Pruritic Diseases and Secondary Changes Flashcards by Kemi Awe

Urticaria most symptomatic

Early lesion and small superficial wheals

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How to treat urticaria?

Antihistamines - decrease pruritus - leads to resolution of wheals

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Assessment that should be performed in all patient’s with itch?

Dermatographism (exaggerated wheal development) mark the skin to see if a wheal develops

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Factors that contribute to itch in atopic dermatitis

Epidermal hyper-innervation and central sensitization

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What is nemolizumab

anti-IL-31 receptor A medication used to decrease itch

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Scabies itch starts when

3-6 weeks after the initial infection
within days of subsequent

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Immune response during scabies targets

Mites

Eggs

Scybala ( fecal matter)

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CTCL and itch

> 60% of patients have itch

frequency intensifies at later stages i.e Sezary Syndrome

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What cytokine is associated with itch in CTCL

IL-31

Nemolizumab is an antibody against the IL-31 RA

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CTCL itch treatment options (experimental)

Nemolizumab

Mogamulizumab

gabapentin 900-2400 mg/day (split into 3 doses)

Mirtazepine 7.5 -15 mg

Naltrexone 50-150 mg/day

Aprepitant (neurokinin 1 blocker)

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Prurigo Nodularis

Dome shaped, firm, hyperpigmented papulonodules +/- central crust/scale/erosion

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Prurigo Nodularis Distribution

Symmetrically along the extremities (typically extensor surface)

Butterfly sign with sparing of the upper mid back

Also spares flexural areas, face and groin

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Prurigo Nodularis Causes

chronic repetitive scratching/picking due to a pruritic systemic or dermatological or psychogenic diseaese

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Prurigo Nodularis Epidemiology

Middle aged adult with dermatologic/psychiatric diseases

occasionally in children with atopic dermatitis

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Prurigo Nodularis Pathology

Epidermal hyperplasia

Compact hyperkeratosis

Vertically arranged collagen fibers

increased number of fibroblasts and capillaris

perivascular/ interstitial mixed inflammatory infiltrate

increased dermal nerve fibers

decreased epidermal nerve fibers

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Prurigo Nodularis Treatments

Psychogenic- SSRIs/TCA

thalidomide (50-200mg/day)/lenalidomide

Liquid nitrogen

Topical capsaicin

calcipotreine

cyclosporine

doxepin

methotrexate

Products with anti-itch properties

pramoxine (cerave itch relief)

polidocanol (asclera, vanthena)

palmitoylethanolamine

oral antihistamines

Non sedating- cetirizine (Zyrtec)

fexofenadine (Allegra)

loratadine (claritin)

desloratadine (clarinex)

Lichen simplex chronicus

well defined plaques exhibiting exaggerated skin lines with a leathery appearance

Lichen simplex chronicus locations

posteriolateral neck

occipital scalp

anogenital region

shins, ankles

dorsal aspects of the feet,hands forearms

lichen simplex chronic pathology

compact hyperkeratosis

acanthosis with irregular elongation

vertically oriented collagen fibers in the papillary dermis

hypergranulosis

lichen simplex chronicus epidemiology

more common in older adults

lichen simplex chronicus Treatments

Avoidance of scratching/itching

topical / intralesional steriods or calcineurin inhibitors

menthol and pramoxine

anti-histamines

behavioral therapy

lidocaine patch

capsacin patches

Scalp pruritus

Primary- lacks skin lesions; associated with anxiety, depression

Secondary- folliculitis, seb derm ,psoriasis

Treatment- emoillents, topical steroid, tar or salicylic acid shampoos, low dose doxepin

Pruritus Ani Epidemiology and appearance

Male>> Female- 4:1 ratio

Appear normal to severely irritated

Pruritus Ani Causes

Primary: anal pruritus in the absence of a cutaneous, anorectal or colonic disorder May be due to **Dietary factors** **Poor hygiene** **Psychogenic** Secondary: due to irritation from stool or hemorrhoids, primary cutaneous disorders, infections/infestations, previous radiation therapy, contact allergy , neoplasms

Pruritis Ani Treatment

sitz baths with black tea (astringent) cool compresses meticulous hygiene mild topical steroids/calcineurin inhibitors treatement of underlying disorders

Pruritis Scroti/Vulvae

worse at nigiht **lichenification** _Acute causes_ infections allergic dermatitis irritant dermatiits _Chronic Causes_ dermatoses malignancy atrophic vulvovaginitis lumbosacral radiculopathy irritation psychogenic (1-7%of cases)

Aquagenic pruritis

- **severe pruritis or burning pain** after water contact moves from the lower extremities and then generalizes - Occurs 30 minutes after exposure to water and lasts for up to 2 hours **spares hands, soles and mucosae** - usually secondary to systemic diseaese- **Polycythemia vera** or skin disorder - idopathic is relatively uncommon

Aquagenic Pruritis Treatment

Alkalinization of baths to pH 8.0 oral antihistamines phototherapy (UVB, PUVA) capsaicin cream (3-6 times/day) clonidine and propranolol for aquadynia

Renal Disease pruritis

Localized/generalized intractable, severe paroxysmal pruritis worse at **night** and **two days after dialysis** Treatments **nb UVB** emoillents gabapentin Renal transplant is curative

Biliary Pruritis

Causes obstructive hepatitides carcinoma