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ABSTRACT: Epidemiological data on chronic pruritus (> 6 weeks) in the general population are sparse. We aimed to provide data on the incidence and prevalence of chronic pruritus, and identify its determinants based on cross-sectional and longitudinal analyses. A cohort of 1,190 participants from a cross-sectional baseline-study (response rate: 57.8%) was followed up after one year. The questionnaire assessed occurrence of chronic pruritus, medical, lifestyle and psychosocial variables. Incident chronic pruritus was defined as reported chronic pruritus at follow-up in those subjects free-of-the-symptom at baseline. Cross-sectional analyses of data from the follow-up assessments addressed potential associations of medical, lifestyle and psychosocial factors with prevalent chronic pruritus. Longitudinal analyses examined sociodemographic factors as potential predictors of incident chronic pruritus. The follow-up response rate was 83.1%. The mean age of subjects was 56 years, and 58% were female. The 12-month cumulative-incidence equalled 7.0% (95% confidence interval (95% CI) 5.2-9.2%. Lifetime prevalence was 25.5% (95% CI 21.8-27.8%). Incidence was significantly associated with age. Determinants of prevalent chronic pruritus in multi-variable analyses were: liver disease, asthma, eczema and dry skin within the medical domain, an elevated body mass index within the lifestyle domain and higher anxiety scores within the psychosocial domain. Findings suggest a considerable 12-month incidence and lifetime prevalence and provide important directions for future research.
Acta Dermato-Venereologica 02/2013;
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Journal of the American Academy of Dermatology 01/2013; · 3.99 Impact Factor
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ABSTRACT: Eczema is a common skin disease in many countries, and although the majority of cases of eczema occur before the age of five years and often resolve during childhood or adolescence, it can also persist into adulthood. Itch is the most important aspect of eczema, often impacting significantly on the quality of life of an affected individual.
To assess the effects of oral antihistamines (H1 antagonists) as monotherapy in children and adults with eczema.
We searched the following databases up to March 2012: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2012, Issue 3), MEDLINE (from 1946), EMBASE (from 1974), and LILACS (from 1982). We examined the reference lists of excluded studies in order to identify further references to relevant trials. We searched trials registers for ongoing and unpublished trials. We also handsearched the abstracts of the International Research Workshops on eczema, as well as the conference proceedings of the European Academy of Dermatology and Venereology (EADV) and the European Academy of Allergology and Clinical Immunology (EAACI), from 2000 to 2011.
We sought to include randomised controlled trials that assessed the effects and safety of oral H1 antihistamines as monotherapy in children and adults with eczema. We excluded studies that compared an antihistamine versus another antihistamine and had no placebo control arm. We also excluded topical antihistamines and oral H1 antihistamines as 'add-on' therapy and studies using any concomitant therapy other than emollients or moisturisers, principally because some of these forms of concomitant therapy may be considered treatment modifiers in assessments of the effects of antihistamines on eczema.
Our search retrieved 409 references to studies. Based on assessments of their titles, abstracts, or both, we excluded all except 36 of these studies. After evaluation of the full text of each report, we excluded a further 35 studies, and 1 study is awaiting classification pending a response from the trial investigators.
No randomised controlled trials met our inclusion criteria.
There is currently no high-level evidence to support or refute the efficacy or safety of oral H1 antihistamines used as monotherapy for eczema. Because most of the studies allowed the use of concomitant medications and involved multi-therapeutic approaches, meaningful assessments of the individual effects of oral H1 antihistamines on eczema were not feasible. Although well-designed randomised controlled trials excluding concomitant medications appear to be needed, consideration should be given to the potential ethical issues raised with the use of antihistamines as monotherapy for the management of eczema by withholding the use of rescue or additional therapies. A further systematic review of studies in which concomitant therapies were permitted might be of value in determining the potential benefits of oral H1 antihistamines as add-on therapy.
Cochrane database of systematic reviews (Online) 01/2013; 2:CD007770. · 5.72 Impact Factor
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ABSTRACT: Background. Occupational skin disease (OSD) is common, and imposes a considerable personal and public burden. To tackle OSD, the German stepwise procedure of handling OSD was set up. It contains an interdisciplinary, integrated inpatient rehabilitation measure [tertiary individual prevention (TIP)] [dermatological treatment and diagnostic procedures, and patient education (health and psychological)]. The primary aims of the TIP are reduction of the severity of OSD, reduction in the use of corticosteroids, facilitation of return to work, decreased absence from work, and enhanced quality of life (QoL). It was positively evaluated for a period of 4 weeks after return to work. Objectives. To investigate whether the observed short-term effects remain significant and meaningful over a period of 12 months after discharge from the TIP. Methods. A prospective design was used to compare clinical and patient-reported outcome data between admission to a 3-week inpatient TIP and 12 months after discharge (12-month follow-up). Results. Of 1788 individuals admitted to the TIP, data from 1617 individuals were available for analysis. We observed a significant reduction in the severity of OSD, the use of topical corticosteroids, and days of absence from work because of OSD. QoL was significantly improved, and 87.4% were able to return to work and remain in the workforce. Conclusions. A randomized controlled trial would have been desirable, but was not possible, for legal and other reasons. However, the long-term 12-month follow-up shows that the TIP is associated with sustained improvements in terms of ability to work, QoL, and prognosis, and reductions in days of absence from work because of skin conditions and topical corticosteroid application. These results indicate that the TIP provided a reduction in the personal and public burden of OSD.
Contact Dermatitis 10/2012; · 3.51 Impact Factor
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Masutaka Furue,
Toshiya Ebata,
Akihiko Ikoma,
Satoshi Takeuchi,
Yoko Kataoka,
Kenji Takamori,
Takahiro Satoh,
Hidehisa Saeki,
Matthias Augustin,
Adam Reich,
Jacek Szepietowski,
Alan Fleischer,
Christine Blome,
Ngoc Quan Phan, Elke Weisshaar,
Gil Yosipovitch,
Sonja Ständer
Acta Dermato-Venereologica 08/2012;
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ABSTRACT: INTRODUCTION: The symptom of chronic pruritus (> 6 weeks of duration) represents a worldwide burden in patients. It is described as the most frequent symptom of the skin complaints and occurs in a broad variety of diseases. However, research on pruritus has been disregarded for a long time, most likely because pruritus used to be considered as a subtype of pain. AREAS COVERED: Although understanding of the epidemiology, clinic and neurobiology of acute and chronic pruritus has considerably expanded in the past years, the therapy of chronic pruritus patients remains challenging. The current guidelines suggest antihistamines, pain modulators, opioid receptor antagonist and antidepressants. Using this, a large number of patients experience relief but mostly no complete resolution. Recent experiences with neurokinin receptor 1 antagonists suggest that target-specific antipruritic drugs are of high efficacy and desirable in chronic pruritus treatments. EXPERT OPINION: New substances and classes of antipruritic drugs are highly needed. Promising candidates are next to neurokinin receptor 1 antagonists, antagonists against the histamine 4 receptor, nerve growth factor receptor or gastrin-releasing peptide receptor.
Expert Opinion on Emerging Drugs 08/2012; 17(3):335-45. · 3.21 Impact Factor
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Elke Weisshaar,
Jacek C Szepietowski,
Ulf Darsow,
Laurent Misery,
Joanna Wallengren,
Thomas Mettang,
Uwe Gieler,
Torello Lotti,
Julien Lambert,
P Maisel,
Markus Streit,
Malcolm W Greaves,
Andrew J Carmichael,
Erwin Tschachler,
Johannes Ring,
Sonja Ständer
Acta Dermato-Venereologica 07/2012; 92(5):563-81.
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ABSTRACT: Chronic itch affects millions of patients worldwide and has a significant impact on quality of life. The assessment of itch and its associated effects is a significant component of clinical practice in itch management. Despite itch being a common complaint, there are few studies describing the use of structured questionnaires for evaluation and measurement of itch and its sensory and affective dimensions. The International Society of the Study of Itch (IFSI) has recently provided invaluable data on the use of visual analogue scales as an assessment tool for itch. However, it is clear that additional tools are needed to better assess the different dimensions of chronic itch and better tailor management. With this goal in mind, a Special Interest Group was initiated by members of IFSI to determine which of the various psychometric properties of itch questionnaires offer the greatest utility in the evaluation of chronic itch. This first consensus paper addresses what domains and structure of itch questionnaires need to be implemented to better assess chronic itch and guide therapy.
Acta Dermato Venereologica 06/2012; 92(5):493-6. · 3.18 Impact Factor
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ABSTRACT: bathe a., weisshaar e. & matterne u. (2012) Chronic pruritus - more than a symptom: a qualitative investigation into patients' subjective illness perceptions. Journal of Advanced Nursing00(0), 000-000. doi: 10.1111/j.1365-2648.2012.06009.x ABSTRACT: Aim. This article is a report of a study exploring the subjective illness perceptions of patients with chronic pruritus (>6 weeks). Background. Pruritus is a common symptom of dermatological as well as other conditions. This pervasive symptom has a substantial impact on quality of life. Little is known about how patients with chronic pruritus construct the symptom, what causes they ascribe, consequences they endure, how they control the symptom and experience the healthcare system. Design. A qualitative design taking a constructivist inquiry perspective. Methods. Semi-structured interviews with 16 patients were conducted between September 2008-February 2009 and analysed by qualitative content analysis. Results. Many patients find it very difficult to adequately describe the symptom to others resulting sometimes in bizarre accounts of the symptom that provoke irritation in lay people and health professionals. This irritation frequently leaves the sufferer feeling misunderstood. Patients often feel their burden is not taken seriously by health professionals. This and various other reasons contribute to difficulties in accepting a given diagnosis. This can leave patients unsatisfied with their current health care and the system. They respond with frequent doctor changes and consideration of complementary and alternative therapeutic methods. Conclusion. Assisting patients with chronic pruritus in their efforts to adequately describe the symptom along with unconditional regard and empathy are key factors that can help enhance the provider-patient relationship and subsequent acceptance of a given diagnosis. A stronger emphasis on the perspectives of these patients may also improve the quality of healthcare provision.
Journal of Advanced Nursing 05/2012; · 1.48 Impact Factor
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Sonja Ständer,
Ulf Darsow,
Thomas Mettang,
Uwe Gieler,
Marcus Maurer,
Hartmut Ständer,
Ulrich Beuers,
Volker Niemeier,
Harald Gollnick,
Maria Vogelgsang, Elke Weisshaar
Journal der Deutschen Dermatologischen Gesellschaft 01/2012; 4(10). · 1.47 Impact Factor
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ABSTRACT: BACKGROUND AND OBJECTIVES. The German stepwise procedure of handling occupational skin diseases (OSDs) offers interdisciplinary integrated (inpatient/outpatient) rehabilitation measures [tertiary individual prevention (TIP)] for severe OSD. In 2005, a prospective cohort multicentre study was started in order to evaluate TIP.
One thousand seven hundred and eighty-eight patients with severe OSD were treated and educated in five clinics with follow-up before and 4 weeks after return to work.
During the inpatient phase, there was a significant improvement in the severity of OSD (Osnabrueck Hand Eczema Severity Index, p < 0.001) and in the quality of life (Dermatology Life Quality Index, p < 0.001). These effects were largely sustained during the outpatient follow-up phase and in the 4 weeks after return to work. Among all patients, 89.4% used topical steroids before TIP, including 52.5% using high-grade topical steroids; 93.2% of the patients were able to refrain from using topical steroids before returning to work. As a result of TIP, return to work was possible for 1587 patients (88.8%).
The primary objectives of TIP (return to work, improvement of OSD, enhancement of quality of life, and reduction in the use of topical steroids) were successfully met. The long-term follow-up (1 and 3 years after TIP) will examine whether these favourable outcomes can be sustained.
Contact Dermatitis 11/2011; 66(3):140-7. · 3.51 Impact Factor
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Acta Dermato-Venereologica 10/2011; 92(5):532-533.
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Acta Dermato-Venereologica 10/2011; 92(5):553-554.
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ABSTRACT: Pruritus is the most frequent symptom in dermatology. Its impact on quality of life is substantial. Epidemiological data on chronic pruritus (>6 weeks) at the population level is sparse, but is important in order to understand the burden and risk factors of this distressing symptom. The aim of this population-based cross-sectional study was to estimate the point, 12-month and lifetime prevalence of chronic pruritus, assessing its association with sociodemographic variables and describing its characteristics. A validated postal questionnaire was sent to 4,500 individuals in from the German General population. Three contact attempts were made. The response rate was 57.8% (n=2,540). The point prevalence of chronic pruritus was 13.5% (95% confidence interval (95% CI) 12.2-14.9%), 12-month prevalence 16.4% (15.0-17.9%) and lifetime prevalence 22.0% (20.4-23.7%). Multivariate analyses found only ethnic origin independently associated with chronic pruritus. The impact of chronic pruritus on quality of life and emotional well-being appears to depend on severity rather than on the presence of the symptom alone. This is the first study to investigate various prevalence estimates of chronic pruritus at the population level. Despite its limitations (self-report and potential self-selection) this study indicates a high burden of chronic pruritus in society.
Acta Dermato-Venereologica 08/2011; 91(6):674-9.
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Journal der Deutschen Dermatologischen Gesellschaft 06/2011; 9(6):456-463. · 1.47 Impact Factor
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Christian Joachim Apfelbacher,
Wilhelm Akst,
Sonja Molin,
Jochen Schmitt,
Andrea Bauer, Elke Weisshaar,
Vera Mahler,
Sabine Treichel,
Thomas Ruzicka,
Thomas Luger,
Peter Elsner,
Thomas Ludwig Diepgen
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ABSTRACT: The aim of the CARPE (German acronym: Chronisches Handekzem-Register zum Patienten-Langzeitmanagement; meaning: chronic hand eczema registry on long-term patient management) registry is to investigate characteristics and treatment modalities in patients affected by chronic hand eczema in Germany.
The registry was built up under the auspices of the German Dermatological Society (Deutsche Dermatologische Gesellschaft, DDG). Patients with chronic hand eczema are prospectively assessed by dermatological examination and patient questionnaire. Socio-economic data and data on diagnostics, skin status, severity and treatment of chronic hand eczema and atopy criteria are repeatedly assessed. Here, we present baseline characteristics of the first 515 patients.
53.8 % of the patients were female, mean age was 47.3 years. The average duration of CHE was 7.7 years. 30.4 % had already received inpatient care, 31.2 % had been on sick leave in the past 12 months. 94.5 % had received topical corticosteroids prior to inclusion in the registry, 31.9 % topical calcineurin inhibitors, 38.3 % UV therapy, 28.6 % systemic antihistamines, 36.5 % systemic treatments, 14.9 % systemic corticosteroids, 25.8 % systemic retinoids.
The CARPE project demonstrates the high medical burden and therapeutic challenge of chronic hand eczema and presents first data for health care research. Furthermore, the designed follow-up study will present important data about the natural history and prognosis of this chronic skin disease.
Journal der Deutschen Dermatologischen Gesellschaft 05/2011; 9(9):682-8. · 1.47 Impact Factor
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ABSTRACT: The pathogenesis of acute and chronic (> 6 weeks duration) pruritus is complex and involves in the skin a network of resident cells (e. g., mast cells, keratinocytes, sensory neurons) and transient inflammatory cells (e. g., eosinophils). Though pruritus and pain show overlapping mechanisms, recent studies have provided evidence that pruritus and pain pathogenesis differ in important points. In the skin, the sensory C-nerve fibers have been investigated intensively. Several classes of histamine-sensitive or histamine-insensitve C-fibers have been described. Epidermal and dermal sensory nerve fibres are now assumed to be of major importance in pruritus induction. They interact with keratinocytes, inflammatory cells such as T lymphocytes, eosinophils and basophils which have been shown to release multiple pruritogenic mediators (e.g., nerve growth factor, interleukin-31) which lead to activation, sensitization and sprouting of skin nerves. Specific receptors have been discovered on cutaneous and spinal neurons to be exclusively involved in the processing of pruritic signals. Just recently, the gastrin-releasing peptide receptor (GRPR) was identified on spinal neurons that are crucially involved in pruritus but not pain processing. Chronic pruritus is notoriously difficult to treat. Newer insights into the underlying pathogenesis of pruritus have enabled novel treatment approaches that target the pruritus-specific pathophysiological mechanism. For example, kappa-opioid receptor agonists and neurokinin-1 antagonists have been found to relieve chronic pruritus.
Journal der Deutschen Dermatologischen Gesellschaft 01/2011; 9(6):456-63. · 1.47 Impact Factor
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Elke Weisshaar
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ABSTRACT: Chronic pruritus may be induced by drugs. In this, chronic pruritus must be differentiated from acute pruritus. Acute pruritus can appear as a side-effect of a medication as for example antibiotics and will usually disappear within some days after discontinuation of the drug. Chronic pruritus is defined as itch sensations lasting longer than six weeks. Chronic pruritus, however, forms a major challenge in diagnostic and therapeutic respect. In view of the demographic development of the population and the frequent polypharmacy especially in the elderly, drugs should always be considered as a possible cause for pruritus.
Therapeutische Umschau 01/2011; 68(1):41-6.
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ABSTRACT: Occupational skin disease (OSD) is common, associated with poor prognosis and poses a significant burden to the individual and society. We applied the theory of planned behaviour (TPB), the prototype-willingness model (PWM) and the health action process approach (HAPA) to the prediction and explanation of occupationally relevant skin protection behaviour in individuals with OSD. We used a longitudinal design. In this study, 150 individuals participating in a 3-week inpatient tertiary prevention programme completed measures assessing the constructs of the TPB, PWM and HAPA at admission (T 0), discharge (T 1) and once the individual had returned to work and worked for 4 consecutive weeks (T 2) (n = 117). Intention was measured at T 0 and skin protection behaviour at T 2. Path analysis was used to assess the longitudinal associations of the models' constructs with intention and skin protection behaviour. TPB as well as PWM variables accounted for 30% of variance in behaviour, HAPA variables for 33%. While not all predictions were confirmed by the data, all three models are able to inform us about the formation of skin protection intention and behaviour in individuals with OSD. The findings are discussed in light of future interventions and research.
Psychology & Health 01/2011; 26(9):1188-207. · 1.69 Impact Factor
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Acta Dermato-Venereologica 01/2010; 90(1):97-8.
