Pruritus is one of the most common dermatologic complaints and, as the most common dermatologic symptom, is a major contributor to frequent dermatology visits. Chronic pruritus mirrors another major medical condition faced by millions of Americans each year ‐ chronic pain. In older literature, pain and pruritus were thought to have been conveyed by the same C fiber, and the proportion contributing to pruritus was just a small subset of this general fiber. Overall, pain and pruritus share many integral similarities. Although these sensations both initiate the body’s awareness to injury, pain and itch may have evolved for sensing different damages such as a burrowing parasite or a noxious stimulus, respectively. This seems to have been validated through analyses of their pathophysiology, acute and chronic conditions, and treatment modalities. However, their symptoms and intrinsic mechanisms vary considerably. It is important to view pruritus in more of an overall, whole body experience, rather than just the sensory aspect. Future studies should investigate the psychological treatment of chronic pruritus, considering the immense similarities with its chronic pain counterpart.
Pregnancy prompts many adaptive and unique physiologic modifications, with cutaneous changes being possibly the most noticeable. These cutaneous changes are of interest to physicians, since they must be diagnosed as anticipated normal physiologic changes or potentially harmful and managed accordingly. Research has been conducted on physiologically normal and abnormal cutaneous manifestations of pregnancy but is lacking in regard to the persistence of these changes after delivery. This prompts the question as to whether these are normal physiologic changes taking longer to resolve, abnormal changes that may have been previously misdiagnosed, or a separate underlying change that is incorrectly attributed to a common dermatosis caused by pregnancy. Some of the conditions that may persist longer than expected during or after pregnancy, and thus require further workup for an underlying condition, include telogen effluvium, severe hirsutism, palmar erythema, and striae. The objective of this review is to focus on these four common cutaneous physiologic changes of pregnancy, and what to consider when they do not resolve as expected.
In 2016, a new drug, crisaborole, was developed and approved, for the first time in 15 years, as an effective treatment for Atopic Dermatitis (AD). Crisaborole is a topical phosphodiesterase 4 (PDE4) inhibitor, which alleviates AD symptoms, such as pruritis, inflammation, and flares. Similar to other topical treatments like corticosteroids and calcineurin inhibitors, crisaborole has been found to cause pain during application. The pain felt during a topical application can be attributed to many possible causes, such as increased sensitivity to pain-provoking and itch-provoking stimuli, prior inflammation, prior damage, and hypersensitized skin of the patient to which the topical cream is applied. Crisaborole has been reported to be effective, yet the application site pain is a major road bump in the effective treatment of some patients. Some possible ways to circumvent this pain are letting the epidermis soothe and heal before starting crisaborole, starting this treatment modality before the skin has a chance to become irritated and inflamed, and numbing the area with an ice pack prior to topical crisaborole application. Overall, crisaborole has been an effective treatment modality, but further research is necessary to allow for safe use of this life-changing AD topical medication.
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