건선과 소양증

최지호 ( Jee Ho Choi ) 한국피부장벽학회 2009 한국피부장벽학회지 Vol.11 No.2

Pruritus is much more commonly complained in psoriatic patients than generally expected and the significance of this complaint has often been overlooked by dermatologists. The clinical features and cause of pruritus in psoriasis are not well known. This lecture is aimed to review the prevalence and related clinical characteristics of pruritus in Korean psoriatic patients and the expression of pruritogenic factors in psoriatic lesions with or without pruritus. Questionnaire data from 152 psoriatic patients were analyzed and psoriasis severity was determined by PASI score evaluation. 112 of 152 (73.7%) psoriatic patients suffered from pruritus. The severity and extent of psoriasis in pruritic patients were significantly higher as compared to non-pruritic patients. Important factors to exacerbate pruritus were emotional stress, hot bath, sweating, and so on. There was no correlation between pruritus and sex, age, duration of disease, family history of psoriasis, smoking, and alcohol habits. The pruritus significantly affected quality of life of psoriatic patients. A skin biopsy was obtained from 10 psoriatic patients with pruritus, 10 psoriatic patients without pruritus and 10 normal controls. Immunofluorescence stainings and confocal laser scanning microscopy were performed. Keratinocytes in the psoriatic plaques of patients with pruritus showed consistently increased expression of substance P receptor (SPR), high-affinity nerve growth factor receptor (TrkA) and calcitonin gene-related peptide receptor (CGRPR). In conclusions, pruritus is a common feature in psoriasis. Considering the well-known roles of neuropeptides in pathogenesis of both psoriasis and pruritus, increased SPR, TrkA and CGRPR may be involved in the pathogenesis of pruritus in psoriasis and in the severity of psoriasis. The attempt to relieve symptom of pruritus may improve the overall quality of life of patients with psoriasis and the psoriatic lesion.

Characteristics of pruritus according to clinical phenotypes of psoriasis and its association with inflammatory mediators

( Sung Min Park ),( Jeong Min Kim ),( Gun Wook Kim ),( Margaret Song ),( Hoon Soo Kim ),( Hyun Chang Ko ),( Moon Bum Kim ),( Byung Soo Kim ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.2

Background: Pruritus is common in psoriasis, but the pathogenesis of pruritus in psoriasis remains unclear. Moreover, reliable information on the characteristics of pruritus according to psoriasis clinical phenotypes is lacking. Objectives: To investigate the clinical characteristics of pruritus according to clinical phenotypes of psoriasis and to determine its association with inflammatory mediators related to pruritus.Methods: Clinical data on pruritus were collected by questionnaire including Leuvin itch scale. Quantitative measurement of serum neuropeptides and cytokines including substance P (SP), histamine, vasoactive intestinal peptide (VIP), neuropeptide Y (NPY), calcitonin gene related peptide (CGRP) and interleukin-31 (IL-31) were analyzed. Results: Eighty-four patients with psoriasis (56 men, 28 women; mean age, 48.1 years) were divided into two groups according to clinical phenotype: chronic stable and eruptive inflammatory. There was no significant difference of pruritus intensity, psoriasis area severity index, and serum level of SP, histamine, VIP, NPY, CGRP, IL-31 between two groups. Serum SP level was significantly higher in patients with pruritus compared with patients without pruritus and normal controls. Conclusion: Substance P may play a role in pruritus of psoriasis as a systemic factor. However, characteristics of pruritus, serum neuropeptides related to pruritus did not differ according to clinical phenotype of psoriasis.

혈액투석 환자의 요독성 가려움증에 관한 연구

심현수 ( Hyun Soo Sim ),서종근 ( Jong Keun Seo ),이숙경 ( Sook Kyung Lee ) 대한피부과학회 2009 대한피부과학회지 Vol.47 No.10

Background: Uremic pruritus is a common disabling problem in patients with end-stage renal disease (ESRD). Not many studies have focused on evaluating the clinical characteristics of uremic pruritus. Objective: The aim of this study was to identify the prevalence and clinical characteristics of uremic pruritus in hemodialysis patients. Methods: A detailed questionnaire was used to evaluate the pruritus of 75 patients who were treated at the hemodialysis unit in Maryknoll Medical Center. We examined the relationship of the quality of dialysis and various factors and medical parameters with uremic pruritus. Results: Pruritus was a common symptom in the study population. Twenty two point seven percent of the patients had severe pruritus in the past, and 36% were affected by it at the time of the study. There was no correlation between the occurrence of pruritus and the demographic or medical parameters of the patients (gender, age, the cause of ESRD, the duration of ESRD and hemodialysis, previous treatment of ESRD, the dialysis efficacy as expressed by Kt/V, and the transfusion and laboratory parameters such as blood urea nitrogen, creatinine, calcium, phosphorus, parathyroid hormone and uric acid). Skin dryness was found in 14 (18.7%) patients. It was assessed as slightly dry skin in 9 (12.0%) patients and as rough skin in 5 (6.7%) patients. A significant relationship was demonstrated between the intensity of xerosis and the frequency of uremic pruritus (p=0.042). The intensity of xerosis was greater in the severe pruritic patients, but any statistically significant correlation was not found. The major factors found to exacerbate pruritus included sleep disturbance, heat, dry skin and dialysis. The major factors found to reduce pruritus included taking a shower or bath, sleeping, dialysis and physical activity. Conclusion: There was a significant relationship between the intensity of xerosis and the frequency of uremic pruritus. A better understanding of the clinical characteristics of uremic pruritus will afford clinicians the necessary elementary tools to discover its origin and the possible effective treatments. (Korean J Dermatol 2009;47(10):1127∼1134)

대상포진에 대한 임상적 연구: 대상포진에서 나타나는 가려움증의 임상적 특징을 중심으로

노태우 ( Tae Woo Noh ),박혜진 ( Hai Jin Park ),김성현 ( Seong Hyun Kim ),강유석 ( Yoo Seok Kang ),이운하 ( Un Ha Lee ),박현수 ( Hyun Su Park ) 대한피부과학회 2012 대한피부과학회지 Vol.50 No.7

Background: Herpes zoster is a common dermatologic disorder. However, there have been no reported studies of the characteristics of pruritus in herpes zoster in Korean literature. Objective: The purpose of this study is to investigate the epidemiological features and clinical characteristics of pruritus in herpes zoster. Methods: Retrospective study was performed by reviewing the medical records of 178 patients with herpes zoster. The analyses of age, gender, accompanying symptoms, dermatomal distribution, underlying disease, treatment and complication were performed. Results: The ratio of male to female patients was 2:3. The age distribution ranged from 1 to 87 years old. A total of 76.4% of the patients with herpes zoster experienced pruritus, and 18.4% of the patient with pruritus had pruritus that disrupted normal activities. There were no relationships between the incidence of pruritus and age of patients, gender, dermatomal distribution, and incidence of pain. As the severity of pain increased, the incidence and the severity of pruritus increased (p=0.01, p=0.01). Pruritus was improved within 3 weeks in the 74.3% of the patients with pruritus; however, 9.6% of the patients felt complaint with pruritus over 6 weeks. The duration of the pruritus extended with advancing age (p=0.01). As the severity of pruritus and pain increased, the duration of pruritus increased (p=0.025). Conclusion: Pruritus is a common symptom in herpes zoster, and this study describes the general aspects of pruritus in herpes zoster. Advancing age and the severity of the pruritus and the pain are possible risk factors of long-lasting pruritus. (Korean J Dermatol 2012;50(7):591∼598)

Comparison of uremic pruritus βetween patients undergoing hemodialysis and peritoneal dialysis

( Ji Won Min ),( Su Hyun Kim ),( Young Ok Kim ),( Dong Chan Jin ),( Ho Chul Song ),( Euy Jin Choi ),( Yong Lim Kim ),( Yon Su Kim ),( Shin Wook Kang ),( Nam Ho Kim ),( Chul Woo Yang ),( Yong Kyun Kim 대한신장학회 2016 Kidney Research and Clinical Practice Vol.35 No.2

Background: Uremic pruritus is a common, but unpleasant, complication of endstage renal disease. The uremic burden may differ between hemodialysis (HD) and peritoneal dialysis (PD) patients. This difference may also change the clinical characteristics of uremic pruritus between the 2 modalities. In this study, we investigated the uremic pruritus between patients on HD and PD. Methods: A total of 425 HD and 223 PD patients from the Clinical Research Center registry in Korea were included. Patients were assessed for pruritus intensity, scratching activity, pruritus distribution, and frequency of pruritus-related sleep disturbance using the visual analog scale and questionnaire. Results: The prevalence of uremic pruritus was higher in PD patients than that in HD patients (62.6% vs. 48.3%, P = 0.001). In the multivariable logistic analysis, PD treatment was significantly associated with the prevalence of uremic pruritus (odds ratio, 1.76; 95% confidence interval, 1.20e2.57, P = 0.004) after adjustment for clinical variables. The visual analog scale score, representing a subjective intensity of itchiness, was significantly higher in PD patients (PD 2.11 ± 2.32 vs. HD 1.65 ± 2.28, P = 0.013) compared with HD patients. The intensity of uremic pruritus was independently related with serum albumin levels (β = e0.143, P = 0.006) in HD patients and total weekly Kt/V (β = e0.176, P = 0.028) in PD patients. Conclusion: Our data demonstrate the difference in prevalence, intensity, and risk factors of uremic pruritus between HD and PD patients. These findings suggest that careful consideration for uremic pruritus might be needed in end-stage renal disease patients according to the dialysis modality.

FC 2-15 : Increased expression of three types of TRP channels, TRPA1, TRPV4 and TRPV3, in burn scars with postburn pruritus

( Yoon Seok Yang ),( Yun Sun Byun ),( Jin Hye Kim ),( Soo Ick Cho ),( Cheol Heon Lee ),( Chun Wook Park ),( Hye One Kim ) 대한피부과학회 2013 대한피부과학회 학술발표대회집 Vol.65 No.2

Background: Postburn pruritus is common distressing sequelae of burn wounds. Empirical antipruritic treatment often fails to show satisfactory outcome on postburn pruritus, as the mechanism of postburn pruritus has not been fully elucidated. TRP channels are a group of ion channels, and some of them involve various sensations such as pruritus, pain, hotness or coldness. Objectives: The aim of the study was to evaluate the manifestation of TRP channels in postburn pruritus. Methods: Fifty-one patients with or without pruritus were recruited. Burn scars were assessed using the scar assessment scales and also assessed by various non-invasive methods. The tissue samples were stained and scored separately in the epidermis and dermis. In addition, real time-PCR was performed to quantify mRNA expression of TRPV1, TPRV3, TRPV4 and TRPA1. Results: Thirty-three patients reported they had postburn pruritus, and 18 did not. In immunohistochemistry, TPRV3 was significantly more elevated in the epidermis, especially in the basal keratinocytes of the burn scars of postburn pruritus patients than in those without. The result of real time-PCR showed that mRNA of TRPA1 and TRPV4 was increased in itching burn scars compared to non-itching burn scars. Conclusion: This study showed that TRPV3 of basal keratinocytes and TRPA1 and TPRV4 could be related to postburn pruritus. These results may help determine a specific therapeutic approach for postburn pruritus.

Hot Topics : P6: Increased Activity of TRPV3 in Keratinocytes in Burn Scars with Postburn Pruritus

( Yong Se Cho ),( Sook Young Park ),( Yoon Seok Yang ),( Bo Young Chung ),( Chun Wook Park ),( Hye One Kim ) 한국피부장벽학회 2015 한국피부장벽학회지 Vol.17 No.2

Postburn pruritus is a common distressing consequence of burn wounds. Empirical antipruritic treatment often fails to have a satisfactory outcome on postburn pruritus, as the mechanism of postburn pruritus has not been fully elucidated. Our previous study had shown that expression of TRPV3 and TRPA1 were markedly increased in burn scars with postburn pruritus than those without it. The aim of this study was to evaluate the manifestation of TRPV3 and TRPA1 in postburn pruritus. Total 51 patients were divided into 2 groups: those with pruritus and those without it. Skin samples were obtained from 2 different sites (burn scars and normal skin). Keratinoocytes (KCs) and fibroblast from those samples were separated. Immunohistochemical staining for TRPV3 and TRPA1 and immunofluorescence staining for loricrin and involucrin were performed in burn scars and normal skin. And qPCR and western blotting of TRPV3, TRPA1, PAR2, NK1R, loricrin, involucrin, TGF beta and alpha SMA were done.. We also measured intracellular Ca(2+) levels following TRPV3 activation and blocking in KCs from scars with or without pruritus. As a result, Anti-TPRV3 was stained stronger in the epidermis of the burn scars of postburn pruritus patients than in those of non-pruritic burn patients. The mRNA and protein levels of TRPV3, PAR2 and NK1R were significantly increased in KCs from pruritic burn scars than in KCs from nonpruritic scars. With TRPV3 activation, intracellular Ca(2+) concentrations were significantly increased only in KCs from pruritic burn scars. We confirmed that TRPV3 of KCs contrubutes to the pathophysiology of postburn pruritus. These results may help determine a novel mechanism for postburn pruritus.

혈액투석 환자에서 요독가려움증의 유병율

신정호 외 중앙대학교 의과대학 의과학연구소 2011 中央醫大誌 Vol.36 No.1/2

Introduction: Uremic pruritus is a common disabling symptom and is associated with quality of life in patients with maintenance hemodialysis. The pathogenesis of uremic pruritus remains uncertain. In this study, we evaluated the prevalence and related factors of uremic pruritus. Materials and Methods: Ninety-three patients who were treated with maintenance hemodialysis for more than 3 months in our center were included and they were researched for clinical findings and possible related factors such as age, sex, dialysis duration, underlying disease and dialysis membrane. We also investigated about antihypertensive drugs, erythropoietin use, laboratory data and dialysis dose. Results: There were fourty-five patients who experienced with pruritus and fourty-eight patients who without pruritus. There were no significant difference between patients with pruritus and without pruritus about sex, dialysis duration, underlying disease, dialysis membrane, erythropoietin use, antihypertensive drugs, laboratory data and dialysis dose. The mean age was different between two groups; the mean age of patients with pruritus was 62.4±12.2 years and that without pruritus was 56.6±12.4 years (p =0.026). Conclusion: The prevalence of pruritus in our study was fourty eight percent, and older age was associated with increased incidence of uremic pruritus.

Increased activity of TRPV3 in keratinocytes in burn scars with postburn pruritus

( Yong Se Cho ),( Sook Young Park ),( Jee Hee Son ),( Yun Sun Byun ),( Yoon Seok Yang ),( Bo Young Chung ),( Hee Jin Cho ),( Chun Wook Park ),( Hye One Kim ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.2

Background: Postburn pruritus is a common distressing consequence of burn wounds. Empirical antipruritic treatment often fails to have a satisfactory outcome on postburn pruritus, as the mechanism of postburn pruritus has not been fully elucidated. Several studies show that TRPV3 are indeed key players in pruritus pathogenesis. Objectives: To evaluate the manifestation of TRPV3 in postburn pruritus. Methods: 51 patients were divided into 2 groups: those with pruritus and those without it. Skin samples were obtained from 2 different sites (burn scars and normal skin). Keratocytes (KC) and fibroblast (FB) from those samples were separated. Immunohistochemical staining for TRPV3 and RT-PCR was performed to measure mRNA expression of loricrin, involucrin and TRPV3 in KC. We also measured intracellular Ca2+ levels following TRPV3 activation in postburn pruritus. Results: Anti-TPRV3 was stained stronger in the epidermis of the burn scars of postburn pruritus patients than in those of non-pruritic burn patients. The result of RT-PCR showed that loricrin and TRPV3 in KC was increased in pruritic burn scars. In immunofluorescence, loricrin and involucrin were strongly stained in the epidermis of pruritic burn scars. After TRPV3 activation, intracellular Ca2+ concentrations were increased in KC from pruritic burn scar. Conclusion: We confirmed that TRPV3 of KC was contributed to occurrence of postburn pruritus. These results may help determine a novel mechanism for postburn pruritus.

Characteristics of Pruritus according to Morphological Phenotype of Psoriasis and Association with Neuropeptides and Interleukin-31

( Sung-min Park ),( Gun-wook Kim ),( Hoon-soo Kim ),( Hyun-chang Ko ),( Moon-bum Kim ),( Byung-soo Kim ) 대한피부과학회 2020 Annals of Dermatology Vol.32 No.1

Background: Pruritus is a common symptom in psoriasis. However, few studies have assessed the characteristics of pruritus according to morphological phenotypes of psoriasis. Objective: To investigate the characteristics of pruritus according to morphological phenotypes of psoriasis and to assess the association with inflammatory mediators related to pruritus. Methods: Psoriasis patients were divided into 2 groups according to clinical phenotype: eruptive inflammatory (EI) and chronic stable (CS). Clinical data of pruritus were assessed by an itch questionnaire. Serum neuropeptides and cytokines including substance P, histamine, vasoactive intestinal peptide, neuropeptide Y, calcitonin gene-related peptide and interleukin-31 (IL-31) were quantitatively measured. Results: In total, 50 patients with psoriasis (30 male, 20 female; mean age, 45.7 years) were studied (EI, n=15 and CS, n=35). Pruritus was reported by 80% of EI and CS patients. There were no significant differences in prevalence of pruritus, pruritus intensity, severity of psoriasis, serum neuropeptides, or IL-31 between the 2 groups. Conclusion: The morphological phenotype does not seem to be an important factor affecting the prevalence and characteristics of pruritus in psoriasis. (Ann Dermatol 32(1) 1∼7, 2020)