Warty nodules on an annular plaque in a renal transplant recipient.
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Humans↗
Biomedical subjects
Gil Yosipovitch
Publications and source records attributed to Gil Yosipovitch.
Mirtazapine for reducing nocturnal itch in patients with chronic pruritus: a pilot study.
Nocturnal pruritus is a significant problem for patients with inflammatory skin diseases and many systemic diseases. The oral therapies currently available have a limited effect. We present an open, uncontrolled pilot study of 3 patients with inflammatory skin diseases and severe nocturnal pruritus who underwent treatment with mirtazapine (Remeron), a noradrenergic and specific serotonergic antidepressant. Mirtazapine is a safe medication without serious side effects and may be an effective alternative for the treatment of nocturnal pruritus.
Adolescent↗
Itching in the new millennium: highlights of the Second International Workshop for the Study of Itch, Toyoma, Japan.
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Animals↗
Circadian and ultradian (12 h) variations of skin blood flow and barrier function in non-irritated and irritated skin-effect of topical corticosteroids.
The skin is the organ that receives the greatest exposure to light and shows a high-amplitude circadian rhythm in epidermal cell proliferation. We have previously demonstrated that the skin barrier function has a significant circadian rhythm. Corticosteroids (CS) are the most commonly used topical treatment in dermatology. Time-dependent differences in their efficacy and side-effects would be of considerable interest. The aims of the current study were to examine time-dependent cycles in the effect of topical CS application in healthy and irritated skin on skin blood flow and its relationship to barrier function. Twenty clinically healthy, diurnally active subjects were examined at eight and nine time points over a 24 or 28 h span respectively, using non-invasive skin bioengineering techniques of laser Doppler imaging, a transepidermal water loss (TEWL) device and a skin thermometer in a 28 h session. The results of this current study demonstrate circadian and ultradian (12 h) variations in skin blood flow. A significant correlation was found between skin temperature and skin blood flow but not with TEWL. Circadian and ultradian rhythms are maintained during treatment with high-potency and mid-potency CS in healthy skin. These rhythms persist during stratum corneum disruption with and without CS application.
Administration, Topical↗
Barrier repair in chronic plaque-type psoriasis.
PURPOSE: To investigate barrier repair after mild trauma in lesional skin of psoriasis patients with chronic plaque-type disease and to compare this with non-involved psoriatic skin and normal controls. METHODS: Transepidermal water loss (TEWL) readings were taken from involved psoriatic skin and non-involved skin of psoriasis patients as well as the skin of normal controls. Three readings were performed at each site: the basal state, immediately after 20 tape strippings and 1 week post stripping. RESULTS: Higher baseline, post-stripping and 1-week recovery TEWL readings in psoriatic-involved skin compared to non-involved and normal control skin. No significant difference in barrier recovery rate in psoriatic-involved skin compared to non-involved and normal control. CONCLUSION: Although there appears to be a derangement of barrier function in lesional skin of psoriasis patients compared to non-lesional skin and the skin of healthy controls, the barrier recovery function of lesional psoriatic skin is still fully operational.
Body Water↗
Do ethnicity and gender have an impact on pain thresholds in minor dermatologic procedures? A study on thermal pain perception thresholds in Asian ethinic groups.
BACKGROUND AND OBJECTIVES: The perception of pain is a personal experience influenced by many factors, including genetic, ethnic and cultural issues. Understanding these perceptions is especially important in dermatologic patients undergoing minor surgical operations and who often differ in their pain response to surgical treatments. Little is known about how these differences affect the perception of experimental pain. The purpose of this study was to determine experimental pain perception differences in three distinct East Asian ethnic populations. METHODS: Pain thresholds were examined with a psychophysical computerized quantitative thermal sensory testing device (TSA 2001) in healthy volunteers recruited from three different Asian ethnic groups. Using the methods of limits, experimental pain perception threshold was measured on the forehead and volar aspect of the forearm in 49 healthy subjects. The measurements were then repeated after skin barrier perturbation with adhesive tape stripping of the stratum corneum. All three ethnic groups were analyzed separately with respect to age, gender educational level and skin type. RESULTS: A total of 20 Chinese, 14 Malay and 15 Indian subjects completed the study. Thermal pain thresholds were similar in all three ethnic groups before and after tape strippings. No significant differences were noted between genders. CONCLUSIONS: Using quantitative sensory thermal testing, we demonstrated that no significant differences in pain occur between different races and genders.
Adult↗
Practical guidelines for relief of itch.
Itch is the major symptom in, skin diseases with a variety of etiologies. Recent progress has been achieved in understanding the pathophysiology of itch in skin diseases. There are many) topical therapies availablte/for managingp ruritus. Emergin;g therapies include dominant ceramide moisturizers, topical immunomodulators, low pH moisturizers, topical aspirin, and combinations of moisturizers with antipruritic compounds. Using these in conjunction with practical measuresf or itch reduction can benefit patients in the outpatient clinical setting.
Adjuvants, Immunologic↗
Itch.
Itch is a common skin sensation, with substantial effects on behaviour. Neurophysiological research has permitted accurate definition of neural pathways of itch, and has confirmed the distinctiveness of itch pathways in comparison with pain. A clinical classification of itch, based on such improved understanding, describes the difference between peripheral (pruritoceptive) and central (neurogenic or neuropathic) itch. New specific and sensitive investigational methods in people and animals enable us to better understand this bothersome symptom, and have important clinical implications. We describe the clinical classification of itch, new findings on neuropathophysiology of itch, methods for assessment, and improved treatments.
Animals↗
Acute Churg-Strauss syndrome in an asthmatic patient receiving montelukast therapy.
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Acetates↗
Prevalence and characterization of uremic pruritus in patients undergoing hemodialysis: uremic pruritus is still a major problem for patients with end-stage renal disease.
BACKGROUND: Pruritus is a common disabling problem in patients with advanced end-stage renal disease. Few studies have evaluated the clinical characteristics of uremic itch. OBJECTIVES: The aim of this multicenter study was to provide a comprehensive description of the prevalence and clinical characteristics of pruritus affecting patients with end-stage renal disease who are undergoing hemodialysis. METHODS: A detailed questionnaire recently developed was used to evaluate pruritus in 219 patients undergoing hemodialysis treatment in 3 dialysis units. We examined the relationship of the quality of dialysis and various factors and medical parameters to itch. RESULTS: Pruritus was a common symptom in the study population. Approximately 66% of the patients had pruritus at some point, and 48% were affected by it at the time of the study. There was no correlation between the occurrence of pruritus and demographic or medical parameters (type of kidney disease, medical management, dialysis efficacy as expressed by Kt/V) of the patient. The data suggest that uremic pruritus tends to be prolonged, frequent, and intense, and it can impair the patient's quality of life including a negative effect on sleep and mood. Major factors found to exacerbate pruritus include rest, heat, dry skin, and sweat. Major factors found to reduce pruritus include activity, sleep, hot and cold shower, and cold. Treatment with angiotensin inhibitors seemed to be more common among those with uremia who had itch (P =.02) whereas furosemide was more commonly used among those who never itched (P =.002). CONCLUSION: This study provides a detailed description of uremic pruritus with new data on its characteristics including affective and sensory dimensions and associated symptoms.
Adult↗
Granular parakeratosis: a case report and literature review.
BACKGROUND: Granular parakeratosis is suspected to result from an error in epidermal differentiation, leading to variably pruritic, hyperpigmented-to-erythematous patches and plaques. Characteristic histopathologic features include a thickened stratum corneum, compact parakeratosis with retention of keratohyalin granules, vascular proliferation, and ectasia. The pathogenesis of this entity is uncertain. METHODS: We present a case of axillary granular parakeratosis and review the literature. RESULTS: The lesion showed a thickened stratum corneum with compact parakeratosis, slight epidermal hyperplasia, and a sparse perivascular lymphohistiocytic infiltrate. Keratohyalin granules were diffusely present within the parakeratotic stratum corneum, and the retained granular layer showed focal vacuolization. CONCLUSIONS: Granular parakeratosis is a rare form of parakeratosis most often seen in the axilla, although other intertriginous areas may be affected. Unique histopathologic findings allow for a specific diagnosis to be made. Although an irritant contact reaction appears causative, mechanical irritation may also play a role in inducing these skin changes.
Administration, Topical↗
Epidermolytic hyperkeratosis and epidermolysis bullosa simplex caused by frameshift mutations altering the v2 tail domains of keratin 1 and keratin 5.
The cytoskeleton of epithelial cells is formed by heteropolymeric keratin proteins characterized by a central alpha-helical rod flanked by nonhelical head and tail domains of variable sequence. Most mutations described in 18 distinct keratins disrupt highly conserved regions at the boundaries of the rod, which have been recognized as zones of overlap during keratin alignment and assembly into intermediate filaments. We recently reported the first mutation located in a keratin tail domain (V2) in ichthyosis hystrix Curth-Macklin. In this study, we report two novel frameshift mutations that are predicted to alter the tail of keratin 1 or keratin 5, leading to an atypical form of epidermolytic hyperkeratosis and a mild form of epidermolysis bullosa simplex, respectively. Mutation analysis of the patient with epidermolytic hyperkeratosis revealed a de novo heterozygous nucleotide insertion (1752insG) in exon 9 of KRT1, predicted to result in an aberrant 69 residue keratin 1 tail. In the patient with mild epidermolysis bullosa simplex, we identified a single nucleotide deletion (1635delG) in exon 9 of KRT5 leading to frameshift and translation of an abnormal V2 domain, 35 amino acids longer than the native keratin 5 tail. Our results, together with previous observations, establish the existence of a subgroup of keratin disorders due to frameshift mutations altering the keratin tail domains that are characterized by phenotypic heterogeneity.
Adolescent↗
Hemorrhagic bullae after cryosurgery in a patient with hemophilia A.
BACKGROUND: A case of hemorrhagic bullae and blisters on the hand of a patient with hemophilia A after cryosurgery for verruca vulgaris is reported. OBJECTIVE: To discuss a hemorrhagic complication in a patient with hemophilia A after cutaneous cryosurgery. METHODS: This is an observatory case report. RESULTS: Even minimal cryosurgery can induce hemorrhagic bullae in patients with hemophilia A. CONCLUSION: The risks and benefits of cryosurgery should be weighed carefully in patients with bleeding disorders such as hemophilia.
Blister↗
Medical pearl: Scleroderma-like skin changes in patients with diabetes mellitus.
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Diabetes Complications↗
Suggested guidelines for screening and management of tuberculosis in patients taking oral glucocorticoids--an important but often neglected issue.
One third of the world's population is infected with tuberculosis and its incidence is increasing. Systemic glucocorticoids are the mainstay of immunosuppressive therapy for immunobullous diseases and collagen vascular diseases in dermatology. Patients who are given prolonged glucocorticoid therapy may be at risk for both the acquisition of primary tuberculosis and the reactivation of nonactive tuberculosis. The purpose of this article is to highlight the importance of screening for tuberculosis and its management in this group of patients, as there are no published guidelines in the dermatology literature on this subject. We summarize the methods used for tuberculosis screening, give an account of treatment regimens for the various types of tuberculosis infection, and suggest a practical approach to screening and management of tuberculosis in patients receiving long-term glucocorticoid therapy.
Comorbidity↗
Assessment of itch: more to be learned and improvements to be made.
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Humans↗
Photo recall phenomenon: an adverse reaction to taxanes.
Taxanes are a new group of chemotherapeutic agents, which share some pharmacological characteristics with methotrexate. Methotrexate has previously been reported to cause a photo recall phenomenon which develops 3-5 days after UV radiation, suggesting that taxanes can induce a similar reaction. This should be added to the list of cutaneous side-effects of this class of chemotherapeutic agents. We report a case of photo recall phenomenon in a 55-year-old Chinese woman with metastatic breast cancer who was undergoing chemotherapy with taxanes.
Antimetabolites, Antineoplastic↗
Itch associated with skin disease: advances in pathophysiology and emerging therapies.
Itch, also known as pruritus, is the major symptom in skin diseases with a variety of etiologies and pathophysiologies. Significant progress has been achieved in understanding the pathophysiology of itch in the last 5 years. Neurophysiological experiments in humans and animals have revealed that itch is carried by specific C nerve fibers. Recent studies have demonstrated that peripheral mediators other than histamine are involved in induction of itch. Mast cell tryptase seems to be an important mediator in itch by its activation of proteinase activated receptor 2 in the sensory nerves. Opioids have central and peripheral itch producing activity. Neuropeptides, such as substance P, induce itch by their effect on mast cells. Based upon our improved understanding of the neurophysiology of itch a clinical classification of itch has been proposed. The classification highlights differences between peripheral pruritoceptive itch, neuropathic itch (itch related to damage to afferent nerve fibers) and neurogenic itch (itch originating in the central nervous system without any evidence of nerve damage). Emerging therapies based on these findings include topical vanilloid receptor antagonists, topical antihistamines, and topical arachidonic acid inhibitors, as well as inhibitors of non-histamine inflammatory mediators, immunomodulators and strontium salts. Systemic therapies include thalidomide, opioid antagonists, phototherapy with narrow band UVB and experimental treatments with cutaneous field stimulation and vagal nerve stimulation. With the new information it seems we will be able to better help our dermatologic patients who have itch, however we are not closer to identifying a single agent specifically targetable to this symptom.
Adjuvants, Immunologic↗