Chronic pruritus in HIV-positive patients in the southeastern United States: Its prevalence and effect on quality of life

Kaushik, Shivani; Cerci, Felipe B.; Miracle, Jill E.; Pokharel, Apar; Chen, Shuo; Chan, Yiong Huak; Wilkin, Aimee M.; Yosipovitch, Gil

doi:10.1016/j.jaad.2013.12.015

Cited by 48 publications

(37 citation statements)

References 21 publications

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“…It is speculated that immune dysregulation leads to a disruption in skin microbiota and the inflammatory response in these patients, leading to SD. CD4 lymphopenia may allow for unhindered proliferation of Malassezia organisms on the skin . Clinical presentation of SD in HIV can be different than in non‐HIV patients.…”

Section: A Complex Relationship With Systemic Diseasesmentioning

confidence: 99%

An update on the microbiology, immunology and genetics of seborrheic dermatitis

Aðalsteinsson

Kaushik

Muzumdar

et al. 2020

Experimental Dermatology

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The underlying mechanism of seborrheic dermatitis (SD) is poorly understood but major scientific progress has been made in recent years related to microbiology, immunology and genetics. In light of this, the major goal of this article was to summarize the most recent articles on SD, specifically related to underlying pathophysiology. SD results from Malassezia hydrolysation of free fatty acids with activation of the immune system by the way of pattern recognition receptors, inflammasome, IL-1β and NF-kB. M. restricta and M. globosa are likely the most virulent subspecies, producing large quantities of irritating oleic acids, leading to IL-8 and IL-17 activation. IL-17 and IL-4 might play a big role in pathogenesis, but this needs to be further studied using novel biologics. No clear genetic predisposition has been established; however, recent studies implicated certain increased-risk human leucocyte antigen (HLA) alleles, such as A*32, DQB1*05 and DRB1*01 as well as possible associations with psoriasis and atopic dermatitis (AD) through the LCE3 gene cluster while SD, and SD-like syndromes, shares genetic mutations that appear to impair the ability of the immune system to restrict Malassezia growth, partially due to complement system dysfunction. A paucity of studies exists looking at the relationship between SD and systemic disease. In HIV, SD is thought to be secondary to a combination of immune dysregulation and disruption in skin microbiota with unhindered Malassezia proliferation. In Parkinson's disease, SD is most likely secondary to parasympathetic hyperactivity with increased sebum production as well as facial immobility which leads to sebum accumulation. K E Y W O R D Sinflammasome, Malassezia, sebaceous glands, seborrheic dermatitis, systemic disease While the order of events is unclear regarding the pathophysiology of SD, it is agreed upon by most sources that the three main prerequisites are as follows: Malassezia colonization, lipid secretion by sebaceous glands and an underlying immune system susceptibility. [1,5,7,38] The pathogenesis can be categorized into five different phases.

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Section: A Complex Relationship With Systemic Diseasesmentioning

confidence: 99%

An update on the microbiology, immunology and genetics of seborrheic dermatitis

Aðalsteinsson

Kaushik

Muzumdar

et al. 2020

Experimental Dermatology

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“…In HIV patients, chronic itch is reported to be one of the most common dermatological complaints that affect quality of life [100]. Although there are currently no reports on HIV and chronic itch in the elderly, it is important to consider that life expectancy in HIV patients has been increasing over the past few years [101].…”

Section: Systemic Conditionsmentioning

confidence: 99%

Chronic Pruritus in the Elderly: Pathophysiology, Diagnosis and Management

2015

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Chronic itch in the elderly is a common problem, with a significant impact on quality of life and sleep in elderly patients. Chronic itch may be attributable to several causes, including dry skin, immunosenescence and neural degeneration. Itch may also be caused by skin diseases, such as seborrhoeic dermatitis and stasis dermatitis; systemic conditions, such as end-stage renal disease and diabetes; and psychogenic conditions, such as depression and anxiety. The use of polypharmacy may also cause itch, with or without a rash. Specifically, thiazides and calcium channel blockers have been known to cause itch in elderly patients. Management should be tailored according to the underlying dermatological or systemic aetiology of itch. Topical treatment is the mainstay of therapy, providing special emphasis on skin hydration and barrier repair. In addition, topical and oral medications that target the nervous system and reduce neuronal hypersensitization, such as gabapentin and selective antidepressants, have a role in treating patients with severe chronic itch. Furthermore, management must account for changes in metabolism and pharmacokinetics of drugs in the aging population in order to prevent the occurrence of adverse effects.

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“…approximately one in four people. Prevalence estimates vary depending on underlying conditions, with 87% of patients with atopic dermatitis and 83–84% of patients with psoriasis reporting itch on a daily basis, and 35% of patients on haemodialysis and 45% of patients with HIV reporting chronic itch …”

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confidence: 99%

Substance P and neurokinin 1 receptor are new targets for the treatment of chronic pruritus*

Ständer

Yosipovitch

2019

Br J Dermatol

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Summary Background Chronic pruritus is a distressing symptom associated with various dermatological conditions and systemic diseases. Current treatment options are often inadequate, resulting in impaired quality of life for many patients. An understanding of the underlying mechanisms of itch across pruritic conditions is important for development of effective, targeted treatments for chronic pruritus. Objectives To provide an overview of the pathogenesis of chronic pruritus, focusing on the role of substance P (SP) and neurokinin 1 receptor (NK1R) in itch signalling, and to describe data supporting NK1R antagonism as a potential strategy for the treatment of chronic pruritus. Methods A PubMed search was conducted to determine what data were available that investigated the role of SP and NK1R in itch signalling. Results SP is a neuropeptide that is a mediator of itch signalling. One of the target receptors for SP is NK1R, which is expressed in the central nervous system and on multiple cell types involved in the initiation and transmission of itch. Studies demonstrating that SP and NK1R are overexpressed across multiple chronic itch‐inducing conditions and that NK1R antagonism disrupts itch signalling and reduces itch provide a rationale for targeting this pathway as a potential treatment of chronic pruritus across multiple diseases. Conclusions A large and growing body of evidence, including recent phase II clinical studies of NK1R antagonists, demonstrate that SP and NK1R play an important role in itch signalling. Additional studies are ongoing to further evaluate the use of NK1R antagonists for the treatment of chronic pruritus. What's already known about this topic? Chronic pruritus has a significant impact on quality of life. Current treatment options for chronic pruritus are inadequate. Substance P (SP) and neurokinin 1 receptor (NK1R) have been shown to play a role in itch signalling, and may be a rational target for addressing chronic pruritus. NK1R antagonists are being evaluated as potential treatment for chronic pruritus. What does this study add? This review provides a compilation of the most up‐to‐date data elucidating the role of SP and NK1R in itch signalling, which supports targeting this pathway as a potential treatment of chronic pruritus. NK1R antagonism disrupts itch signalling and reduces itch. A summary of the latest data on NK1R antagonists in the treatment of pruritus is provided.

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Chronic pruritus in HIV-positive patients in the southeastern United States: Its prevalence and effect on quality of life

Cited by 48 publications

References 21 publications

An update on the microbiology, immunology and genetics of seborrheic dermatitis

An update on the microbiology, immunology and genetics of seborrheic dermatitis

Chronic Pruritus in the Elderly: Pathophysiology, Diagnosis and Management

Substance P and neurokinin 1 receptor are new targets for the treatment of chronic pruritus*

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