Immunophenotyping of inflammatory cells in subacute prurigo

Contact sensitization in prurigo patients

BACKGROUND

There are no studies on contact allergy in patients with prurigo. With itch being important in the pathophysiology of prurigo diseases and being a symptom of allergic contact dermatitis, we aimed to investigate contact allergy in patients suffering from prurigo.

OBJECTIVES

Exploratory analysis of patch test results in prurigo patients.

MATERIALS AND METHODS

A retrospective analysis of data of the Information Network of Departments of Dermatology, 2005-2014, was performed.

RESULTS

Of 116 744 patch tested patients, 639 (0.55%) were diagnosed with prurigo. The median age was 61 years, 286 (45%) were pensioners, and 252 (39.5%) had generalized prurigo. The indication for patch testing was exclusion of contact allergy in 412 patients (64.5%), and 223 patients (35%) had at least one positive patch test reaction. There was no distinctive pattern of sensitization. Prurigo patients had significantly more (and stronger) reactions to the irritant control patch test with sodium lauryl sulfate than a control group (27.6% versus 21.0%).

CONCLUSIONS

Although prurigo is not a typical clinical manifestation of contact sensitization, our results indicate that patch testing in these patients may be helpful.

Ipilimumab in patients with cancer and the management of dermatologic adverse events

Ipilimumab is a fully human monoclonal antibody that blocks cytotoxic T-lymphocyte antigen-4 to augment antitumor T-cell responses. Phase III studies have demonstrated survival benefit in both previously treated and treatment-naïve patients with metastatic melanoma. In clinical trials, adverse events (AEs) related to treatment with ipilimumab were mostly grade 1/2 (as per Common Terminology Criteria for AEs, Version 4.02), and mostly reversible with appropriate management. Distinct immune-related AEs that may reflect the mechanism of action of ipilimumab have been identified, and occur commonly in the skin, typically presenting as a maculopapular rash, which can be accompanied by pruritus, pruritus with no skin lesions, alopecia, and vitiligo. Histologic analyses have revealed epidermal spongiosis, and perivascular CD4(+) T-cell infiltrates with some eosinophils in areas of rash. Timely implementation of toxicity-specific treatment guidelines that emphasize vigilance and early intervention allows mitigation of dermatologic AEs. Adherence to guidelines is necessary to maintain quality of life, ensure consistent dosing, and obtain the best possible clinical outcome.

Prurigo as a symptom of atopic and non-atopic diseases: aetiological survey in a consecutive cohort of 108 patients

BACKGROUND

Prurigo nodularis Hyde (PN) is a highly pruritic condition due to a vicious circle of repeated itching and scratching. There are no representative clinical studies investigating comorbidities in a large collective of PN patients.

OBJECTIVE

This pilot study aimed to investigate the exact distribution of the coexisting diseases in a large representative consecutive cohort of PN patients.

METHODS

A total of 108 PN patients (36.1% male; mean age of 61.5 ± 16.7 years) were enrolled in the study.

RESULTS

In 87.0% of patients, diseases underlying PN could be established (18.5% skin disease, 7.4% systemic origin, 1.8% neurological diseases, 59.3% mixed origin). Due to several possible causative co-factors, the majority of patients were classified in the group of mixed origin (59.3%). In 53.1% of these patients, at least one dermatological factor was involved in the induction of PN. Interestingly, nearly half (46.3%) of all PN patients had either an atopic predisposition or atopic dermatitis as a single cause of PN (18.5%) or as one co-factor of PN of mixed origin (27.8%). Considering the different underlying diseases, there was no significant age or gender difference.

CONCLUSION

PN does not seem to represent a characteristic symptom of one disease only. Multiple pruritogenic diseases are linked to evolution and improvement of PN upon treatment. Atopic predisposition is a major factor in nearly half of PN patients. The large collective of the present study helped detect a broad range of underlying diseases and thus to provide recommendations for rational diagnostics.