaminic drug nor topical application of betamethasone improved the situation to a relevant extent. For 12 months the occurrence of pruritus had not been referred to hormonal treatment by the physicians in charge. Complete cessation of pruritus was seen within a few days after the patient had stopped hormonal medication on her own. CONCLUSION: Patients should be asked for pregnancy associated pruritus or jaundice before receiving drug combinations with estrogens and gestagens. In case of a positive history, the physician should inform them about possible side effects such as pruritus and icterus.

Estradiol↗
PubMed2000

The inhibition of epidural morphine-induced pruritus by epidural droperidol.

UNLABELLED: IV droperidol inhibits epidural morphine-induced pruritus, but this effect disappears when the dose is increased from 2.5 to 5.0 mg. This study was performed to determine whether epidural droperidol would have a similar effect. In this double-blinded study, we enrolled 140 patients undergoing Cesarean delivery under epidural anesthesia who were randomly allocated to four groups. Anesthesia consisted of 150 mg of 0.5% bupivacaine with 1:200,000 epinephrine, with 2 mg of morphine and 0.0, 1.25, 2.5, or 5.0 mg of droperidol (Groups 1 to 4). During the postoperative period, patients were assessed for pruritus (absent, mild, moderate, or severe) and other untoward symptoms. The chi(2) test was used to compare the incidence of the side effects. For the analysis of pruritus, we used the Mantel-Haenszel test for linear association. Droperidol induced a dose-related reduction in the incidence of pruritus (P < 0.001). This reduction was independent of the incidence of somnolence, which increased with droperidol dose (P < 0.05 when the incidence of somnolence in Groups 1 and 4 was compared). We conclude that droperidol, in doses up to 5 mg epidurally, induces a dose-related reduction in the incidence of pruritus without inducing significant side effects. IMPLICATIONS: Epidural morphine is effective for pain control but yields some side effects, including pruritus, that can be severe. Studying patients undergoing Cesarean delivery, we found a dose-related reduction in the incidence of pruritus using epidural droperidol.

Adult↗
PubMed2005

How best to fight that nasty itch - from new insights into the neuroimmunological, neuroendocrine, and neurophysiological bases of pruritus to novel therapeutic approaches.

While the enormous clinical and psychosocial importance of pruritus in many areas of medicine and the detrimental effects of chronic 'itch' on the quality of life of an affected individual are widely appreciated, the complexity of this sensation is still often grossly underestimated. The current Controversies feature highlights this complexity by portraying pruritus as a truly interdisciplinary problem at the crossroads of neurophysiology, neuroimmunology, neuropharmacology, protease research, internal medicine, and dermatology, which is combated most successfully if one keeps the multilayered nature of 'itch' in mind and adopts a holistic treatment approach - beyond the customary, frequently frustrane monotherapy with histamine receptor antagonists. In view of the often unsatisfactory, unidimensional, and altogether rather crude standard instruments for pruritus management that we still tend to use in clinical practice today, an interdisciplinary team of pruritus experts here critically examines recent progress in pruritus research that future itch management must take into consideration. Focusing on new insights into the neuroimmunological, neuroendocrine, and neurophysiological bases of pruritus, and discussing available neuropharmacological tools, specific research avenues are highlighted, whose pursuit promises to lead to novel, and hopefully more effective, forms of pruritus management.

Dermatology↗
PubMed1994

Flumecinol for the treatment of pruritus associated with primary biliary cirrhosis.

OBJECTIVE: To determine whether flumecinol (3-trifluoromethyl-alpha-ethylbenzhydrol, Zixoryn) is effective in ameliorating pruritus of cholestasis, particularly in primary bilary cirrhosis. METHODS AND RESULTS: 50 patients (46 with primary biliary cirrhosis, PBC) took oral flumecinol 600 mg or identical placebo once weekly for 3 weeks. Patients assessed pruritus by scoring a daily 100 mm visual analogue scale (VAS; 0 = no itch, 100 = severe, continuous, day and night intolerable itch). Quality of life was similarly measured. Patients scored the VAS daily for a 7-day baseline and for a further 21 days. Subjectively, pruritus improved in 13 of 24 on flumecinol and 10 of 26 on placebo (chi 2 = 1.24, P = 0.27). Median difference in fall in VAS pruritus score between baseline week (mean score for each individual used) and the last week was 8.0 [95% confidence interval (CI) -2.1 to 20.8] and for VAS quality of life was 5.0 (95% Cl 0.4 to 13.0) both in favour of flumecinol over placebo. Later, 19 patients (all PBC) were randomised to flumecinol 300 mg or placebo daily for 3 weeks. Subjectively, pruritus improved in 7 of 10 on flumecinol and 1 of 9 on placebo (Fisher's exact test, P = 0.02). Median difference in fall in VAS pruritus score was 19.8 mm (95% CI 3.3 to 40.7 mm) in favour of flumecinol over placebo and for quality of life was 3.5 mm (95% Cl -5.9 to 24.9 mm). Flumecinol did not significantly affect liver function tests, antipyrine clearance or serum total bile acids, and was not associated with any significant side-effects. CONCLUSION: Flumecinol was safe at the above doses and short term treatment with 300 mg daily, significantly ameliorated pruritus in primary biliary cirrhosis.

Administration, Oral↗
PubMed1997

The effect of subhypnotic doses of propofol on the incidence of pruritus after intrathecal morphine for caesarean section.

The effect of subhypnotic doses of propofol on intrathecal morphine-induced pruritus was studied in a prospective, randomly allocated, double-blind controlled trial. Fifty-eight women undergoing elective lower segment Caesarean section for a singleton fetus received spinal anaesthesia with 2.5 ml hyperbaric 0.5% bupivacaine and 0.2 mg of preservative-free morphine. They then received propofol 1 ml (10 mg) or Intralipid 1 ml (control group) intravenously after delivery. Pruritus was assessed using a five-point verbal rating scale at hourly intervals for 8 h. A second dose of their allocated treatment drug was administered at the first recording of significant pruritus. The pruritus score was reassessed after 5 min and the treatment was repeated if pruritus remained. There were no differences between the groups in the onset of pruritus or its successful treatment. No adverse side-effects were associated with this dose of propofol. There were no differences in the incidence of post-operative nausea and vomiting between the two groups. Subhypnotic propofol is not an effective treatment for intrathecal morphine-induced pruritus in women following Caesarean section.

Adult↗
PubMed2004

Pruritus in adult dermatomyositis.

Dermatomyositis has a significant clinical component of pruritus that has not yet been studied. Pruritus can significantly affect the life of patients. The aim of the present work was to study the degree of pruritus experienced by patients. A four-question survey was sent to patients with documented dermatomyositis. The survey used a 100-mm Visual Analogue Scale (VAS) to describe current, worst and daily pruritus, and the effect this has on daily activities. Twenty-six subjects returned completed questionnaires: four had no pruritus; the majority had a significant amount with means above 50 on the VAS. A mean of 44.6 was found for the effect on daily life. Further studies should be performed to examine the prevalence and severity of pruritus in this population and it's effect on their quality of life. Clinicians must be aware of the significant pruritus and provide adequate therapy to improve quality of life.

Adult↗
PubMed1994

Effects of azelastin on pruritus and plasma histamine levels in hemodialysis patients.

BACKGROUND: Persistent pruritus is the most common symptom in hemodialysis patients. Its causes are poorly understood and there is no effective treatment. We have studied the effect of azelastin HCL on the plasma histamine concentrations and pruritus in maintenance dialysis patients with or without erythropoietin therapy. PATIENTS: Twenty-eight hemodialysis patients were divided into four groups according to the presence or absence of pruritus and whether or not they received erythropoietin therapy. RESULTS: Histamine concentrations in the patient groups were significantly higher than in healthy volunteers, but a significant difference could not be found among the four groups. The patients with pruritus showed no change in their histamine concentration during treatment with azelastin HCL, but their pruritus scores decreased remarkably. CONCLUSIONS: The present data do not support the thesis that the increased plasma histamine concentration is causally related to pruritus in hemodialysis patients or that the antiallergic drug, azelastin HCL, alleviates the pruritus of dialysis patients by decreasing plasma histamine levels. The possible role of the increased tissue levels of histamine remains to be studied.

Adult↗
PubMed2006

Onset of pruritus relief with pimecrolimus cream 1% in adult patients with atopic dermatitis: a randomized trial.

BACKGROUND: Pimecrolimus cream 1% (Elidel, Novartis Pharmaceuticals AG) effectively improves/relieves pruritus associated with atopic dermatitis (AD), but few data are available regarding the timing of relief. The purpose of this study was to investigate the timing of pruritus relief produced with pimecrolimus in adults with mild/moderate AD and moderate/severe pruritus. METHODS: Patients were randomized to 7 days of treatment with pimecrolimus (n = 100) or vehicle (n = 98). Pruritus severity was assessed daily on a 4-point scale (0 = absent, 3 = severe), reflecting the previous 24 h experience. Patients who completed this core study were eligible to enter a voluntary 5-week, open-label extension study. RESULTS: A significant effect was noted within 48 h of treatment, with pruritus improving in 56% of pimecrolimus-treated patients and 34% of vehicle-treated patients (P = 0.003). Pruritus relief was maintained during the remainder of the core and extension phases, and was accompanied by an improvement in the Investigator's Global Assessment score. CONCLUSION: Pimecrolimus cream 1% significantly reduced pruritus within 48 h.

Administration, Topical↗
PubMed2002

Neurogenic pruritus: an unrecognised problem? A retrospective case series of treatment by acupuncture.

Intractable localised segmental pruritus without a rash has been reported over the years under various titles depending on the area of the body affected. Notalgia paresthetica and brachioradial pruritus are the two terms used for what is believed to be a form of neuropathy. The clinical observations reported here suggest that other localised cases of pruritus exist that share common clinical features, and the term neurogenic pruritus is suggested to encompass these under one clinical condition. Acupuncture has been used to treat skin conditions, of which pruritus is one symptom. This retrospective study looked at the symptomatic relief of neurogenic pruritus in 16 patients using acupuncture. In 12 cases the affected dermatomes of the body were innervated by cervical spinal nerves, seven innervated by dorsal spinal nerves and four innervated by the lumbar spinal nerves. Seven patients had areas affected by two different regions of the spine. Restricted neck or back movements were noted in patients as were areas of paravertebral spasm or tenderness of the muscles. Total resolution of symptoms as judged by VAS occurred in 75% of patients. Relapse occurred in 37% of patients within 1-12 months following treatment. Acupuncture appeared to be effective in alleviating the distressing symptom of itching in patients presenting with neurogenic pruritus.

Acupuncture Therapy↗
PubMedDate not supplied

Pruritus and hydration state of stratum corneum in hemodialysis patients.

BACKGROUND: Xerosis is the most frequent cutaneous manifestation in hemodialysis (HD) patients, but the association between dry skin and pruritus remains to be clarified. Since the skin surface hygrometer can detect the changes of water content in the stratum corneum more sensitively, we re-examined the relationship between the severity of pruritus and water content in dialysis patients. METHODS: Fifty patients who had been undergoing regular HD were examined for the degree of pruritus by clinical grading. Water contents in the stratum corneum at volar forearm and lower leg were assessed by measurement of high-frequency conductance using a skin surface hygrometer both at pre- and postdialysis. RESULTS: Thirty-seven (74%) of dialysis patients complained of pruritus. High-frequency conductance values were significantly lower in HD patients compared to those of age-matched control subjects (n = 13) both at forearm (35.1+/-3.0 vs. 73.3+/-10.4 microS, p<0.01) and lower leg (14.2+/-1.1 vs. 52.4+/-7.5 microS, p<0.01). There was no relationship between the severity of pruritus and age, gender, HD duration, underlying renal disease, or removing fluid volume. A significant reduction of itching score was found in patients using polysulfone membrane. A single HD session using cellulose triacetate or polysulfone membrane significantly increased water content both at forearm and lower leg (p<0.05). However, the degree of pruritus did not correlate with the skin water content both at the beginning and the end of HD session, respectively. CONCLUSION: It follows from these findings that water content in the stratum corneum was reduced in HD patients, but did not correlate with the severity of pruritus.

Adult↗
PubMed1997

Is aluminum toxicity responsible for uremic pruritus in chronic hemodialysis patients?

Pruritus is a common symptom among patients undergoing long-term hemodialysis. However, its etiology remains unclear. In an attempt to clarify its cause we tried to correlate pruritus and its intensity with several serological variables in 94 hemodialysis patients. Our results show that higher serum aluminum concentrations are found in dialysis patients with pruritus (p = 0.008) and that the intensity of pruritus is also significantly related to the aluminum concentration (p = 0.007). The intensity of pruritus was also correlated with the calcium-phosphate product (p = 0.03). Our findings suggest that prolonged exposure to aluminum in patients with chronic renal failure might be involved in the pathogenesis of uremic pruritus and elevated calcium-phosphate product seems to be an additional factor predisposing to pruritus.

Adult↗
PubMed2003

Nalbuphine versus ondansetron for prevention of intrathecal morphine-induced pruritus after cesarean delivery.

UNLABELLED: In this prospective, randomized, double-blinded study, we compared the prophylactic efficacy of nalbuphine and ondansetron for the prevention of intrathecal morphine-induced pruritus after cesarean delivery. Two-hundred-forty parturients were randomly allocated into four groups. The N-4 group, O-4 group, O-8 group, and placebo group received IV 4 mg of nalbuphine, 4 mg of ondansetron, 8 mg of ondansetron, and 4 mL of normal saline, respectively, immediately after the baby was delivered. In the postanesthesia care unit, we found that the severity of pruritus score in the four groups was significantly different (P < 0.001). The prophylactic success rate for pruritus of the N-4, O-4, O-8, and placebo groups was 20%, 13%, 12%, and 6%, respectively (P < 0.001). The pruritus score between N-4 and placebo and O-4 and placebo was significantly different (P < 0.001 and P = 0.006, respectively). Treatment for pruritus was requested by patients in 25%, 47%, 51%, and 72% of patients in the N-4, O-4, O-8, and placebo groups, respectively (P < 0.001). There were no differences among groups in nausea/vomiting score, pain score, sedation score, or shivering score at 4, 8, and 24 h after surgery. Nalbuphine and ondansetron are more effective than placebo for the prevention of intrathecal morphine-induced pruritus after cesarean delivery. IMPLICATIONS: Nalbuphine and ondansetron are more effective than placebo for the prevention of intrathecal morphine-induced pruritus after cesarean delivery.

Adult↗
PubMed2003

HIV-associated pruritus: etiology and management.

With the advent of highly active antiretroviral therapy (HAART), life-threatening opportunistic infection has become less common in patients with HIV infection and longevity has increased dramatically. With increased longevity, the problems of living with a chronic disease have become more prominent in this patient population. Disorders such as fat redistribution and metabolic abnormalities can result from antiviral medications and from HIV disease itself. Pruritus is one of the most common symptoms encountered in patients with HIV. The spectrum of skin diseases in such patients encompasses dermatoses of diverse etiologies; a few are peculiar to patients with HIV while others are not. Some of these conditions may cause severe and sometimes intractable pruritus that provokes scratching, picking, disfigurement, sleep loss, and significant psychological stress. Moreover, the expense of ongoing medical treatments can be daunting. Skin rash can sometimes be the initial presentation of HIV infection or serve as a harbinger of disease progression. Causes of pruritus include skin infections, infestations, papulosquamous disorders, photodermatitis, xerosis, drug reactions, and occasionally lymphoproliferative disorders. Drug eruptions are particularly common in patients who are HIV positive, presumably as a result of immune dysregulation, altered drug metabolism, and polypharmacy. Itching can also result from systemic diseases such as chronic renal failure, liver disease, or systemic lymphoma. Workup of pruritus should include a careful examination of the skin, hair, nails, and mucous membranes to establish a primary dermatologic diagnosis. If no dermatologic cause is found, a systemic cause or medication-related etiology should be sought. Idiopathic HIV pruritus is a diagnosis of exclusion and should only be considered when a specific diagnosis cannot be established. The management of HIV-associated pruritus should be directed at the underlying condition. Phototherapy has been found to be useful in the treatment of several HIV-associated dermatoses and idiopathic pruritus as well. Unfortunately, some of the treatments that have been suggested for patients with HIV are anecdotal or based on small uncontrolled studies. The last decade has seen a surge in the utilization of HAART which, to some degree, reconstitutes the immune system and ameliorates some dermatologic diseases. On the other hand, some skin diseases flare temporarily when HAART is started. Unless frank drug allergy is suspected, HAART does not need to be stopped.

AIDS-Related Opportunistic Infections↗