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BACKGROUND: Prurigo nodularis (PN) is a chronic inflammatory skin condition that has a significant unmet needs for effective treatment options. OBJECTIVE: To assess the efficacy and safety of dupilumab in adult patients with PN refractory to traditional therapies. METHODS: This ongoing, real-life study examined dupilumab treatment in 8 adult patients diagnosed with PN for at least 6 months. The included patients were prescribed 300 mg dupilumab biweekly for at least 16 weeks. Efficacy was the primary outcome by means of multiple standardized scale measurements while safety was also reported. RESULTS: PN patients treated with dupilumab showed notable clinical improvement. After 16 weeks of dupilumab treatment, the mean Investigator Global Assessment (IGA) score reduced from 3.75 to 1.50. Patients mean Numerical Rating Scale Itch Intensity (NRSI), Dermatology Life Quality Index (DLQI), and Hospital Anxiety and Depression Scale (HADS) ratings reduced from 8.625, 15.13, and 14.50 to 1.563, 4.625, and 1.000 respectively. The majority of the patients (87.5%) reported dupilumab as effective while no adverse events have been reported. STUDY LIMITATIONS: This study was limited to a small cohort of adult PN patients and a short-time observation period. CONCLUSIONS: Dupilumab is effective and tolerable in adult PN patients with significant improvement in skin lesions, itching, and quality of life.

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Abstract Background: Lichen simplex chronicus is a dermatological condition due to excessive scratching, with few studies on psychoneuroimmunology. Objective: We aimed to estimate the levels of stress, depression, and anxiety, and to measure serum levels of neurotrophins in patients with lichen simplex chronicus, and to correlate these parameters with the severity of the disease and pruritus. Methods: Thirty-six patients with lichen simplex chronicus and 36 age- and sex-matched healthy controls were included. Each participant was administered the Hospital Anxiety and Depression Scale and Perceived Stress Scale questionnaires, along with a visual analog scale for pruritus. Levels of neurotrophins (brain-derived neurotrophic factor, neurotrophin-3, nerve growth factor, glial cell line-derived neurotrophic factor) were determined by ELISA assays. Results: The scores of Perceived Stress Scale-10, Hospital Anxiety and Depression Scale were statistically higher in patients (p < 0.05 for all). The serum levels of all neurotrophins were significantly lower in patients compared to healthy controls (p < 0.05 for all). Disease severity showed no correlation with all four neurotrophins. In linear regression models applied for increased visual analog scale-pruritus scores and disease severity these two variables were statistically significant predictors (p = 0.043). Study limitations: A direct causal relationship was not addressed. Conclusion: Lichen simplex chronicus patients are at risk of increased levels of stress, anxiety, depression, and present decreased levels of neurotrophins, that may suggest a role in the pathophysiology of this disorder.

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BACKGROUND: Lichen simplex chronicus is a dermatological condition due to excessive scratching, with few studies on psychoneuroimmunology. OBJECTIVE: We aimed to estimate the levels of stress, depression, and anxiety, and to measure serum levels of neurotrophins in patients with lichen simplex chronicus, and to correlate these parameters with the severity of the disease and pruritus. METHODS: Thirty-six patients with lichen simplex chronicus and 36 age- and sex-matched healthy controls were included. Each participant was administered the Hospital Anxiety and Depression Scale and Perceived Stress Scale questionnaires, along with a visual analog scale for pruritus. Levels of neurotrophins (brain-derived neurotrophic factor, neurotrophin-3, nerve growth factor, glial cell line-derived neurotrophic factor) were determined by ELISA assays. RESULTS: The scores of Perceived Stress Scale-10, Hospital Anxiety and Depression Scale were statistically higher in patients (p < 0.05 for all). The serum levels of all neurotrophins were significantly lower in patients compared to healthy controls (p < 0.05 for all). Disease severity showed no correlation with all four neurotrophins. In linear regression models applied for increased visual analog scale-pruritus scores and disease severity these two variables were statistically significant predictors (p = 0.043). STUDY LIMITATIONS: A direct causal relationship was not addressed. CONCLUSION: Lichen simplex chronicus patients are at risk of increased levels of stress, anxiety, depression, and present decreased levels of neurotrophins, that may suggest a role in the pathophysiology of this disorder.

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Lichen simplex chronicus is a skin disease that mostly affects female patients, with a peak incidence between ages 35 and 50 years. On the scalp, it appears as a single or multiple oval lesions, showing scaling and hair shaft loss or breakage. An important dermoscopic feature of the disease are the "broom fibers." Histopathology reveals the "hamburger" and the "gear wheel" signs. The aim of this report is to demonstrate a case of lichen simplex chronicus on the scalp with typical and exuberant clinical, dermoscopic, and histopathological findings.

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Abstract: Lichen simplex chronicus is a skin disease that mostly affects female patients, with a peak incidence between ages 35 and 50 years. On the scalp, it appears as a single or multiple oval lesions, showing scaling and hair shaft loss or breakage. An important dermoscopic feature of the disease are the "broom fibers." Histopathology reveals the "hamburger" and the "gear wheel" signs. The aim of this report is to demonstrate a case of lichen simplex chronicus on the scalp with typical and exuberant clinical, dermoscopic, and histopathological findings.

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This is a cross-sectional study, conducted from May to November/2014, in a dermatology reference unit, through review of medical records and interviews. In a sample of 49 patients with brachioradial pruritus, we observed higher prevalence of Caucasian (81.6%) and women (73.5 %), with a mean age of 56.1 years. Pruritus occurred in the topography of brachioradialis muscle in 87.8% of cases; 59.2% of the sample reported worsening of pruritus with sun exposure; the mean intensity of this symptom before treatment was 8.63. Therapy effectiveness was described as "very good/good" in 79.2% of cases, and for 55.3% relapses were categorized as "uncommon".

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The skin has the distinction of being the largest, visible and accessible part of the human body, and it hides a close and old relationship with the human psyche, and so has been demonstrated in the last years, where more elements of the Mental Health are elucidated playing a role in the pathogenesis of skin diseases, as well as there are some descriptions of the inverse relationship, this is, on how the skin diseases affect Mental Health of the individual. In this paper we propose to emphasize the importance of the issue, to consider a comprehensive approach to everyday Dermatology in Primary Care Medicine.

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Vulvar pruritus can be caused by a wide spectrum of diseases, that depend on age, environmental and genetic factors. The most common causes are candidiasis, contact dermatitis and lichen simplex chronicus. Candidiasis is the most common cause of acute vulvar pruritus and is characterized by burning, itching and vaginal whitish secretion. Contact dermatitis is caused by irritants or allergens that are in contact with the genital area, which causes imbalance in the skin barrier causing irritation, swelling, burning, among other manifestations. Lichen simplex chronicus is characterized by lichenification (thickening of the skin) secondary to the chronic itch-scratch cycle in vulvar area. It is an illnes with a tendency to chronicity, but with topical corticosteroids treatment usually might be controlled. Prompt treatment, multidisciplinary and careful attention to irritants and secondary infections prevent these entities become an important and permanent problem.

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Se describe el caso clínico de un infante de 2 años de edad, producto de un parto distócico por cesárea a las 40 semanas, debido a una desproporción cefalopélvica, alimentado con lactancia materna exclusiva hasta los 6 meses de vida, quien fue llevado a consulta por presentar prurito persistente, más exacerbado en las noches y lesiones eritematopapulosas en los pliegues de codos y rodillas, así como en el axilar izquierdo. Según los resultados de los exámenes complementarios, los niveles de inmunoglobulinas E estaban elevados, por lo cual fue medicado con antihistamínicos, esteroides en ciclos cortos (vías tópica y oral), factor de transferencia e inmunomoduladores tópicos; también se le ofrecieron orientaciones higienoambientales y dietéticas. Después de 2 meses de tratamiento mejoró ostensiblemente el cuadro clínico y se mantuvo en seguimiento por su área de salud(AU)

The case report of a 2-year-old child born of a dystocia cesarian section at 40 weeks due to a cephalopelvic disproportion is described, who was exclusively breastfed until 6 months of age and taken to the clinic because of persistent itching, which was exacerbated at night, and erythematous papulous lesions in elbow and knee folds, as well as in the left axilla. According to the results of complementary tests there were high levels of immunoglobulin E, so that he received antihistamines, short-course steroids (topical and oral routes), transfer factor and topical immunomodulators; hygienic, environmental and dietetic guidances were also given. After 2 months of treatment the clinical pattern improved significantly and he was monitored in the health area(AU)

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Los prurigos constituyen un grupo heterogéneo de trastornos,de etiología dudosa o desconocida, caracterizados por pruritoacentuado, como síntoma subjetivo principal, y una erupción crónica o recurrente de tipo papulonodular, como síntomaobjetivo. Se dividen en agudos y crónicos, y las formas agudasson las más frecuentes en la infancia.Presentamos el caso de un niño con prurigo nodular, la variedadcrónica de los prurigos, de aparición bilateral y simétricaen ambas regiones axilares

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La alta incidencia de cuadros de vulvovaginitis asociadas a dermatitis de contacto de liquen simple crónico nos motiva a revisar en este artículo las pautas para el diagnóstico y manejo de estas entidades. Dentro del ámbito del diagnóstico diferencial, se menciona dos entidades menos frecuentas –liquen escleroso y atrófico y liquen plano–, destacando las consecuencuas devastadoras que pueden surgir de no realizar un diagnóstico temprano y manejo adecuado de estas patologías.

The high incidence of vulvovaginitis associated to contact dermatitis and chronic simple lichen motivated us to review these topics in this article. Guidelines for diagnosis and therapy are propossed for vulvovaginitis associated to dermatosis. Within the scope of differential diagnosis two less frequent diseases are mentioned –lichen escleroatrophicus and liches planus–, emphasizing the devasting consequences that can arise by not doing an early diagnosis and therapy.

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Presentamos un caso de liquen simple crónico vulvar izquierdo, en una paciente con diagnóstico psiquiátrico de trastorno bipolar, tratado repetidamente como micosis. Se realizó biopsia que confirmó el diagnóstico y se trató exitosamente con antihistamínicos orales y corticoides tópicos.

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La terapia con PUVA tópica se ha usado desde la década de los 70 (1) en los países escandinavos y estados unidos, como una alternativa para disminuir los efectos adversos sistémicos de la terapia con PUVA oral, manteniendo la eficacia clínica. Los baños de PUVA son una excelente forma de PUVA tópica que permite una distribución homogénea del psoraleno, prácticamente sin exposición sistémica (2). Se ha usado en dermatosis tan variadas como la psoriasis, el liquen plano, el granuloma anular (3), el eccema crónico (4), el eccema atópico (5), la micosis fungoide, etc. Presentamos dos pacientes con eccema crónico refractario a tratamientos habituales que respondieron satisfactoriamente a los baños de PUVA

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Se presenta el tratamiento de un caso con neurodermatitis congénita, de una profesional psicóloga de 30 años, quien no podía controlar su conducta de rascarse, produciéndose permanentemente escoriaciones en su piel. Se aplicó el entrenamiento autógeno de Schultz, abreviado en ocho, registrándose los valores electromiográficos, a nivel frontal, y la temperatura de ambas manos, durante la práctica del procedimiento. Los resultados del tratamiento fueron exitosos en lo inmediato, con posterioridad a dicho tratamiento y a los tres meses de seguimiento. El éxito se operacionalizó en términos de lograr controlar la conducta de rascarse y posibilitar la cicatrización de las escoriaciones (AU)

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Se presenta el tratamiento de un caso con neurodermatitis congénita, de una profesional psicóloga de 30 años, quien no podía controlar su conducta de rascarse, produciéndose permanentemente escoriaciones en su piel. Se aplicó el entrenamiento autógeno de Schultz, abreviado en ocho, registrándose los valores electromiográficos, a nivel frontal, y la temperatura de ambas manos, durante la práctica del procedimiento. Los resultados del tratamiento fueron exitosos en lo inmediato, con posterioridad a dicho tratamiento y a los tres meses de seguimiento. El éxito se operacionalizó en términos de lograr controlar la conducta de rascarse y posibilitar la cicatrización de las escoriaciones

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La liquenificación gigante de Pautrier es una forma rara y exhuberente de liquen simple crónico que resulta del rascado intenso de zonas intertriginosas tales como genitales, ingles y axilas. Presentamos un caso de esta rara afección en el que las lesiones aparecían ulceradas haciendo de esta manera difícil el diagnóstico (AU)

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