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Combination treatment of dupilumab with bortezomib in a patient with IgG kappa gammopathy of renal significance, uremic pruritus and chronic lichenoid dermatitis.

Chronic pruritus (CP) is one of the most frequent symptoms among dermatological conditions, capable of reducing the quality of life (QoL). CP may be induced by atopic dermatitis or other dermatological and/or non-dermatological conditions. In this article, we report the case of a patient affected by generalized CP, characterised by multiple papulo-nodular and escoriatic lesions, developed after the onset of an immunoglobulin G (IgG) kappa monoclonal gammopathy of renal significance (MGRS), associated with renal insufficiency. Therefore, a combined treatment with dupilumab for CP and bortezomib

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… In addition to AD, Dupilumab showed good response rates also in CP induced by other conditions, such as prurigo nodularis, uremic pruritus (UP), chronic idiopathic pruritus, lichen planus and eosinophilic dermatosis of hematologic malignancy ( 5 ). … Among extra-cutaneous diseases, multiple myeloma (MM) and renal failure can exacerbate chronic prurigo; specifically, various cutaneous manifestations can be observed in MM patients ( 7 ). …

Grzybowski's Generalized Eruptive Keratoacanthomas in a Patient with Terminal Kidney Disease-An Unmet Medical Need Equally Ameliorated by Topical Imiquimod Cream and Lapacho Tea Wraps: A Case Report.

IntroductionDevelopment of singular keratoacanthoma (KA) is generally considered a benign condition as it has a tendency to regress spontaneously in spite of histological similarity to squamous cell carcinoma. Most KAs undergo excision to rule out differential diagnoses. Several alternative treatment modalities (keratinolytic, ablative, immunomodulating, antiproliferative, or targeted therapy) have been described in the past with varying success, underlining the therapeutic challenges associated with large or multiple lesions. Isomorphic response (Koebner phenomenon) may limit the efficacy of

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… The Witten–Zak familial type of multiple KA on the other hand is often found in association with prurigo simplex subacuta [ 6 ]. Chronic prurigo may provoke the localized sporadic form typically found on the lower extremities. Some cases of pruritic multiple KA are difficult to classify, though. … Given the pruritic nature of GEKA, a therapeutic attempt with cyclosporine alone or in combination might be justified based on experiences of the treatment of chronic prurigo and prurigo-associated sporadic localized type of multiple KA [ 26 ]. …

The clinical effectiveness and safety of traditional Chinese medicine uremic clearance granule combined with high-flux hemodialysis in the treatment of uremic pruritus: A protocol for systematic review and meta analysis.

BackgroundSkin pruritus is a common complication in patients with uremia. When the hemodialysis time of patients is extended, and the probability of skin pruritus is greater. Patients often have the symptoms of skin pruritus intolerable, affecting the normal sleep and normal life of patients. The patients with uremic pruritus often constant scratching and pruritus skin, resulting in broken skin, and further symptoms such as infection, and subsequent skin shedding, prurigo nodularis, and other adverse complications, aggravating the patient's condition. Some patients will experience symptoms suc…

Dermatological manifestations of hematologic neoplasms. Part II: nonspecific skin lesions/paraneoplastic diseases.

Cutaneous manifestations occur in the course of hematologic malignancies and precede, accompany or occur late in relation to the diagnosis. They result from paraneoplastic phenomena, tumor infiltrations, immunosuppression resulting from the hematologic disease itself or its treatment. The dermatologist must be aware of these conditions that may be helpful both in the diagnosis of the underlying disease and in reducing patient morbidity. This review (part II) addresses the paraneoplastic dermatological changes associated with systemic hematologic malignancies.

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… Chronic prurigo as a onset of Hodgkin’s lymphoma. Med Clín. 2021;156:47. doi: 10.1016/j.medcli.2019.10.004. 43. Dumont S., Péchère M., Toutous Trellu L. Chronic prurigo: an unusual presentation of Hodgkin lymphoma. Case Rep Dermatol. 2018;10:122–126. doi: 10.1159/000489161. 44. … Hodgkin’s disease manifesting as prurigo nodularis. Pediatr Dermatol. 1990;7:136–139. doi: 10.1111/j.1525-1470.1990.tb00670.x. 45. Schweda K., Hainz M., Loquai C., Grabbe S., Saloga J., Tuettenberg A. …

Chronic pruritus: a narrative review.

Chronic pruritus encompasses a manifestation of several cutaneous, allergic, infectious, neurological, psychological, and systemic conditions, whose etiological investigation and therapeutic strategy can be challenging. This comprehensive review aims to enhance the understanding of pruritus by highlighting important elements in its pathogenesis, including keratinocytes, Merkel cells and mast cells, nerve fibers, histaminergic and nonhistaminergic pathways, and the interaction of itch signals with the central nervous system. Diagnostic evaluation of chronic pruritus may require a meticulous app

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… Lesional (altered) skin (CPL), where an underlying skin disorder is present; (ii) Chronic Pruritus on Primarily Non-Lesional (unchanged) skin (CPNL), where there are no initial skin lesions (formerly known as pruritus sine materia); and (iii) Chronic pruritus with severe scratching lesions (e.g., chronic prurigo … potentially contributing to the pruritic phenotype associated with this condition. 20 Merkel cells These cells trigger the pruritus-scratch cycle after stimulation by the Piezzo receptor-2. 19 The complex formed by Merkel cells and pruriceptive MRGPRA3+ endings (C fibers) in cases of xerosis and prurigo …

"Look Beyond the Skin": A case report about chronic pruritus.

A healthy 23-year-old female developed generalized pruritus over a year that began on her feet and gradually progressed to involve more than 50% of her entire body surface area. Punch skin biopsies were inconclusive, whereas a two-view chest x-ray was suspicious for lymphadenopathy. A chest computed tomography scan with contrast identified an anterior mediastinal mass which was biopsied and diagnosed as a nodular sclerosis type of Hodgkin's lymphoma. Subsequently, appropriate therapy was initiated resulting in complete resolution of the patient's chronic itch. This case underscores the clinica

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… Punch biopsies obtained from the right dorsal forearm and right buttock showed erosion, prurigo nodule-like changes, and healing skin response ( Figure 2 ). … Prurigo papule. Superficial epidermal erosion with serum crusting, epithelial hyperplasia and reactive dermal inflammation and fibrosis (H&E, original magnification 40×) Figure 3. …

Eosinophilic Dermatosis of Hematological Malignancy.

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… The clinical differential diagnosis includes arthropod bite, dermatitis herpetiformis, drug reaction, eosinophilic cellulitis, eosinophilic folliculitis, leukemia cutis, papular urticaria, scabies, and urticarial stage of bullous pemphigoid.[ 2 ] Atopic dermatitis may present as prurigo or prurigo-like …

A Case of Dominant Dystrophic Epidermolysis Bullosa with a G2043R Mutation in the Type VII Collagen Gene.

Dear Editor, Dystrophic epidermolysis bullosa (DEB) is a subepidermal bulla, characterized by severe itching, lichenoid or nodular prurigo-like lesions, skin erosion, scars, milia, and nail dystrophy, resulting from COL7A1 mutation. Herein, we report a case of dominant DEB with a G2043R mutation in COL7A1. A-25-year-old Japanese woman was referred to our clinic for recurrent intense pruritis and hypertrophic scars on the abdomen (Figure 1, a). She presented with paper-like scars on her forehead, breast, back, buttock, and extremities (Figure 1, b) with mild toenail hypoplasia (Figure 1, c), bu…

[Pruritus and the hepatitis C virus. The MULTIVIRC Unit].

OBJECTIVE: Determine the characteristics of pruritus in a selected population of patients with positive hepatitis C virus serology. PATIENT … USSION: Pruritus in our patient population was generally associated with non-specific excoriations, prurigo or xerosis in 19 cases (70 p. 100). As only ambulatory patients were retained for analysis, this is not a comprehensive population and the percentage of non-specific pruritus, evaluated at 1.8 p. 100, is probably an underestimation. Cholestasis cann …

Obstetrical and fetal outcomes of a new management strategy in patients with intra-hepatic cholestasis of pregnancy.

PURPOSES: To determine the incidence, obstetrical, and fetal complication rates of intrahepatic cholestasis of pregnancy (ICP) in patients managed expectantly to 40-weeks gestation. METHODS: In a prospective cohort study conducted between February 2008 and January 2010, a total of 21,960 pregnant women in Qassim Region of Saudi Arabia were screened for ICP using specific criteria for diagnosis. The course of pregnancy was monitored to 40-weeks gestation or spontaneous onset of labor, whichever comes first. The measured outcomes were compared with a cross-matched group of healthy pregnant wome

Efficacy and safety of dupilumab in a patient with metastatic clear cell renal cell carcinoma.

This case report evaluated the efficacy and safety of dupilumab, a monoclonal antibody targeting interleukin-4 and interleukin-13, in a patient with atopic dermatitis (AD) and a history of metastatic renal cancer. Over 20 months of follow-up, the patient experienced significant improvement in AD symptoms without any recurrence of cancer. In addition to not stimulating carcinogenesis, dupilumab might synergistically inhibit tumor-induced immunosuppression, thereby potentially preventing tumor progression. This case suggests that dupilumab could be a viable treatment option for patients with AD

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… unknown scale Stable 175 days – Lukac et al. 2022 71 Bulous pemphigoid Metastatic melanoma After Tacrolimus Unknown Clearance Stable 229 days – Lukac et al. 2022 79 Chronic kidney disease Metastatic kidney cancer After Prednisone Unknown Improvement but unknown scale Stable 68 days – Lukac et al. 2022 73 Prurigo … | Bulous pemphigoid | Metastatic melanoma | After | Tacrolimus | Unknown | Clearance | Stable | 229 days | – Lukac et al. | 2022 | 79 | Chronic kidney disease | Metastatic kidney cancer | After | Prednisone | Unknown | Improvement but unknown scale | Stable | 68 days | – Lukac et al. | 2022 | 73 | Prurigo …

Fc Epsilon RI-Neuroimmune Interplay in Pruritus Triggered by Particulate Matter in Atopic Dermatitis Patients.

Atopic dermatitis (AD) is the most common chronic relapsing neuroinflammatory skin disease that is characterized by a complex and multifactorial pathophysiology. It reflects a profound interplay between genetic and environmental factors, and a recently disclosed neuroimmune dysregulation that drives skin barrier disruption, pruritus, and microbial imbalance. In terms of the key external environmental players that impact AD, air quality and itch severity linkage have been thoroughly researched. The impact of ambient air pollutants including particulate matter (PM) and AD pruritic exacerbation h

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… This feed-forward mechanism probably also contributes to epidermal thickening and maybe fibrotic changes, as seen in prurigo lesions. In addition, substance P and its receptors, neurokinin-1, TRPV2, TRPA1, PAR2 and PAR4 are overexpressed in pruritic skin lesions [ 4 ]. 6. … Which cytokines are critical in which AD patient, and whether we can stratify each patient to an optimal personalized therapy, still needs to be clarified for AD or prurigo. Research has recently indicated that the FcεRI signaling pathway is highly associated with itch in atopic skin diseases. …

Autoimmune Progesterone Dermatitis Diagnosed by Lymphocyte Transformation Test and Progesterone Provocation Test.

Autoimmune progesterone dermatitis (APD) is rare autoimmune response to endogenous progesterone or to earlier exposure to exogenous progeste … menstrual flares. The typical symptoms of APD are skin lesions such as eczema, erythema multiforme, prurigo, stomatitis, papulopustular lesions, folliculitis, urticaria, angioedema, and rarely anaphylaxis (2) that develop 3-10 days before and subside 1-2 days after menses, with recurrent cyclic aggravation (1,3,4). Frequently, patients have a history of e …

Management of Itch in the Elderly: A Review.

Chronic itch is common in the elderly patient and may be caused by a variety of known dermatologic and non-dermatologic conditions and can have a significant effect on quality of life. Age-related changes in barrier function, immunosenescence, and neuronal changes and neuropathies are common predisposing factors to chronic itch in this age group. Certain primary dermatologic conditions are more common in the elderly and can cause chronic itch. Also, co-morbid diseases particularly of the renal, hepatobiliary, or hematologic systems, psychologic conditions, or medications may contribute to chro

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… Stander S Kwon P Hirman J Serlopitant reduced pruritus in patients with prurigo nodularis in a phase 2, randomized, placebo-controlled trial J Am Acad Dermatol 2019 80 5 1395 1402 10.1016/j.jaad.2019.01.052 30894279 117. … Nakamura M Koo JY Phototherapy for the treatment of prurigo nodularis: a review Dermatol Online J 2016 22 13030 27617458 120. …

Skin manifestations associated with systemic diseases - Part II.

The skin, by reflecting internal processes, externalizes what happens inside the body in many diseases. Thus, the skin, as an organ, extrapolates its functions of protection, barrier and signals the existence of systemic diseases, expanding the importance of the dermatologist beyond the skin surface. Thus, the dermatologist investigates diagnostic hypotheses for conditions related to all systems and refers patients to the appropriate specialty. Combined with examination by a trained eye, the skin, due to its easy access, is still the ideal place for performing biopsies, which often clarify the

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… The lesions comprise intensely pruritic hyperchromic nodules or papules, with umbilication and hyperkeratosis at the top of the lesion, located on the extensor surfaces of the extremities, and have a differential diagnosis with prurigo nodularis. … Renal (dialytic patients, in particular): very intense, worsens at night, may progress to nodular prurigo, Kyrle’s disease. The most affected area is the back (butterfly sign – the central area is spared), followed by the arms, head and abdomen. …

Adult onset atopic dermatitis with secondary follicular mucinosis with cyclosporine induced spiny follicular hyperkeratosis and hair casts.

Secondary follicular mucinosis developing in adult patient with atopic dermatitis (AD) was observed on histology. Due to severity of disease, patient was started on oral cyclosporine 300 mg daily in 3 divided doses. Two weeks later patient started developing multiple spiny follicular keratoses mainly on face but also on extremities and trunk along with hair casts on scalp. Repeat biopsy from such keratotic lesions confirmed diagnosis spiny follicular hyperkeratosis (SFH). On investigations no evidence of multiple myeloma or any other malignancy was found. Cyclosporine was stopped and lesions c

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… (b) Multiple excoriated prurigo nodularis like lesions over leg Figure 2 (a) Skin biopsy from forearm plaque showing hyperkeratosis, epidermal hyperplasia with features of chronic eczematous dermatitis. Additionally some follicles studded with mucin are also seen. (H and E, ×40). …

Porokeratoses-A Comprehensive Review on the Genetics and Metabolomics, Imaging Methods and Management of Common Clinical Variants.

Porokeratosis is a heterogeneous group of keratinising disorders characterised by the presence of particular microscopic structural changes, namely the presence of the cornoid lamella. This structure develops as a consequence of a defective isoprenoid pathway, critical for cholesterol synthesis. Commonly recognised variants include disseminated superficial actinic porokeratosis, disseminated superficial porokeratosis, porokeratosis of Mibelli, palmoplantar porokeratosis (including porokeratosis palmaris et plantaris disseminata and punctate porokeratosis), linear porokeratosis, verrucous porok

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… Rarely, DSAP develops bullous [ 28 ] or prurigo nodularis-like forms [ 29 ]. … For the pruriginous nature of EDP, such coexistence with prurigo nodularis should always be considered. Nevertheless, the presence of a hyperkeratotic rim should be of aid in distinguishing DSP from prurigo nodularis (background hyperpigmentation and white radial lines) [ 240 ]. …