Frank Brennan1 and Dedee F. Murrell2*
1Palliative Medicine, Calvary Hospital, 91 Rocky Point Road, and 2Department of Dermatology, St George Hospital, University of New South Wales, Gray St, Kogarah, Sydney, NSW 2217 Australia. *E-mail: email@example.com
Accepted Aug 28, 2013; Epub ahead of print Oct 24, 2013
The inaugural Australian symposium on pruritus was convened at St George Hospital, Sydney on August 10, 2013. The co-conveners were Professor Dedee Murrell, Executive Vice President of the International Society of Dermatology (ISD) and Dr Frank Brennan, Palliative Medicine Physician. The impetus behind the symposium was the recognition of two facts. Firstly, the significant developments in the understanding of the pathophysiology of pruritus in recent years and, secondly, the paucity of education and understanding by colleagues across multiple disciplines of those developments. Given that the symptom of pruritus manifests in many diseases the symposium was deliberately multi-disciplinary in focus.
The symposium commenced with a recognition of international work in this area, including the formation of the International Federation for the Study of Itch (IFSI) in 2005, the publication of European Guidelines on Chronic Pruritus in 2012 (1) and the international conferences convened on this topic.
The structure of the symposium was simple. It commenced with an overview of the pathophysiology of pruritus. It then proceeded to an analysis of itch measurement instruments and the aetiology and management of pruritus in the context of multiple disease states. They included pruritus in the setting of allergy and atopy, atopic dermatitis, cholestasis, uraemia, solid tumors and haematological conditions, pruritus secondary to opioids and pruritus as a sequelae to burns.
Frank Brennan gave an overview of the current understanding of the pathogenesis of pruritus. Synthesising developments in neuroscience he outlined the increasingly complex picture that has emerged of histaminergic and non-histaminergic transmission of itch, the role of itch receptors in the dorsal horn and central signalling in the brain. Connie Katelaris, Immunologist and Allergy Physician, outlined the role of histamine and histamine receptors in itch. Dedee Murrell presented an overview of pruritus in atopic dermatitis, one of the most common dermatological conditions that presents with itch. Chris Lim surveyed the instruments used to measure the severity of pruritus. John Freiman, Hepatologist, outlined the pathogenesis and management of cholestatic pruritus. Freda Passam, Haematologist, presented an overview of haematological conditions and pruritus with a particular focus on myeloproliferative disorders, Hodgkin’s Lymphoma and the cutaneous T-cell lymphomas that are notoriously pruritic. Anica Vasic, Pain Specialist, spoke on the mechanisms and management of opioid-induced itch. Frank Brennan spoke on uraemic pruritus, Paul Gray, a Pain Specialist with a particular interest in burns spoke on the phenomenon of post-burns pruritus and Craig Lewis, Medical Oncologist surveyed the symptom of itch and its management in cancer medicine.
A feature of the day was an interview with a patient in front of the symposium participants. The patient presented with a challenging combination of pruritus secondary to a life-long history of atopy and, in later years, uraemic pruritus. Connie Katelaris surveyed the history and immunological results of the patient and made clinical recommendations.
The symposium was well attended by a combination of clinicians from multiple disciplines. Delegates found that the symposium synthesised the growing literature on the pathophysiology and management of pruritus in the varied diseases that present with this often disabling symptom. The podcast and transcript of a national radio interview of the two conveners by Dr Norman Swan of the Australian Broadcasting Corporation, discussing the symptom of pruritus and publicising the symposium and can be accessed by readers (2).
Fig. 1. Speakers and delegates at the Pruritus symposium in Sydney.