Tejesh Patel

The University of Tennessee Health Science Center, Memphis, TN, United States

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Publications (13)37.19 Total impact

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    ABSTRACT: In 1996 el Darouti and Abu el Ela described seven Egyptian patients with similar cutaneous lesions and proposed necrolytic acral erythema (NAE) as a distinct entity of the necrolytic erythema family. Since then, NAE has emerged as a cutaneous manifestation of hepatitis C virus infection and taken its place in the literature as a marker for systemic disease. NAE initially presents with burning, pruritic eruptions of circumscribed, erythematous papules with flaccid vesiculation on the acral surfaces universally affecting the dorsum of the feet. The presenting papules of acute NAE evolve over time into confluent, velvety, hyperkeratotic plaques with decreased central erythema but a characteristic dark erythematous rim and adherent scale. Although mostly misdiagnosed as psoriasis or inflammatory dermatitis, NAE can be definitively placed among the necrolytic erythema family as a distinct entity based on clinical and histopathologic characteristics. We report a case of necrolytic acral erythema in a 17-year-old followed by a review of the literature.
    Pediatric Dermatology 10/2011; 28(6):701-6. · 1.04 Impact Factor
  • Urvi Patel, Tejesh Patel, Robert B Skinner
    Archives of dermatology 08/2011; 147(8):997-8. · 4.76 Impact Factor
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    ABSTRACT: The term "urticaria multiforme" has recently been proposed to replace acute annular urticaria and refers to a benign cutaneous hypersensitivity reaction characterized by the acute onset of large, polycyclic, and annular wheals with ecchymotic centers. It is associated with acral and facial angioedema, dermatographism, favorable response to antihistamines, and a self-limited course. It is most often mistaken for erythema multiforme and occasionally for serum sickness-like reaction. We report a case of urticaria multiforme in a 4-month-old infant, followed by a review of the literature.
    Pediatric Dermatology 07/2011; 28(4):436-8. · 1.04 Impact Factor
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    ABSTRACT: Burning mouth syndrome (BMS) is a chronic orofacial pain syndrome that occurs in middle-aged and postmenopausal women and poses a therapeutic challenge to dermatologists and dentists. It has been suggested previously that BMS is a small-fiber neuropathy. This study was designed to examine thermal sensory and pain thresholds in the oral mucosa and chin, both innervated by the trigeminal nerve, in patients with BMS, as well as in healthy controls. In addition, the study proposed to examine whether there are any differences in oral thermal and pain sensations between the advanced age group, where BMS is prevalent and a younger group. Thermal and pain thresholds of BMS patients did not differ significantly from those of healthy subjects. An increased threshold to thermal warmth and a decreased threshold for cold sensation for the tongue and chin were noted in the group over 50 years in comparison with younger subjects, indicating a decreased sensitivity to thermal stimuli. The group over 50 years of age displayed an increased sensitivity to cold pain and a decreased sensitivity to hot pain in the tongue (compared with the chin). BMS patients do not demonstrate alterations in thermal and pain detection, thus failing to support a true small nerve neuropathy in this condition.
    Skin Research and Technology 01/2011; 17(2):196-200. · 1.41 Impact Factor
  • Tejesh Patel, Gil Yosipovitch
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    ABSTRACT: The elderly in North America represent the fastest growing segment of the population and the most common skin complaint in this age group is pruritus. The multitude of variables that come with advanced age means that the management of pruritus in the elderly poses a particular therapeutic challenge. Pruritus in advanced age may result from a variety of etiologies, although xerosis is the most common. In addition, certain cutaneous and systemic diseases that are associated with pruritus are more prevalent in the elderly. At present, there is no universally accepted therapy for pruritus. Currently, management of pruritus in the elderly must take an individualistically tailored approach with consideration of the patient's general health, the severity of symptoms, and the adverse effects of treatment. Physical and cognitive limitations, multiple comorbid conditions, and polypharmacy are some aspects that can influence the choice of treatment in this age group.
    Skin therapy letter 09/2010; 15(8):5-9.
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    Tejesh Patel, Gil Yosipovitch
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    ABSTRACT: Pruritus is the predominant symptom of skin disease. Owing to the poorly understood pathophysiology, the development of effective treatment modalities for pruritus has proven to be particularly difficult. At present, there is no universally accepted therapy for itch. The purpose of this review is to provide an update on the treatment of pruritus. An overview of current, emerging and possible future therapies for pruritus is provided. Insights into possible treatment regimes for pruritus in different clinical scenarios. The therapy of pruritus is challenging and at present takes on an individualistic approach. Recent advancements in the mechanisms that underlie this distressing symptom have identified new targets for future therapy.
    Expert Opinion on Pharmacotherapy 07/2010; 11(10):1673-82. · 2.86 Impact Factor
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    ABSTRACT: Topical application of capsaicin commonly produces burning, stinging and itching as well as hyperalgesia to heat stimuli via activation of transient receptor potential vanilloid subtype 1. To investigate whether there are differences in sensory response and neurogenic inflammation to topical capsaicin in four different ethnic populations with different skin types. The study was performed in 40 healthy subjects consisting of 10 African Americans, 10 East Asians, 10 Hispanics and 10 Caucasians. Warmth sensation and heat pain detection thresholds, as well as pain intensity, were measured before and after application of capsaicin or placebo on forearms along with skin blood flow and the extent of the flare reaction. In African Americans the heat pain detection threshold, pain intensity and skin blood flow did not change significantly after capsaicin application, while in the other three ethnic groups a significant change occurred characterized by hyperalgesia and vasodilatation. The postcapsaicin warmth sensation threshold increased in African Americans and decreased in Hispanics, the latter also uniquely experiencing postcapsaicin itch. Our observations indicate that African Americans display a limited hypersensitivity following topical capsaicin, compared with the three other ethnic groups.
    British Journal of Dermatology 05/2010; 162(5):1023-9. · 3.76 Impact Factor
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    ABSTRACT: Little is known about brain mechanisms supporting the experience of chronic puritus in disease states. To examine the difference in brain processing of histamine-induced itch in patients with active atopic dermatitis (AD) vs. healthy controls with the emerging technique of functional magnetic resonance imaging (fMRI) using arterial spin labelling (ASL). Itch was induced with histamine iontophoresis in eight patients with AD and seven healthy subjects. We found significant differences in brain processing of histamine-induced itch between patients with AD and healthy subjects. Patients with AD exhibited bilateral activation of the anterior cingulate cortex (ACC), posterior cingulate cortex (PCC), retrosplenial cingulate cortex and dorsolateral prefrontal cortex (DLPFC) as well as contralateral activation of the caudate nucleus and putamen. In contrast, healthy subjects activated the primary motor cortex, primary somatosensory cortex and superior parietal lobe. The PCC and precuneus exhibited significantly greater activity in patients vs. healthy subjects. A significant correlation between percentage changes of brain activation was noted in the activation of the ACC and contralateral insula and histamine-induced itch intensity as well as disease severity in patients with AD. In addition, an association was noted between DLPFC activity and disease severity. Our results demonstrate that ASL fMRI is a promising technique to assess brain activity in chronic itch. Brain activity of acute itch in AD seems to differ from that in healthy subjects. Moreover, the activity in cortical areas involved in affect and emotion correlated to measures of disease severity.
    British Journal of Dermatology 06/2009; 161(5):1072-80. · 3.76 Impact Factor
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    ABSTRACT: The objective of this study was to evaluate the efficacy of a commercially available anti-itch lotion containing 1% pramoxine hydrochloride versus control lotion in the treatment of uremic pruritus in adult hemodialysis patients. This was a randomized, double-blind, controlled comparative trial set in a community hemodialysis center. The study population comprised 28 individuals (mean age 53.5) with moderate to severe uremic pruritus who had been receiving hemodialysis for at least 3 months. All participants were recruited from one community hemodialysis center. Topical anti-itch lotion containing 1% pramoxine was applied twice daily to all affected areas of pruritus for 4 weeks. The main outcome measure was a reduction in itch intensity. Secondary outcomes included increases in the investigator's global assessment and improvement in skin hydration. There was a 61% decrease in itch intensity in the treatment group, whereas a 12% reduction in itch intensity was observed in the control group. The rate of decline in itching was also greater in the treatment arm versus the control arm. No significant differences were displayed in other studied disease-related variables. Our study shows that individuals using pramoxine 1% lotion experienced a reduction in pruritus to a greater degree than those using the control lotion. This safe, convenient and effective topical lotion may potentially benefit the large number of patients affected by pruritus associated with end-stage renal disease.
    Journal of Dermatological Treatment 10/2008; 20(2):76-81. · 1.50 Impact Factor
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    ABSTRACT: Repetitive scratching is the most common behavioural response to itch in atopic dermatitis (AD). Patients with chronic itch often report that very hot showers inhibit itch. We recently reported that scratching and noxious heat stimuli inhibit histamine-induced itch in healthy subjects. However, no psychophysical studies have been performed in AD to assess the effects of repetitive heat pain stimuli and scratching on histamine-induced itch. To examine the effects of repetitive noxious heat and scratching on itch intensity in patients with AD using quantitative sensory testing devices. Itch was induced with histamine iontophoresis in 16 patients with AD in both lesional and nonlesional skin as well as in 10 healthy subjects. Repetitive noxious heat and scratching were applied 3 cm distal to the area of histamine iontophoresis. Subjects rated their perceived intensity of histamine-induced itch with a computerized visual analogue scale. Our results demonstrate that repetitive noxious heat and scratching do not inhibit itch intensity in lesional and nonlesional AD skin but do so in healthy skin. Of note, both these stimuli increase itch intensity in lesional AD skin. Our results strongly suggest that scratching and noxious thermal stimuli have a different effect upon histamine-induced itch perception in patients with AD when compared with healthy controls. This difference may be associated with both peripheral and central sensitization of nerve fibres in AD.
    British Journal of Dermatology 02/2008; 158(1):78-83. · 3.76 Impact Factor
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    ABSTRACT: Although patients with rosacea often complain of increased skin sensitivity, there has been no quantitative sensory testing of this phenomenon. Furthermore, cutaneous blood flow in these patients has not been assessed using state-of-the-art laser Doppler imaging (LDI). To assess heat pain thresholds and skin blood flow using quantitative thermal sensory testing and LDI in patients with untreated rosacea. Of the total 24 subjects enrolled, 8 had papulopustular rosacea (PPR), 8 had erythematotelangiectatic rosacea (ETR) and 8 were control subjects. Subjective burning perception, heat pain threshold, skin blood flow, and skin temperature was assessed in all subjects. In the ETR and PPR groups, two areas were compared: affected and nonaffected. Heat pain thresholds of areas affected by rosacea were lower than those of nonaffected areas. In addition, subjective burning perception was increased in rosacea patients when compared with control subjects. Although PPR-affected skin had elevated skin blood flow when compared with nonaffected skin, this was not significant for ETR-affected skin. The small number of subjects enrolled was the main limitation. This study showed enhanced sensitivity to noxious heat stimuli in rosacea-affected skin, which was more prominent in the PPR group.
    Journal of the American Academy of Dermatology 12/2007; 57(5):800-5. · 4.91 Impact Factor
  • Tejesh Patel, Yozo Ishiuji, Gil Yosipovitch
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    ABSTRACT: Menthol is a naturally occurring cyclic terpene alcohol of plant origin, which has been used since antiquity for medicinal purposes. Its use in dermatology is ubiquitous, where it is frequently part of topical antipruritic, antiseptic, analgesic, and cooling formulations. Despite its widespread use, it was only recently that the mechanism by which menthol elicits the same cool sensation as low temperature was elucidated upon, with the discovery of the TRPM8 receptor. Although almost 5 years have passed since the discovery of this receptor, many dermatologists are still unaware of menthol's underlying target. The purpose of this review is to highlight the recent advances in the mechanism of action of menthol and to provide an overview of its dermatologic applications.
    Journal of the American Academy of Dermatology 12/2007; 57(5):873-8. · 4.91 Impact Factor
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    Tejesh Patel, Yozo Ishiuji, Gil Yosipovitch
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    ABSTRACT: Pruritus is exacerbated at night in many systemic and dermatological diseases, resulting in reports of significantly diminished quality of life and sleep disturbances. At present, the underlying mechanisms responsible for night-time itching are not well understood. Nocturnal pruritus may be related to the circadian rhythm of itch mediators and possibly the disruption of such patterns. Diurnal changes in skin physiology, such as temperature and barrier function, may also play a role. Currently, the paucity of specific treatment options for nocturnal pruritus is alarming and needs to be addressed by future research. This review describes the scale of the problem associated with nocturnal pruritus, the impact it has on patients, possible underlying mechanisms and, lastly, treatment options.
    Acta Dermato Venereologica 02/2007; 87(4):295-8. · 3.49 Impact Factor