Hartmut Ständer

S2k-Leitlinie - Chronischer Pruritus

© 2012 The Authors • DDG

Topical pimecrolimus and tacrolimus transiently induce neuropeptide release and mast cell degranulation in murine skin

Background  The topical calcineurin inhibitors pimecrolimus and tacrolimus have been demonstrated to be an effective new anti‐inflammatory therapy. The only clinically relevant side‐effect reported is transient application site burning and stinging itch at the beginning of topical therapy.

Diagnostisches und therapeutisches Vorgehen beichronischem Pruritus

Abteilung Klinische Neurodermatologie, Klinik und Poliklinik fur Hautkrankheiten, Universitatsklinikum Munster, Dermatologische Klinik Inselspital Bern, Schweiz, Zentrum fur Allergie und Umwelt, Klinik und Poliklinik fur Dermatologie und Allergologie am Biederstein, Technische Universitat Munchen, Zentrum fur Psychosomatische Medizin, Psychosomatische Dermatologie, Universitatsklinikum Giessen, Hautarztpraxis, Nurnberg, Dermatologie Bad Bentheim, Paulinenkrankenhaus, Bad Bentheim, Klinik fur Dermatologie und Venerologie, Universitatsklinikum Magdeburg, Klinische Sozialmedizin, Berufs und Umweltdermatologie, Universitatsklinikum Heidelberg

Predisposing factors of actinic keratosis in a North-West German population.

The growing incident rates of skin cancer and their corresponding precursor lesions, e.g. actinic keratosis (AK), among Caucasians have become an important public health problem. A multicenter case-control study was conducted to identify the risk factors of AK of a prototypical Central European population. The study population comprised a total of 331 cases and 383 controls. Using multivariate analysis we identified ten independent variables predicting the AK risk. The five most crucial were age (OR 1.11; 95% CI 1.08-1,14), gender (OR 3.92; 95% CI 2.42-6.36), history of previous skin malignancies (OR 6.47; 95% CI 3.21-13.03), pale skin phototype (OR 2.5; 95% CI 1.53-4.06), and sun exposure for occupational reasons (OR 1.72; 95% CI 1.01-2.92). Additionally, sun exposure for recreational reasons, denial of the use of sunscreens, painful sunburn episodes before the age of 20, and a familial history of skin malignancies are also significant independent correlates of AK. Our epidemiological data suggest that constitutional susceptibility and sunlight exposure are equally involved in the onset of AK. Additional prophylactic and educational efforts should focus on increasing sun protection policies and educational programs especially aimed at outdoor workers, men, fair skinned individuals and patients with a history of previous skin malignancies. These measures should be able to reduce the excessive incidence rates of AK among Caucasians in Central Europe.

S2k Guidelines for the diagnosis and treatment of chronic pruritus - update - short version: Guidelines for pruritus

Associated with a host of different diseases, pruritus is a cardinal symptom that poses an interdisciplinary diagnostic and therapeutic challenge. Over time, that symptom may progress independently of the initial cause, thus losing its function as a warning sign and turning into a clinically relevant disease of its own. In Germany, approximately 13.5 % of the general population are affected by chronic pruritus, with an incidence of 7 %. All forms of chronic pruritus require targeted treatment consisting of (a) diagnosis and management of the underlying disease, (b) dermatological treatment of primary or secondary (for example, dry skin, scratch lesions) symptoms, (c) symptomatic antipruritic treatment, and (d) psychological/psychotherapeutic treatment in case of an underlying or associated psychological or psychosomatic condition. Medical care of patients with chronic pruritus should therefore include an interdisciplinary approach, in particular with respect to diagnosis and therapy of the underlying disease as well as in terms of the management of treatment and adverse events. The objective of the present interdisciplinary guidelines is to define and standardize diagnostic and therapeutic procedures in patients with chronic pruritus. This is a short version of the current S2 guidelines on chronic pruritus. The long version may be found at www.awmf.org.

Extracorporeal photopheresis with permanent subcutaneous right atrial catheters.

Background: Adequate peripheral venous access is crucial for successful extracorporeal photopheresis (ECP). As this approach is not always feasible in older patients and patients with graft‐versus‐host disease, central venous catheters play an increasing role in providing long‐term vascular access for ECP.However, not all catheters are able to deliver the minimum flow rate of 7 ml/min for ECP.

S2k-Leitlinie zur Diagnostik und Therapie des chronischen Pruritus - Update - Kurzversion: Leitlinie Pruritus

Pruritus ist ein fachübergreifendes Leitsymptom zahlreicher Erkrankungen und stellt eine interdisziplinäre diagnostische und therapeutische Herausforderung dar. Das Symptom kann sich mit zunehmender Dauer unabhängig von der Ursache fortsetzen und so die eigentliche Warnfunktion verlieren. Stattdessen erlangt das Symptom als chronischer Pruritus einen eigenständigen Krankheitswert. Chronischer Pruritus wird in Deutschland bei ca. 13,5 % der Allgemeinbevölkerung beobachtet mit einer Inzidenz von 7 %. Bei allen Formen von chronischem Pruritus bedarf es einer gezielten Versorgung der Patienten bestehend aus den Säulen (a) Diagnostik und Therapie der Grunderkrankung, (b) einer dermatologischen Therapie primärer oder sekundärer (z. B. trockene Haut, Kratzläsionen) Symptome, (c) einer symptomatisch‐antipruritischen Therapie und (d) bei einer begleitenden oder zugrundeliegenden psychischen oder psychosomatischen Erkrankung einer entsprechenden psychologisch‐psychotherapeutischen Behandlung. Es wird daher empfohlen, die Versorgung von Patienten mit chronischem Pruritus interdisziplinär, insbesondere hinsichtlich Diagnostik und Therapie der Grunderkrankung und des Therapie‐ und Nebenwirkungs‐Management durchzuführen. Das Ziel dieser interdisziplinär erstellten Leitlinie ist es, das Vorgehen bei chronischem Pruritus zu definieren und zu standardisieren. Dies ist die Kurzversion der aktualisierten S2‐Leitlinie zu chronischem Pruritus. Die Langversion findet sich unter www.awmf.org.

Management of chronic pruritus: from the dermatological office to the specialized itch center

Patient care for those affected by chronic pruritus is remarkably complex due to its high prevalence and multifactorial nature. It requires a comprehensive assessment of the patient’s medical history, extensive diagnostic procedures, and long treatment duration, including management of possible accompanying disorders such as sleep disturbances and mental distress. It is important to prioritize patient’s needs when developing a therapeutic treatment plan. Standardized questionnaires and scales should be used to better analyze the patient history, quality of life, symptom intensity, and course of treatment. These can be distributed via digital platforms, allowing for more effective communication between the treating agents and gathering of large volumes of data in central databases. In today’s health care system, it is essential for physicians with itch-related specializations and specialized itch centers to cooperate. It is thus crucial to focus efforts on the further development of specialized treatment centers and training courses for medical practitioners. There are, however, various regulatory and economic barriers to overcome in the modern health care system before patients with chronic pruritus can be offered the best possible care. Accordingly, health care authorities should be made aware of the difficulties associated with the management of chronic pruritus and of the high individual and societal burden it represents.