SFN is present in PLCA. Pruritus in PLCA is likely associated with hypersensitivity of cutaneous nerve fibres, which may be related to an increased expression of epidermal IL-31 receptors. Targeting IL-31 receptors is therefore a potential therapeutic approach.
Aquagenic pruritus (AP) is a rare condition with unknown pathogenesis. We explored its pathogenesis through investigations of a patient and report the first case to be effectively treated with atenolol. A 36-year-old Indian female presented with idiopathic AP. Small-fiber neuropathy involving itch/pain-transmitting C-fibers appears to be pathogenetically important: compared with matched controls, our patient had increased intra-epidermal nerve fibers, raised warmth detection threshold, and marked hyperknesis to electrical stimulation. Autonomic nerve function tests and fingertips vasoconstriction response were normal, indicating integrity of other small (Aδ and C) nerve fibers. She was initially treated with propranolol with good response, but was subsequently switched to atenolol for convenient once-a-day dosing. Symptoms were well controlled long term with no side effect experienced. Atenolol may exert its effect in AP through blockage of over-activated neuronal sodium channels. Through the investigations, we propose that the pathogenesis of idiopathic AP may involve the following: upon contact of the skin with water, yet-unknown mediator/s released stimulate dysfunctional and hyper-innervated C-nerve fibers, which may have resulted from a sodium channel defect. Atenolol may be a preferred therapeutic option compared with propanolol, in view of its convenient once-a-day dosing and better side effect profile.
Summary
At present, beyond clinical assessment, the diagnosis of skin diseases is primarily made histologically. However, skin biopsies have many disadvantages, including pain, scarring, risk of infection, and sampling error. With recent advances in skin imaging technology, the clinical use of imaging methods for the practical management of skin diseases has become an option. The in vivo high‐definition optical coherence tomography (HD‐OCT) has recently been developed and commercialized (Skintell®; Agfa, Belgium). Compared with conventional OCT, it has a higher resolution; compared with reflectance confocal microscopy, it has a shorter time for image acquisition as well as a greater penetration depth and a larger field of view. HD‐OCT is promising but much work is still required to develop it from a research tool to a valuable adjunct for the noninvasive diagnosis of skin lesions. Substantial work has been done to identify HD‐OCT features in various diseases but interpretation can be time‐consuming and tedious. Projects aimed at automating these processes and improving image quality are currently under way.
Research letterDrug-free microneedles in the treatment of keloids: a single-blinded intraindividual controlled clinical trial Mean AE SD 218 AE 330 196 AE 293 213 AE 317 À22Á5 AE 49Á2 1 7 Á0 AE 38Á8 À5Á6 AE 22Á9 Median (range) 117 (10Á3-1592) 132 (5Á2-1423) 115 (10Á7-1550) À9Á7 (À169 to 83Á3) 7Á0 (À94 to 127) À1Á7 (À66Á3 to 34Á7) P-value within microneedle group 0Á001 0Á014 0Á41 P-value vs. control group < 0Á001 0Á024 0Á007The size of keloids was based on the mean of three measurements per keloid.
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