Dermatology. 2012 Feb 2;
Siepmann D, Weishaupt C, Luger TA, Ständer S

Objectives: The first guideline for the treatment of chronic pruritus was published in 2005. The recommendations are based mainly on case series studies or expert opinions. This retrospective study aimed at analyzing the outcome of treatment according to the German guidelines in a representative cohort of patients. Methods: 385 consecutive patients with chronic pruritus were evaluated for therapeutic outcome. Results: 268/385 patients (69.6%) reported an antipruritic effect while 117/385 (30.4%) showed no response. Three therapeutic steps were undertaken by 40.3% of the responding patients. Conclusions: Treating pruritus patients according to the German guideline achieved a high response rate. A prolonged treatment period with multiple therapeutic steps was needed by a high number of patients due to the lack of specific antipruritic substances. Given that multiple therapy steps produce a high disease and economic burden, novel target-specific therapies are eligible.

Gynecol Obstet Invest. 2012 Feb 1;
Derbent AU, Ulukanlıgil M, Keskin EA, Soylu G, Kafalı H

Aim: To compare the clinical and microbiological results between patients with infectious vaginitis receiving vaginal irrigation with saline or no irrigation before standard antibiotic therapy. Methods: Women with vaginitis (n = 109) were randomized to receive vaginal irrigation with saline or no irrigation before standard antibiotic therapy. The vaginal symptoms perceived by subjects and clinical findings were assessed with a standardized scale during four follow-up visits, and Gram stain Nugent scores and vaginal fluid cultures were analyzed at each visit. Results: Vaginal discharge (z = 7.159; p < 0.001), pruritus (z = 5.169; p < 0.001), itching (z = 2.969; p < 0.003) and odor scores (z = 2.303; p < 0.021) were significantly reduced in the study group compared to the control group between the first visit and 3-5 days after irrigation, before the start of antibiotic therapy. The second and third visits (15 and 30-45 days after antibiotic therapy) showed that the patients' symptoms and amounts of visible vaginal discharge did not differ between the two groups. Moreover, the microbiological cures of patients in each group did not differ at these visits (z = 0.447; p = 0.655). Conclusion: Vaginal irrigation with saline significantly reduces self-reported symptoms in the short term but has no effect on long-term clinical and laboratory results in women with infectious vaginitis.

Gastroenterol Hepatol (N Y). 2011 Sep; 7(9): 615-7
Levy C

Sleep Med. 2012 Jan 30;
Karroum EG, Golmard JL, Leu-Semenescu S, Arnulf I

OBJECTIVE: To characterize the verbal descriptors of the sensations in restless legs syndrome (RLS) in depth. METHODS: Fifty-six patients with primary RLS (interviewed in person) and 738 members of the French RLS Association (sent a postal questionnaire) were included in the study. Patients in the clinical series were asked to report their RLS sensations in detail. The two groups completed a French reconstruction of the McGill Pain Questionnaire (QDSA) to assess their RLS sensations. RESULTS: All patients in both groups had abnormal sensations associated with the urge to move the legs. Most patients in the clinical series reported spontaneous "electrical," "prickling," "burning," "tingling," and "itching" sensations. In the QDSA, more than two-thirds of subjects in both groups selected the sensory subclasses "temporal" and "paresthesias," and the affective subclasses "evaluative," "nervous tension," "asthenia, fatigue," and "punishment." More than one-third of subjects chose the sensory words "electric shocks," "irradiating," and "tingling," and the affective words "exhausting," "distressing," "unbearable," "irritating," and "depressing." The subjects used more heat than cold descriptors to express their sensations. CONCLUSION: RLS is a primary sensory disorder without any pure motor form. The sensory descriptors in RLS could be similar to those of neuropathic pain, except for rare cold and numbness sensations.

Arch Med Sci. 2011 Aug; 7(4): 685-93
Matsota P, Batistaki C, Apostolaki S, Kostopanagiotou G

The aim of this study was to compare the postoperative analgesic efficacy of epidural ropivacaine 0.15%, levobupivacaine 0.15% and ropivacaine 0.15% plus fentanyl 2 µg/ml, used with a patient-controlled epidural analgesia (PCEA) device after Caesarean section.Sixty women undergoing elective Caesarean section under combined spinal-epidural anaesthesia were enrolled. Postoperatively, patients received PCEA with either ropivacaine or levobupivacaine 0.15% (basal rate 6 ml/h, bolus 5 ml/20 min), or ropivacaine 0.15% plus fentanyl 2 µg/ml (basal rate 6 ml/h, bolus 4 ml/20 min). Sympathetic and sensory level of analgesia, motor ability (Bromage 0-3), and pain scores at rest, movement and cough (VAS 0-10), haemodynamic parameters, oxygenation, side effects and total doses of local anaesthetic were documented every 6 h for 24 h. Patient satisfaction was assessed using a descriptive scale.No significant difference was observed in pain scores at all time intervals. A significantly higher sympathetic and sensory blockade occurred with levobupivacaine and ropivacaine 0.15% compared to ropivacaine 0.15% plus fentanyl, with no significant difference in total local analgesic consumption at 24 h (p = 0.08). Rescue analgesic requirements did not differ between the groups (p = 0.8) while patients' satisfaction was significantly higher in the ropivacaine 0.15% plus fentanyl group (p = 0.02). Haemodynamics, oxygenation, nausea, pruritus and numbness did not differ between the groups.Dilute local anaesthetic solutions provided satisfactory postoperative analgesia after Caesarean section when used with a PCEA device. The combination of ropivacaine 0.15% with fentanyl 2 µg/ml appeared superior, since it provided higher patient satisfaction with statistically equal pain scores and local anaesthetic consumption.

Case Report Ophthalmol. 2011 Sep; 2(3): 398-400
Lei HL, Ku WC, Sun MH, Chen KJ, Lai JY, Sun CC

The most common ocular adverse event following the use of cyclosporine A (CsA) 0.05% ophthalmic emulsion is ocular burning (17%). Other adverse effects that have been reported include conjunctival hyperemia (1-5%), discharge, epiphora, eye pain, foreign body sensation, pruritus, stinging and blurred vision. Here, we report a specific side effect of CsA, namely eye drop-induced eyelash elongation in a patient with refractory giant papillary conjunctivitis.Observational case report.Case report and review of the literature.A 32-year-old female with giant papillary conjunctivitis on the left eye, who had undergone papillectomy 3 years previously and was refractory to topical steroid therapy, was treated with CsA 0.05% ophthalmic emulsion (Restasis) 4 times a day, preservative-frees artificial tears and gentamicin ophthalmic solution in the left eye. After 5 months of topical CsA treatment, elongated eyelashes of her left eye were observed without other adverse effects.Although hypertrichosis and trichomegaly have been documented in the literature as side effects of systemic CsA, topical CsA 0.05% eye drop-induced elongated eyelashes have not been reported, and we believe ophthalmologists should be mindful and inform patients about this specific side effect.

Parasitol Res. 2012 Jan 31;
Rocconi F, Di Tommaso M, Traversa D, Palmieri C, Pampurini F, Boari A

Adult stages of Dirofilaria repens (Nematoda, Filarioidea) reside in the subcutaneous tissues of the definitive or occasional host as dogs, other animals, and humans, and it is transmitted by mosquitoes. Canine infections with adults and circulating larvae of D. repens are often considered asymptomatic, although in some cases, the parasite causes subcutaneous nodules, diffused dermatitis, skin lesions, and itching. This report provides a complete clinical description of an unusual case of allergic diffused dermatitis caused by D. repens in a naturally infected dog and its successful treatment with the use of a spot-on solution containing imidacloprid 10%/moxidectin 2.5%. The dog presented multiple pustules and alopecic areas with lichenification, hyperpigmentation, and erythematous scaling margins without pruritus. Histological examination was compatible with allergic dermatitis. After being unsuccessfully managed for suspected food hypersensitivity, with a significantly worsening of the lesions, a Knott's analysis detected nematode larvae in the blood. Morphological and molecular identification showed them to be D. repens. The dog was then treated with a single administration of a spot-on formulation containing imidacloprid 10%/moxidectin 2.5%, and the dermatological signs completely resolved within 2 months after treatment. The dog showed no recurrence of the lesions, and no circulating microfilariae were found upon microscopic and molecular examination for six consecutive months after treatment. This report indicates the apparent primary role of D. repens in causing hypersensitivity-like skin disease without pruritus in a dog. It also confirms, as recently shown elsewhere, the efficacy of imidacloprid 10%/moxidectin 2.5% in the treatment of dermatitis caused by D. repens.

Turk J Gastroenterol. 2011 Dec; 22(6): 602-5
Pata O, Vardarelı E, Ozcan A, Serteser M, Unsal I, Saruç M, Unlü C, Tözün N

Background/aims: The aim of this study was to determine the incidence, obstetrical and fetal complication rates of intrahepatic cholestasis of pregnancy in patients managed actively around 38 weeks and evaluate the correlation of these results with liver function tests and bile acids. Material and Methods: In this cohort study 3710 women were booked for delivery, of which 32 pregnant women were diagnosed as intrahepatic cholestasis of pregnancy. All data concerning obstetric- medical history, laboratory results, symptom onset time, pruritus degree, treatment response, and delivery time and infants information were recorded in the study protocol. Statistical analyses were conducted with SPSS 12.0 version and correlations were assessed by Spearman Rank correlation analysis. Results: The incidence of intrahepatic cholestasis of pregnancy was 0.86%. The symptoms appeared around 32 weeks. 16.6% multiparas had a previously affected pregnancy and 21.8% of intrahepatic cholestasis of pregnancy patients had family history of intrahepatic cholestasis of pregnancy. Symptom onset varied according to season (p<0.05). Most patients (69.5%) were diagnosed in winter and the beginning of spring. There were no reported cases of clinical maternal jaundice, bleeding tendency or stillbirth. Pruritus was decreased by ursodeoxycholic acid treatment. Total bile acids tended to be higher in patients with preterm delivery (r=0.409, p=0.038). Conclusion: Total bile acids are correlated with preterm delivery. An attempt to deliver at around 38 weeks may improve perinatal outcome.

Int Arch Allergy Immunol. 2012 Jan 26; 158(2): 184-190
Guilemany JM, García-Piñero A, Alobid I, Centellas S, Mariño FS, Valero A, Bernal-Sprekelsen M, Picado C, Mullol J

Background: Persistent allergic rhinitis (PER) has a moderate impact on the sense of smell, but no controlled study has reported the effect of antihistamines on the loss of smell in patients with PER. Methods: Patients with PER and subjective loss of the sense of smell (n = 27) were included in this pilot randomised, double-blind, placebo-controlled study. Nasal symptoms, nasal endoscopy, skin prick test, acoustic rhinometry, peak nasal inspiratory flow, nasal nitric oxide (nNO), and olfactometry (Barcelona Smell Test-24; BAST-24) were performed and evaluated in all PER patients at baseline and after 7 and 30 days of treatment with levocetirizine 5 mg or placebo. Results: The study population was randomized into two homogeneous groups: levocetirizine (n = 14) and placebo groups (n = 13). The evolution of symptoms reflected the therapeutic effect of levocetirizine treatment on rhinorrhea, nasal itching, eye itching, sneezing, and the total symptoms score after 7 and 30 days. Significant improvement in loss of smell by a visual analog scale (VAS) was observed after 7 days of levocetirizine treatment (7.2 ± 4.3; p < 0.05) compared to placebo (-9.4 ± 6.2). Improvement in smell identification by BAST-24 was strongly correlated (r = 0.72; p < 0.05) with smell improvement by VAS after 30 days. After 7 days of treatment with levocetirizine, the nNO values decreased (-494 ± 188) compared to placebo (155 ± 284 ppb; p < 0.05). Conclusions: The CIRANO study suggests that levocetirizine is effective on PER symptoms, including a transient improvement in loss of smell, and that this improvement concurs more with reduction of nasal inflammation than of nasal patency.

J Am Acad Dermatol. 2012 Jan 26;
Ahern K, Gilmore ES, Poligone B

BACKGROUND: Pruritus can be a distressing and even debilitating symptom for patients with cutaneous T-cell lymphoma (CTCL). To date, few studies have evaluated the pathophysiology of this symptom. Because of this, therapy for pruritus in CTCL has mainly relied on those therapies that target and treat the lymphoma. For patients living with CTCL that relapses or becomes refractory to treatment, and who continue to experience severe itch, this lymphoma-targeted treatment may not be enough to combat their pruritus. Therefore, other itch-targeted therapies are needed for use in this disease. OBJECTIVE: We sought to evaluate the current evidence regarding the mechanism of action and treatments for pruritus associated with CTCL. METHODS: An explicit and thorough search was restricted to all peer-reviewed literature available through MEDLINE (1950 to September 2011) and PubMed. Search terms used were "pruritus," "cutaneous T-cell lymphoma," "CTCL," "mycosis fungoides," "MF," and "Sézary syndrome." All studies that involved pruritus in CTCL, mycosis fungoides, or Sézary syndrome were evaluated by all 3 authors. RESULTS: The current literature helps to identify therapies and possible mechanisms for treating patients with CTCL-associated pruritus. LIMITATION: Most studies were preclinical. Only studies involving mechanisms of action or treatment were included. CONCLUSION: A guideline is necessary to assist in the treatment of pruritus in CTCL and additional studies are necessary to uncover the exact mechanism or mechanisms of action.

Urol Oncol. 2012 Jan 25;
Walker LM, Tran S, Wassersug RJ, Thomas B, Robinson JW

OBJECTIVE: Androgen deprivation therapy (ADT) is the primary treatment for advanced prostate cancer (CaP). There is growing evidence that ADT negatively affects men's psychosocial well-being (e.g., causing sexual dysfunction, bodily feminization) and physical health (e.g., increasing the risk of osteoporosis and metabolic syndrome). Although strategies for managing the majority of side effects exist, it is not clear that patients are benefiting from this knowledge. METHODS: Seventy-nine newly prescribed ADT patients and 54 of their partners were given a checklist of various common and uncommon ADT side effects. They were asked to indicate the drug side effects that they had heard of or anticipated. RESULTS: Both patients and their partners were poorly informed about the side effects of luteinizing hormone-releasing hormone (LHRH) agonists used for ADT. More than 70% did not know that anemia, memory problems, loss of body hair, and depression can occur following treatment. Over 50% were unaware of significant potential side effects such as reduced muscle mass, osteoporosis, increased fracture risk, weight gain, genital shrinkage, and gynecomastia. Concurrently, more than 20% mistakenly anticipated dizziness and itching. CONCLUSION: The lack of awareness of ADT side effects may partially explain why ADT currently results in significant decreases in the quality of life of patients and their partners. Patients uninformed about side effects do not engage in behaviors to prevent or reduce the risk of adverse effects. Improved efforts to educate patients about treatment side effects and coping strategies may result in improved psychosocial and physical health for CaP patients undergoing ADT.

J Clin Anesth. 2012 Feb; 24(1): 44-50
Maalouf D, Liu SS, Movahedi R, Goytizolo E, Memstoudis SG, Yadeau JT, Gordon MA, Urban M, Ma Y, Wukovits B, Marcello D, Reid S, Cook A

To determine whether ultrasound guidance improves the quality of continuous popliteal block when compared with a nerve stimulator after major foot and ankle surgery.Prospective, randomized, double-blinded clinical trial.Operating room, Postanesthesia Care Unit (PACU), and hospital wards of a university-affiliated hospital.45 ASA physical status 1, 2, and 3 patients undergoing elective major foot and ankle surgery.Placement of a popliteal sciactic nerve catheter using either nerve stimulator or ultrasound guidance. In the PACU, a continuous infusion of ropivacaine 0.2% was started at a basal rate of 4 mL/hr and adjusted in a standardized fashion to maintain visual analog scale (VAS) pain scores < 4. All patients also received intravenous (IV) patient-controlled analgesia with hydromorphone and oral opioids.VAS pain scores at rest and with physical therapy, ropivacaine use, opioid use, and opioid-related side effects were recorded.Cummulative ropivacaine use was lower in patients whose catheter was placed by ultrasound than by nerve stimulator guidance (mean 50 vs 197 mL, P < 0.001). Pain scores at rest and during activity were similar between groups. Cumulative opioid consumption (mean 858 vs 809 mg oral morphine equivalents) and daily frequencies of nausea (5% to 33% vs 0 to 24%) and pruritus (0 to 21% vs 0 to 24%) were similar between groups. Length of hospital stay was similar between groups (3.5 vs 3.7 days).Ultrasound guidance was associated with less local anesthetic consumption than with the nerve stimulator; however, there was little clinical benefit, as all other outcomes were similar between groups.