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Concept: Pruritus ani

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Abstract Background: Pruritus ani (PA) is defined as intense chronic itching affecting perianal skin. Objective: We aimed to determine the efficacy of topical tacrolimus treatment in atopic dermatitis (AD) patients who have PA. Methods: The study included 32 patients with AD who were suffering PA. Patients were randomized into two groups. In total, 16 patients used 0.03% tacrolimus ointment and 16 patients used Vaseline® as placebo. All groups applied topical treatments to their perianal area twice daily for 4 weeks. The treatments were then reversed for 4 weeks after a 2 weeks wash out period. Results: In total, 32 patients with AD who had refractory anal itching were enrolled in the present study. None of the patients had obtained successful results with previous treatments. There was a statistically significant decrease in the recorded EASI, DLQI and itching scores for the tacrolimus group compared to the placebo groupat weeks 4 and 6 of treatment (p < 0.05). Conclusion: Topical tacrolimus treatment was well tolerated and effective in controlling persistent PA in AD patients.

Concepts: Allergy, Symptoms, Tacrolimus, Hemorrhoid, Itch, Anal fissure, Atopic dermatitis, Pruritus ani

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Wearable technology is an exciting new field in humans and animals. In dogs activity monitors have helped to provide objective measurement tools where pet owner observation had been the only source of information. Previous research has focused on measuring overall activity versus rest. This has been relatively useful in determining changes in activity in orthopedic disease or post-surgical cases [Malek et al., BMC Vet Res 8:185, 2012, Yashari et al., BMC Vet Res 11:146, 2015]. Assessment of pruritus via changes in activity, however, requires an assumption that increased activity is due to scratching or other pruritic behaviors. This is an inaccurate method with obvious flaws as other behaviors may also register as greater activity. The objective of this study was to validate the ability of a multidimensional high frequency sensor and advanced computer analysis system, (Vetrax®, AgLogica Holdings, Inc., Norcross, GA, USA) to specifically identify pruritic behaviors (scratching and head shaking). To establish differences between behaviors, sensor and time stamped video data were collected from 361 normal and pruritic dogs. Video annotations were made by two observers independently, while blinded to sensor data, and then evaluated for agreement. Annotations that agreed between the two were used for further analysis. The annotations specified behaviors at specific times in order to compare with sensor data. A computer algorithm was developed to interpret and differentiate between these behaviors. Test subject data was then utilized to test and score the system’s ability to accurately predict behaviors.

Concepts: Algorithm, Measurement, Observation, Computer, Computer program, Wearable computer, Itch, Pruritus ani

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Itch is a common side-effect of treatment with anti-EGFR antibodies and tyrosine-kinase inhibitors. We designed a pilot single-centre study to assess the effects of aprepitant-a neurokinin receptor inhibitor-for management of severe pruritus induced by biological drugs.

Concepts: Immune system, Chemotherapy, Allergy, Itch, Pruritus ani

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Conservative surgery of hemorrhoidal disease is less painful than traditional hemorrhoidectomy, and mucopexy has less risk of serious postoperative complications than stapled hemorrhoidopexy. The aim of this study was to evaluate the safety and effectiveness of a standardized, modified hemorrhoidopexy, named Mucopexy-Recto Anal Lifting (MuRAL),with the HemorPex System (HPS) in patients with symptomatic III and IV degree hemorrhoids.

Concepts: Minimally invasive, Dietary fiber, Fecal incontinence, Surgical staple, Hemorrhoid, Anal fissure, Perianal hematoma, Pruritus ani

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Benign anorectal conditions produce anal pain, rectal bleeding, or discharge from the perianal region, which are highly prevalent symptoms in the general population. Hemorrhoidal disease, anal fissure, perianal abscess, proctalgia syndromes and pruritus anii are the most common clinical disorders. Well-trained physicians irrespective of their specialty can treat most of these disorders and refer them to a specialist in proctology only when necessary. The aim of this review is to provide a practical guide to the management of benign anorectal disorders in terms of their initial management and the criteria for specialist referral.

Concepts: Medicine, Disease, Rectum, Hemorrhoid, Anal fissure, Anus, Pruritus ani, Proctology

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Interleukin-31 (IL-31) is implicated in pruritus associated with pruritic skin diseases like atopic dermatitis. Although pruritus is a prominent feature in dermatomyositis (DM), few studies have evaluated the pathogenesis of DM-associated itch.

Concepts: Allergy, Itch, Pruritus ani

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Veterinarians and pet owners have limited ability to assess pruritic behaviors in dogs. This pilot study assessed the capacity of the Vetrax® triaxial accelerometer to measure these behaviors in six dogs with pruritus likely due to environmental allergens. Dogs wore the activity monitor for two weeks while consuming their usual pet food (baseline), then for eight weeks while consuming a veterinary-exclusive pet food for dogs with suspected non-food-related skin conditions (Hill’s Prescription Diet® Derm DefenseTM Canine dry food). Veterinarians and owners completed questionnaires during baseline, phase 1 (days 1-28) and phase 2 (days 29-56) without knowledge of the activity data. Continuous 3-axis accelerometer data was processed using proprietary behavior recognition algorithms and analyzed using general linear mixed models with false discovery rate-adjusted p values. Veterinarian-assessed overall clinical signs of pruritus were significantly predicted by scratching (β 0.176, p = 0.008), head shaking (β 0.197, p < 0.001) and sleep quality (β -0.154, p < 0.001), while owner-assessed quality of life was significantly predicted by scratching (β -0.103, p = 0.013) and head shaking (β -0.146, p < 0.001). Among dogs exhibiting pruritus signs eating the veterinary-exclusive food, the Vetrax® sensor provided an objective assessment of clinically relevant pruritic behaviors that agreed with owner and veterinarian reports.

Concepts: Psychology, Evaluation, Allergy, Assessment, Veterinary medicine, Veterinarian, Itch, Pruritus ani

0

Pruritus is the most frequently reported complaint or symptom for psoriasis patients. Despite the morbidity associated with pruritus in psoriasis few studies have evaluated the prevalence of itch in psoriasis with the current use of biological agents.

Concepts: Symptoms, Itch, Pruritus ani

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Opioids in skin function during stress response, regeneration, ageing and, particularly in regulating sensation. In chronic pruritus, topical treatment with Naltrexone changes μ-opioid receptor (μ-OR) localization to relieve itch. The molecular mechanisms behind the effects of Naltrexone on μ-OR function in reduction of itching behavior has not been studied. There is an immediate need to understand the endogenous complexity of μ-OR dynamics in normal and pathological skin conditions. Here we evaluate real-time behavior of μ-OR-Endomorphine complexes in the presence of agonist and antagonists. The μ-OR ligand Endomorphine-1 (EM) was conjugated to the fluorescent dye Tetramethylrhodamine (TAMRA) to investigate the effects of agonist and antagonists in N/TERT-1 keratinocytes. The cellular localization of the EM-TAMRA was followed through time resolved confocal microscopy and population analysis was performed by flow cytometry. The in vitro analyses demonstrate fast internalization and trafficking of the endogenous EM-TAMRA-μ-OR interactions in a qualitative manner. Competition with Endomorphine-1, Naltrexone and CTOP show both canonical and non-canonical effects in basal and differentiated keratinocytes. Acute and chronic treatment with Naltrexone and Endomorphine-1 increases EM-TAMRA binding to skin cells. Although Naltrexone is clinically effective in relieving itch, the mechanisms behind re-distribution of μ-ORs during clinical treatments are not known. Our study has given insight into cellular mechanisms of μ-OR ligand-receptor interactions after opioid agonist and antagonist treatments in vitro. These findings potentially offer opportunities in using novel treatment strategies for skin and peripheral sensory disorders.

Concepts: Receptor, Opioid, Flow cytometry, Skin, Receptor antagonist, Buprenorphine, Itch, Pruritus ani