New articles from Acta Dermato-Venereologica Acta Dermato-Venereologica is an international peer-review journal for clinical and experimental research in the field of dermatology and venereology. 96:2 2016 - Current Problems in Dermatology, Vol. 48. Tattooed Skin and Health
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2015-08-04 Bookreview
96:2 2016 - Food Allergy: Molecular Basis and Clinical Practice
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2015-10-13 Bookreview
96:2 2016 - Dyskeratosis of the Face: A Quiz
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2015-09-10 Quiz
96:2 2016 - Alopecic Lesions on the Scalp in a Young Woman: A Quiz
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2015-09-01 Quiz
96:2 2016 - Dietary Regimes for Treatment of Acne Vulgaris: A Critical Review of Published Clinical Trials
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2015-10-05 Shortcom
96:2 2016 - Phacomatosis Melanorosea: A Further Case of an Unusual Skin Disorder
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2015-07-15 Shortcom
96:2 2016 - The Adult Phenotype of Tuberous Sclerosis Complex
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2015-09-22 Shortcom
96:2 2016 - Evaluation of Mononuclear Cells in Lichen Planus Pemphigoides
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2015-07-15 Shortcom
96:2 2016 - Acquired Port-wine Stain with Local Heat
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2015-08-18 Shortcom
96:2 2016 - Pigmented Dermatofibrosarcoma Protuberans and Blue Naevi with Similar Dermoscopy: A Case Report
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2015-08-20 Shortcom
96:2 2016 - Disseminated Favus Caused by Microsporum gypseum in a Patient with Systemic Lupus Erythematosus
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2015-09-14 Shortcom
96:2 2016 - Sclerosing Lipogranuloma with Multiple Skin Lesions and Pulmonary Involvement, Secondary to a Factitious Disorder
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2015-09-03 Shortcom
96:2 2016 - Lichen Planus Possibly Induced by Acyclovir in a Child
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2015-08-18 Shortcom
96:2 2016 - Acute Generalized Exanthematous Pustulosis Caused by Faropenem: A Possible Pathogenetic Role for Interleukin-23
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2015-09-01 Shortcom
96:2 2016 - Exceptional Association of Syringotropic Mycosis Fungoides with Chronic Lymphocytic Leukaemia
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2015-09-07 Shortcom
96:2 2016 - Paraneoplastic Autoimmune Multi-organ Syndrome: Association with Retroperitoneal Kaposi’s Sarcoma
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2015-07-09 Shortcom
96:2 2016 - Exacerbation of Psoriasis During Nivolumab Therapy for Metastatic Melanoma
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2015-09-03 Shortcom
96:2 2016 - Treatment of Skin Calcifications with Intra-lesional Injection of Sodium Thiosulphate: A Case Series
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2015-08-25 Shortcom
96:2 2016 - Zileuton for Pruritus in Sjögren-Larsson Syndrome: A Randomized Double-blind Placebo-controlled Crossover Trial
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2015-08-18 Shortcom
96:2 2016 - Improving Dermatological Care for Elderly People Living in Permanent Healthcare Institutions: Suggestions from Dutch Dermatologists
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2015-09-30 Shortcom
96:2 2016 - Down-titration of Adalimumab and Etanercept in Psoriatic Patients: A Multicentre Observational Study
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2015-09-23 Shortcom
96:2 2016 - Secondary Cutaneous Diffuse Large B-cell Lymphoma has a Higher International Prognostic Index Score and Worse Prognosis Than Diffuse Large B-cell Lymphoma, Leg Type
Diffuse large B-cell lymphoma (DLBCL) can be separated into 2 groups: nodal and extranodal disease. The aim of this study was to analyse the clinical features of skin lesions and survival outcomes of cutaneous DLBCL according to the primary tumour site. A total of 44 patients with cutaneous DLBCL were classified as primary cutaneous DLBCL, leg type or cutaneous DLBCL secondary to primary disease. Although skin lesion characteristics did not differ significantly between groups, extensive cutaneous lesions were more often observed in secondary cutaneous DLBCL compared with DLBCL, leg type. Secondary cutaneous DLBCL was more commonly associated with an advanced stage and higher International Prognostic Index score than DLBCL, leg type. DLBCL, leg type demonstrated a better survival outcome than secondary cutaneous DLBCL. The multiplicity of skin lesions and time-point of cutaneous involvement were associated with prognosis in secondary cutaneous DLBCL. Survival outcomes and prognostic factors differ depending on the primary tumour site of cutaneous DLBCL.]]>
2015-09-15 Clinical
96:2 2016 - Photodynamic Therapy for Actinic Keratoses: A Randomized Prospective Non-sponsored Cost-effectiveness Study of Daylight-mediated Treatment Compared with Light-emitting Diode Treatment
Daylight-mediated photodynamic therapy (DL-PDT) is considered as effective as conventional PDT using artificial light (light-emitting diode (LED)-PDT) for treatment of actinic keratoses (AK). This randomized prospective non-sponsored study assessed the cost-effectiveness of DL-PDT compared with LED-PDT. Seventy patients with 210 AKs were randomized to DL-PDT or LED-PDT groups. Effectiveness was assessed at 6 months. The costs included societal costs and private costs, including the time patients spent in treatment. Results are presented as incremental cost-effectiveness ratio (ICER). The total costs per patient were significantly lower for DL-PDT (€132) compared with LED-PDT (€170), giving a cost saving of €38 (p = 0.022). The estimated probabilities for patients’ complete response were 0.429 for DL-PDT and 0.686 for LED-PDT; a difference in probability of being healed of 0.257. ICER showed a monetary gain of €147 per unit of effectiveness lost. DL-PDT is less costly and less effective than LED-PDT. In terms of cost-effectiveness analysis, DL-PDT provides lower value for money compared with LED-PDT.]]>
2015-09-23 Clinical
96:2 2016 - Contact Allergy in Danish Healthcare Workers: A Retrospective Matched Case-control Study
Contact dermatitis in healthcare workers is a world wide problem. We conducted a retrospective observational study of the patch-test results of 1402 healthcare workers and 1402 matched controls with contact dermatitis who were treated at 3 hospitals departments in Denmark between 2007 and 2014. The primary objective was to determine whether healthcare work was associated with contact allergy to thiuram mix. Unadjusted univariate analyses revealed that healthcare work was significantly associated with occupational contact dermatitis and hand dermatitis. Contact allergy to thiuram mix was more common in healthcare workers was significantly associated with having occupational contact dermatitis, hand dermatitis and older age. In conclusion, we report here a potential problem of contact allergy to thiurams in healthcare workers with contact dermatitis. Legislative authorities may in the future focus on the use of rubber accelerators in, for example, protective gloves, which are widely used by healthcare professionals.]]>
2015-09-14 Clinical
96:2 2016 - Disability Pensions due to Skin Diseases: A Cohort Study in Swedish Construction Workers
Disability pensions due to skin diseases in Swedish male construction workers were studied by linking data from pension registers and an occupational health service. Incidence rates of disability pensions for cement workers, painters and plumbers were compared with 2 control groups. A total of 623 disability pensions were granted during 4 decades of follow-up. The main diagnoses were eczema (36%) and psoriasis (49%). Pensions were mostly granted in the age range 55–64 years. Among painters, cement workers and plumbers the incidence rates for disability pensions were 33.3, 24.5 and 20.4 cases/100,000 person-years, respectively, compared with 13.7 and 9.2 cases/100,000 person-years in control groups. Relative risks were highest for eczema, and were notable for psoriasis. Attributable fractions for eczema were 90% in cement workers and painters and 75% in plumbers compared with control groups. Attributable fractions for psoriasis in the occupational groups studied were in the range 54–67%. In conclusion, eczema and psoriasis have a high impact on loss of work ability, as reflected by disability pensions.]]>
2015-08-26 Clinical
96:2 2016 - Are Common Skin Diseases among Norwegian Dermatological Outpatients Associated with Psychological Problems Compared with Controls? An Observational Study
Dermatological disease has been shown to be associated with psychological comorbidity. The aim of this observational study is to describe the distribution of skin disease and the prevalence of depression, anxiety and stress among Norwegian dermatological outpatients. Thirteen percent of outpatients had clinical anxiety compared with 3.7% of healthy controls, and 5.8% had clinical depression compared with 0.9% of controls. Adjusted odds ratio for clinical anxiety was 4.53 in patients compared with controls, and for clinical depression 6.25, which is much higher than previously described in a larger European study. Patients with tumours had less depression. Chronic inflammatory skin conditions had an especially high impact on patient’s psychological wellbeing and should not be undervalued relative to, for instance, skin cancer in health strategies. These results argue strongly for including skin disease prevention and treatment in future health strategies.]]>
2015-09-03 Clinical
96:2 2016 - Disutility in Patients with Hidradenitis Suppurativa: A Cross-sectional Study Using EuroQoL-5D
Disutility reflects the disability caused by a disease. The EuroQoL-5D (EQ-5D) questionnaire is a measure of health-related overall utility. The questionnaire has only been applied previously to a small number of patients with hidradenitis. In this study a survey of 421 patients with hidradenitis suppurativa was conducted using the EQ-5D questionnaire. Questions regarding pain, malodour and pruritus were included to determine quantitatively whether these factors are associated with low EQ-5D index and visual analogue scale (VAS) scores. The index and VAS scores obtained were compared with reference values for the general population in Denmark. A significantly decreased utility in patients with hidradenitis suppurativa was found for all age group levels, except for 65–74-year-olds. The total index score in the cohort was 0.705 (population mean 0.887) and the VAS was 62.25 (population mean 82.6). Multivariate analysis found significant associations between loss of utility and pain, malodour and pruritus (p < 0.0001). Patients with hidradenitis suppurativa had a significantly decreased EQ-5D compared with the background population. Malodour and pruritus were found to be associated with low index values, and pain and malodour with low VAS. Patient-reported pain and discomfort had the most negative overall effect on mean index scores.]]>
2015-09-10 Clinical
96:2 2016 - Impact of Depression on Risk of Myocardial Infarction, Stroke and Cardiovascular Death in Patients with Psoriasis: A Danish Nationwide Study
Psoriasis is associated with depression, myocardial infarction (MI) and stroke. Patients with depression have increased cardiovascular risk. However, the link between psoriasis, depression and cardiovascular disease is unclear. This link was investigated in a nationwide Danish cohort of patients with psoriasis (n = 29,406). Incidence rates were calculated, and incidence rate ratios (IRRs) adjusted for age, gender, socio-economic status, medication and comorbidity were estimated by Poisson regression models. Risk of MI (IRR 1.57, 95% confidence interval (95% CI) 1.07–2.29), stroke (IRR 1.95, 95% CI 1.43–2.66), and cardiovascular death (IRR 2.24, 95% CI 1.53–3.26) were increased significantly during acute depression, and risk of stroke (IRR 1.51, 95% CI 1.19–1.90) was increased significantly in chronic depression. During remission from depression, only the risk of stroke was increased. In conclusion, in patients with psoriasis, depression is associated with increased risk of MI, stroke and cardiovascular death, especially during acute depression.]]>
2015-09-11 Clinical
96:2 2016 - Increased Prevalence of Advanced Liver Fibrosis in Patients with Psoriasis: A Cross-sectional Analysis from the Rotterdam Study
Prevalence of non-alcoholic fatty liver disease is increased in patients with psoriasis. However, it is not known how liver fibrosis correlates with psoriasis. This study investigated the association between psoriasis and liver fibrosis compared with participants without psoriasis within the population-based Rotterdam Study. All participants were screened for liver fibrosis using transient elastography. Liver stiffness > 9.5 kPa suggested advanced liver fibrosis. Psoriasis was identified using a validated algorithm. A total of 1,535 participants were included (mean age ± standard deviation 70.5 ± 7.9 years; 50.8% female; median body mass index 26.4 kg/m2 (interquartile range 24.2–28.9)) of whom 74 (4.7%) had psoriasis. Prevalence of advanced liver fibrosis was 8.1% in psoriasis patients compared with 3.6% in the reference group (p = 0.05). The risk of advanced liver fibrosis in psoriasis patients remained comparable after adjustment for demographics, lifestyle characteristics and laboratory findings (odds ratio 2.57 (95% confidence interval 1.00–6.63). This study suggests that elderly people with psoriasis are twice as likely to have advanced liver fibrosis irrespective of common risk factors.]]>
2015-08-20 Clinical
96:2 2016 - Survival and Effectiveness of Tumour Necrosis Factor-alpha Inhibitors in the Treatment of Plaque Psoriasis under Daily Life Conditions: Report from the Psoriasis Registry Austria
This retrospective multicentre analysis from the Psoriasis Registry Austria (PsoRA) was conducted to determine drug effectiveness and survival of anti-tumour necrosis factor alpha (anti-TNF-α) agents in patients with moderate-to-severe chronic plaque psoriasis over a 9-year period. Data on 1,019 treatment cycles with adalimumab (n = 460), etanercept (n = 501), and/or infliximab (n = 58) administered to 827 patients (272 women, 555 men) were available for analysis. Compared with etanercept, adalimumab and infliximab showed superior short-term effectiveness. Intention-to-treat-calculated median drug survivals for adalimumab (1,264 days) and etanercept (1,438 days) were similar to each other (p = 0.74), but significantly superior to that of infliximab (477 days) (p = 7.0e-07 vs. adalimumab and p=2.2e-07 vs. etanercept, respectively). Their drug survival rates at 36 months were 51.6%, 56.0%, and 22.6%, respectively. Survival rates correlated significantly with effectiveness for adalimumab and etanercept, but not for infliximab.]]>
2015-09-29 Clinical
96:2 2016 - Molecular Typing of Treponema pallidum in Denmark: A Nationwide Study of Syphilis
The aim of this nationwide study is to determine the strain type diversity among patients diagnosed with syphilis by PCR during a 4-year period in Denmark. Epidemiological data, including HIV status, for all patients were obtained from the Danish national syphilis registration system. Molecular strain typing was based on characterization of 3 variable treponemal genes, arp, tpr and tp0548. A total of 278 specimens from 269 patients were included. Among the fully typeable specimens (n = 197), 22 strain types were identified, with 1 type, 14d/g, accounting for 54%. The majority (93%) of the patients reported acquiring syphilis in Denmark. Among patients with concurrent HIV, 9 full strain types were identified and no difference in strain type was found by HIV status (p = 0.197). In conclusion, the majority of patients were infected in Denmark and the HIV-infected syphilis patients were diagnosed with a wide spectrum of different strain types of Treponema pallidum.]]>
2015-08-19 Investigative
96:2 2016 - Complement Fixation Test: An Update of an Old Method for Diagnosis of Bullous Pemphigoid
The complement fixation test (CFT) is a method traditionally used for diagnosis of gestational pemphigoid. Its performance in diagnosis of bullous pemphigoid (BP) has not been investigated in a large patient cohort. The aim of this single-centre, retrospective, serological case-control study of 300 patients with BP and 136 control patients was to analyse its operating characteristics. CFT was found to have a sensitivity of 71.7% and a specificity of 100%. Furthermore, CFT diagnosed 20 of 46 patients with BP (43.5%) who were negative for both BP180 and BP230 enzyme-linked immunoassays (ELISAs), 31 of 66 patients (47.0%) who were negative for indirect immunofluorescence of the oesophagus, 5 of 14 patients (35.7%) who were serologically negative for all investigated serological assays, and 7 of 18 patients (38.9%) in whom direct immunofluorescence was negative. Combination of CFT with all other serological assays resulted in a sensitivity of 95.3%. In conclusion, CFT is suitable for the diagnosis of BP, and can help to diagnose serologically challenging cases. ]]>
2015-09-08 Investigative
96:2 2016 - Enzyme-linked Immunoassay Index for Anti-NC16a IgG and IgE Auto­antibodies Correlates with Severity and Activity of Bullous Pemphigoid
Bullous pemphigoid (BP) is characterized by IgG and IgE autoantibodies to the NC16a domain of BP180. This study evaluated the correlation between body surface area (BSA), total serum IgE and enzyme-linked immunoassay (ELISA) for IgG and IgE anti-NC16a in 77 patients with BP in the active stage, and the degree of conversion to negative of the studied parameters in clinical remission. Statistically positive correlations were observed between BSA and examined parameters (correlation index 0.2548, 0.2491, 0.311, respectively). Originally, patients with BP with positive ELISAs for both IgG and IgE autoantibodies presented twice as extensive skin lesions as those with positive IgG and negative IgE ELISAs. Conversion of ELISAs for IgG and IgE to negative in clinical remission occurred in 9.3% and 81% of patients with BP, respectively. This confirmed that ELISA for IgE anti-NC16a is a helpful parameter in the modification of current treatment and the assessment of risk of relapse in BP.]]>
2015-10-01 Investigative
96:2 2016 - Total Body Photography as an Aid to Skin Self-examination: A Patient’s Perspective
Skin self-examination can help patients who are at high risk for developing melanoma to become more involved in their own surveillance and treatment. This study examined the use of total body photography as an aid to skin self-examination from the patients’ perspective. A total of 179 individuals at high risk for developing melanoma who had undergone total body photography (60.5% response rate) completed a self-reported questionnaire assessing the frequency of skin self-examination, perceived usefulness of total body photography, and a variety of potential demographic, clinical and psychological factors. Only approximately half of the participants indicated skin self-examination as useful and 78.9% preferred clinical skin examination by a specialist. Finding total body photography useful was associated with having received instructions on how to perform skin self-examination, the use of a (hand)mirror, and confidence to detect changing moles. These findings allow us to develop strategies to further improve patients’ self-screening behaviours. ]]>
2015-09-10 Investigative
96:2 2016 - Modelling the Future: System Dynamics in the Cutaneous Malignant Melanoma Care Pathway
Incidence rates for cutaneous malignant melanoma are increasing worldwide. Estimates of the future number of melanoma cases are important for strategic planning of the care pathway. The aim of this study was to use system dynamics modelling to evaluate the long-term effects of changes in incidence, population growth and preventive interventions. Historical data on invasive melanoma cases in Western Sweden from 1990 to 2006 were obtained. Using computer simulation software, a model estimating the accumulated number of melanoma cases for 2014 to 2023 was developed. Five future scenarios were designed: stable incidence, business-as-usual, 25% reduced patient’s delay, 50% reduced doctor’s delay, and a combination of the last two, called improved overall secondary prevention. After 10 years, improved overall secondary prevention would have resulted in a 42% decrease in melanomas > 4 mm and a 10% increase in melanomas ≤ 1 mm, compared with business-as-usual. System dynamics is a valuable tool, which can help policymakers choose the preventive interventions with the greatest impact.]]>
2015-10-06 Investigative
96:2 2016 - Corticosteroid Phobia Among Pharmacists Regarding Atopic Derma­titis in Children: A National French Survey
Fear of corticosteroid use among patients and parents of children with atopic dermatitis (AD) may be increased by professional caregiver’s mistrust to corticosteroids and a lack of consistency in information provision. This study used a French national survey to assess mistrust among pharmacists of the use of topical steroids for treatment of AD in children. From all pharmacies in France, a random sample of 500 (approximately 2%) was selected to receive a postal survey comprising a standardized questionnaire of 50 items exploring trust, knowledge, beliefs and practices related to the use of topical steroids for children with AD. The main outcome was self-assessment of pharmacists’ confidence in topical steroids on a 0–10 visual analogue scale. The mean confidence was 4.46 (95% confidence interval 4.11–4.82). This study highlights that pharmacists have only moderate confidence in topical steroids. This lack of trust may have a high impact on maintaining fear of corticosteroids in parents and patients.]]>
2015-08-20 Investigative
96:2 2016 - Cost-effectiveness of Maintenance Treatment with a Barrier-strengthe­ning Moisturizing Cream in Patients with Atopic Dermatitis in Finland, Norway and Sweden
Atopic dermatitis is a chronic skin disorder with high prevalence, especially in the Nordic countries. Effective maintenance therapy during symptom-free episodes may prolong the time to eczema relapse according to a previously published clinical trial. The present study evaluates the cost-effectiveness of a barrier-strengthening moisturizer containing 5% urea, compared with a moisturizer with no active ingredients during eczema-free periods. A health economic microsimulation model, based on efficacy data from the randomized clinical trial, analysed the cost-effectiveness of the barrier-strengthening treatment in Finland, Norway and Sweden. The barrier-strengthening moisturizer was cost-saving compared with the moisturizer with no active ingredients in all 3 countries. The result was confirmed in all but one sensitivity analysis. In conclusion, the barrier-strengthening moisturizer is cost-effective as maintenance therapy for patients with atopic dermatitis compared with a moisturizer with no active ingredients.]]>
2015-09-02 Investigative
96:2 2016 - A Promoter Polymorphism of the Vitamin D Metabolism Gene Cyp24a1 is Associated with Severe Atopic Dermatitis in Adults
Atopic dermatitis (AD) is a chronic inflammatory skin disease in which genetic and environmental factors result in impaired epidermal barrier functioning and an altered immune response. Vitamin D influences these 2 pathomechanisms, and beneficial results have been suggested in AD. The aim of this study was to investigate the potential roles of the 2 essential vitamin D metabolizing enzymes. The frequencies of 6 common polymorphisms in the genes encoding the vitamin D synthesizing enzyme Cyp27b1 or the inactivating enzyme Cyp24a1 were assessed in 281 patients with AD and 278 healthy donors in a case-control setting. The Cyp24a1 rs2248359-major C allele was significantly over-represented in patients with AD compared with controls, which was more pronounced in patients with severe AD. In addition, haplotypes of the Cyp24a1 and Cyp27b1 genes were associated with AD. These data support that vitamin D mediates beneficial functions in AD and suggest that future studies on the impact of vitamin D on AD should consider the individual genotypes of the vitamin D metabolizing enzymes.]]>
2015-09-15 Investigative
96:2 2016 - Insulin Resistance May Contribute to Upregulation of Adhesion Molecules on Endothelial Cells in Psoriatic Plaques
Psoriasis primarily affects the skin, but also has a systemic dimension and is associated with severe comorbidities. Since endothelial cells play an important role in psoriasis as well as in the development of cardiovascular comorbidities, we investigated whether a common mechanism, namely cytokine-induced insulin resistance, underlies both pathologies. Activation of the insulin pathway was studied in psoriatic skin and dermal endothelial cells. Expression of adhesion molecules was assessed by flow cytometry, as well as their biological function in flow chamber experiments. The phosphorylation status of Akt, a central kinase in the insulin pathway, suggests that endothelial cells within psoriatic plaques are rendered insulin resistant by pro-inflammatory cytokines. Insulin counteracts the expression of adhesion molecules, but has limited effects on interactions between T cells and endothelial cells. Pro-inflammatory cytokines induce insulin resistance in endothelial cells, which may contribute to the development of the inflammatory infiltrate in psoriasis. ]]>
2015-09-22 Clinical
96:2 2016 - Psychological Interventions in the Treatment of Chronic Itch
Patients with chronic itch suffer from higher levels of depression and anxiety than their healthy counterparts. Furthermore, psychological factors, such as stress, are known to aggravate itch. The mere act of thinking about itching can induce the sensation. Interventions like habit reversal training and arousal reduction have been shown to have positive effects on itch relief. Yet, there is still limited data on the psychological management to control the itch scratch cycle and a description of methods suitable to address itch. In this review, we describe different psychological interventions shown to be effective in the treatment of chronic itch. We also provide suggestions based on our experience of suitable interventions for patients with different types of itch. ]]>
2015-08-19 Review