Neurotrophin-4 production by human epidermal keratinocytes: increased expression in atopic dermatitis.

The mast cell, which is a histamine-containing cell, has been found to have far more functions in skin inflammation than hitherto understood. To investigate the appearance of mast cells in prurigo nodularis, histamine immunohistochemistry in combination with nerve growth factor receptor (NGFr) double-staining as well as electron microscopic studies were performed. The results revealed that the histamine-containing cell number was increased in the lesional dermis. The mast cell size was also increased and the shape had become more dendritic. They tended to contact the epidermis and even infiltrated into it. In the histamine and NGFr double-staining, both an increased histamine-containing mast cell number and an increased number of NGFr-immunoreactive nerve fiber profiles were revealed in the upper dermis of the prurigo nodularis lesional skin. Mast cells were seen in close vicinity to NGFr-positive nerves and sometimes even seemingly to contact single nerve fibers. At the ultrastructural level, it is obvious that the mast cell bodies become larger, having more abundant cytoplasm and organelles (e.g. mitochondria), but comparatively fewer characteristic granules. Mast cells were often observed to sprout long dendrites, with or without granules. The cells were also frequently seen to contact other cell types, and a mast cell infiltration into the epidermis was also found. The statistical results of mast cell numbers showed a significant increase in prurigo nodularis lesional skin compared to the normal controls. The present results further indicate that mast cells, together with cutaneous nerve fibers, are actively involved in the pathogenesis of the disease.

Histamine‐containing mast cells and their relationship to NGFr‐immunoreactive nerves in prurigo nodularis: a reappraisal

Chronic prurigo (CPG) is a highly burdensome pruritic disease characterized by chronic itch, a prolonged scratching behavior and the development of localized or generalized hyperkeratotic pruriginous lesions. Neuronal sensitization and the development of an itch-scratch cycle contribute to the augmentation of pruritus and the chronicity of the disease. We provide here the first international guideline for a rational diagnostic and therapeutic approach for CPG. Recommendations are based on available evidence and expert opinion. The diagnosis of CPG is made clinically. A detailed medical history together with laboratory and radiological examinations are advised in order to determine the severity of CPG, identify the underlying origin of the itch and assist in the elaboration of a treatment plan. Therapeutically, it is advised to adopt a multimodal approach, including general strategies to control itch, treatment of the underlying pruritic conditions, and of the pruriginous lesions. Topical (corticosteroids, calcineurin inhibitors, capsaicin) and systemic antipruritic agents (eg, gabapentinoids, immunosuppressants, and opioid modulators) as well as physical treatment modalities (phototherapy, cryotherapy) should be employed in a step-wise approach. Psychosomatic or psychological interventions may be recommended in CPG patients with signs of psychiatric/psychological comorbidities. (Less)

/pdf/ifsi-guideline-on-chronic-prurigo-including-prurigo-2h4brogttj.pdf

IFSI-Guideline on Chronic Prurigo including Prurigo nodularis.

https://www.jidonline.org/article/S0022-202X(15)47161-1/pdf

Skin pigmentation in relation to the menstrual cycle

Prurigo nodularis is an intensely pruritic dermatosis characterized by lichenified and excoriated papules and nodules. The course of prurigo nodularis is often chronic, and some patients respond very poorly to the standard therapeutic modalities. Because the pathogenesis of this disease remains obscure, the treatment of prurigo nodularis can be disappointing and frustrating for both the patients and physicians. Thalidomide, a tumor necrosis factor-alpha antagonist, has been suggested as an alternative treatment option for recalcitrant prurigo nodularis. In the past, the regimen for treatment of prurigo nodularis often required thalidomide at 200 mg/day. We recruited patients with intractable prurigo nodularis and treated them with low-dose thalidomide. Six patients with idiopathic prurigo nodularis were successfully treated with low-dose thalidomide (50-100 mg/day) without clinical development of peripheral neuropathy. In summary, our preliminary results suggest that low-dose thalidomide may be a safe and effective treatment option for patients with recalcitrant idiopathic prurigo nodularis.

Treatment of idiopathic prurigo nodularis in Taiwanese patients with low-dose thalidomide.

The annual meetings of the American Dermatological Association are the milestones on which are inscribed the results of the year's activities in scientific research. The high standard set by the founders of this Association has been maintained by the diligent work of their successors. The responsibility of presiding at this, the forty-fifth annual session, is keenly realized and words cannot convey to you my deep appreciation of the honor you have conferred on me. The brilliant record of achievement of the Association has been recorded by my predecessors, so I shall today briefly discuss two topicsthat have occupied much of my thought for some time. In the past there has been no organized effort to train men in the practice of dermatology and syphilology. The major portion of the men now engaged in this practice selected the method of acquiring their knowledge themselves. Some began as assistants to established dermatologists

Dermatologic training and practice

We have had under our observation for some time a small group of patients with a type of peribuccal pigmentation sufficiently different from the usual disorders of this area and of a sufficiently uniform character to warrant consideration as a distinct clinical entity. A review of the literature convinced us that the disorder in question is identical with that described by Brocq 1 in 1923 as erythrose peribuccale pigmentaire, so we adopted his title. Our patients were all women in the thirties or early forties. The condition absorbed a disproportionate amount of their attention on account of the cosmetic disfigurement and the extraordinary resistance to treatment. It was observed only in private patients, and we found it impossible to secure a biopsy from this region of the face. Consequently, our study is purely clinical, unsupported by histologic evidence. The disorder consists of a diffuse brownish or brownish-red pigmentation, most marked

Erythrose peribuccale pigmentaire de brocq

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Dermatologic training and practice

Erythrose peribuccale pigmentaire de brocq