Evaluation and management of a patient with chronic pruritus

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Presentation transcript:

Evaluation and management of a patient with chronic pruritus Martin Steinhoff, MD, PhD, Ferda Cevikbas, PhD, Iwei Yeh, MD, Kim Chong, MD, Jörg Buddenkotte, PhD, Akihiko Ikoma, MD, PhD Journal of Allergy and Clinical Immunology Volume 130, Issue 4, Pages 1015-1016.e7 (October 2012) DOI: 10.1016/j.jaci.2012.08.006 Copyright © 2012 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E1 Clinical appearance of a 53-year-old woman with generalized pruritus. A, Eczematous skin lesions on the patient's arm with a clinical appearance typical of atopic dermatitis (left) and multiple papules with erosions on her leg (right, arrows). B, Severely pruritic nodules developed on her legs 1 year later. Journal of Allergy and Clinical Immunology 2012 130, 1015-1016.e7DOI: (10.1016/j.jaci.2012.08.006) Copyright © 2012 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E2 Histology (hematoxylin and eosin staining) of skin specimens from papular/nodular skin lesions of the patient's leg. A, Histology from a papular lesion at the initial visit. Irregular parakeratosis, acanthosis, and spongiosis in the epidermis and lymphomonocytic infiltrate and prominent intravascular eosinophils (arrows) in the upper dermis are shown. B, Histology from a prurigo nodularis lesion in the second visit a year later. Thick hyperkeratosis, parakeratosis, acanthosis, and an inflammatory cell infiltrate, as well as a lymphomonocytic infiltrate, vasodilatation, and prominent intravascular eosinophils (arrows) in the upper dermis, are shown. Journal of Allergy and Clinical Immunology 2012 130, 1015-1016.e7DOI: (10.1016/j.jaci.2012.08.006) Copyright © 2012 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E3 Potential causes of chronic pruritus. A, Skin disease causing chronic pruritis. B, Systemic and other noncutaneous diseases causing chronic pruritis. ACE, Angiotensin-converting enzyme; PPPP, puritic papules and pustules of pregnancy. Modified from Hong et al.E6 Journal of Allergy and Clinical Immunology 2012 130, 1015-1016.e7DOI: (10.1016/j.jaci.2012.08.006) Copyright © 2012 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E4 Diagnostic algorithm to determine the origins of chronic pruritus. ALT, Alanine aminotransferase; AP, alkaline phosphatase; AST, aspartate aminotransferase; BUN, blood urea nitrogen; DIF, direct immunofluorescence; GI, gastrointestinal. Modified from Steinhoff et al.E7 Journal of Allergy and Clinical Immunology 2012 130, 1015-1016.e7DOI: (10.1016/j.jaci.2012.08.006) Copyright © 2012 American Academy of Allergy, Asthma & Immunology Terms and Conditions