Shawn G. Kwatra

Gabapentin and pregabalin for the treatment of chronic pruritus.

Chronic pruritus is a distressing symptom that is often refractory to treatment. Patients frequently fail topical therapies and oral over-the-counter antihistamines, prompting the clinician to consider alternative therapies such as neuroactive agents. Herein, the use of gabapentin and pregabalin, 2 medications well known for treating neuropathic pain and epilepsy that are occasionally used for relieving chronic pruritus is explored. The findings from original sources published to date to evaluate the use of gabapentin and pregabalin as antipruritic agents are explored. They are found to be promising alternative treatments for the relief of several forms of chronic pruritus, particularly uremic pruritus and neuropathic or neurogenic itch, in patients who fail conservative therapies.

Thalidomide for the treatment of chronic refractory pruritus

Pruritus is a common and often times difficult to treat symptom in many dermatologic and systemic diseases. For pruritus with an inflammatory or autoimmune origin, therapies such as topical corticosteroids and antihistamines are often initiated. However, in the case that these and additional systemic therapies are ineffective, thalidomide, an immunomodulator and neuromodulator, may be a useful alternative treatment. Considerable relief of chronic pruritus has been demonstrated with thalidomide in case reports, case series, and controlled trials. Double-blind controlled studies demonstrated thalidomides efficacy as an antipruritic agent in patients with uremic pruritus, primary biliary cirrhosis, and prurigo nodularis. In case reports, case series, and open-label trials, thalidomide significantly reduced pruritus associated with conditions such as actinic prurigo and paraneoplastic pruritus. Because of variations in study design and evaluation of antipruritic effect, it is difficult to fully understand thalidomides role based on the evidence described to date in the medical literature. In this review, we provide an overview of the reported findings and evaluate thalidomides utility in managing refractory pruritus in the context of its adverse risk profile. We propose that thalidomide can be an alternative or combination antipruritic treatment for patients who do not obtain enough relief from conservative therapy.

The Emerging Zika Virus Threat: A Guide for Dermatologists

We provide a guide for dermatologists to follow if they encounter patients with a rash and clinical history suspicious of Zika virus infection, including diagnostic testing and management options. We also provide an illustrative case report of a patient from Brazil who was diagnosed with Zika virus infection after presenting with a generalized pruritic rash. One of the most prominent symptoms of Zika virus infection is a cutaneous eruption. As such, it is especially necessary for dermatologists to understand this virus so that they may appropriately recognize this entity as a diagnostic consideration in the clinic. The rash associated with Zika virus infection is most commonly an erythematous maculopapular eruption that presents after an initial 3–4xa0days of fever, headache, and arthralgia or myalgia. The rash typically lasts for an average of 6xa0days, and can spread to involve any part of the body, including the face, torso, extremities, palms, and soles.

Seasonal variation of itch: A study using real-time data from 2004 to 2016

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Food and drug administration approval process for dermatology drugs in the United States

Abstract Aim: The purpose of this review is to elucidate the steps involved in the FDA’s approval of new dermatology drugs. Methods: To help illustrate the process of drug approval, we use examples from the recent approval of dupilumab (REGN668; Regeneron Pharmaceuticals). Results: In general, new dermatology drugs must undergo pre-clinical studies on non-human subjects and three phases of clinical trials in humans before undergoing review by the Food and Drug Administration (FDA). This review process involves an interdisciplinary team of scientists that determines if the drug should be brought to market based on its efficacy, risk-to-benefit ratio, and ability to be labeled. The team that specifically reviews dermatology drugs within the Center for Drug Evaluation and Research (CDER) at the FDA is the Division of Dermatologic and Dental Drug Products. Conclusions: The drug development process is enhanced by clinician input during all stages of development.

Addressing minority representation in dermatology: Answering a call to action through structured mentorship and instruction

This study uses course evaluation responses and anecdotal feedback to assess a pilot program that includes direct mentorship to encourage inner-city high school students from populations underrepresented in medicine to consider careers in dermatology.

Atopic Dermatitis Disease Complications

This chapter will describe infectious complications of atopic dermatitis, including bacterial, viral, and fungal infections and the evolving understanding of the relationship between atopic dermatitis and infectious disease. The underlying immunological dysregulation and poor skin barrier function associated with atopic dermatitis not only increases the likelihood of infectious complications, but also lends atopic dermatitis skin vulnerable to flares induced by environmental triggers. Thus, this chapter will also highlight the impact of common external environmental agents on precipitating flares of disease. Lastly, this chapter will discuss complications that can arise from treatments and the association of atopic dermatitis with more serious conditions such as lymphoma.

Atypical lymphocytic lobular panniculitis: an overlap condition with features of subcutaneous panniculitis-like T-cell lymphoma and lupus profundus

A woman aged 45u2005years presented for evaluation of skin lesions. She reported an 8–9-year history of occasionally tender, waxing-and-waning skin nodules refractory to dapsone, prednisone and methotrexate. Examination revealed multiple indurated subcutaneous nodules distributed on the upper extremities, with scattered patches of lipoatrophy in areas of nodule regression (figure 1). Her medical history was unremarkable; CBC and CMP were within normal limits, with no history of radiotherapy or evidence of internal organ involvement. She had a positive ANA titre (1:160, speckled), but negative anti-dsDNA, anti-Smith, anti-Ro and anti-La antibodies.nnnnFigurexa01 nMultiple erythematous subcutaneous nodules distributed over the patients right arm.nnnnDifferential diagnosis included erythema nodosum (EN), erythema induratum of Bazin (EIB), lupus profundus (LP) and cutaneous lymphoma.nnInitial wedge biopsy in 2008 disclosed a predominantly lobular panniculitic process with some septal involvement (figure 2A). Broad zones of necrosis were present (figure 2B). The infiltrate consisted of a pleomorphic population of lymphocytes with occasional larger atypical lymphocytes (figure 2C). There were foci of adipocyte rimming by the atypical lymphocytes (figure 2C). Immunophenotyping revealed predominance of CD3+ T cells …

Nephrogenic systemic fibrosis: fibrotic plaques and contracture following exposure to gadolinium-based contrast media

A 55-year-old man with a history of end-stage renal disease secondary to systemic lupus, status post-deceased donor kidney transplants in 1988 and 2008, presented to the transplant dermatology clinic. Detailed examination revealed cobblestoning (figure 1) and faintly erythaematous, hyperpigmented, indurated plaques on both legs and arms (figure 2) with slight fissuring in the left antecubital fossa (figure 3). The patient had accompanying stiffness and contracture of the left arm (figure 3), which were attributable to nephrogenic systemic fibrosis (NSF).nnnnFigurexa01 nSkin with ‘cobblestone’ or ‘woody’ appearance, typical of nephrogenic systemic fibrosis.nnnnnnFigurexa02 nHyperpigmented fibrotic indurated plaques on the patients right arm (A), left leg (B) and right leg (C).nnnnnnFigurexa03 nFissuring in the left antecubital fossa and stiff contracture of the patients left arm.nnnnIn March 2005, the patient received gadodiamide, a linear gadolinium-based (0.2u2005mmol/kg) MRI contrast agent, for an MRI study and subsequently developed severe skin fibrosis of his extremities …

Interleukin-31 receptor and pruritus associated with primary localized cutaneous amyloidosis.

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