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Background: Treatment of prurigo nodularis (PN) is challenging and new treatment options are needed. Objective: To evaluate the efficacy and safety of two oral doses of the kappa opioid agonist and mu opioid antagonist nalbuphine extended release (NAL‐ER) tablets in a phase 2, multicentre, randomized, double‐blind, placebo‐controlled trial with an open‐label, 50‐week extension phase. Methods: Subjects with moderate‐to‐severe PN were randomized to NAL‐ER 81 mg (NAL‐ER81) or 162 mg (NAL‐ER162) tablets twice‐daily or placebo for 8 weeks of stable dosing following a 2‐week titration period. Subjects completing Week 10 with a Worst Itch Numerical Rating Scale (WI‐NRS) score ≥5 at the time of rollover (or during the observation period) were eligible for open‐label treatment. Results: Of 63 randomized subjects, 62 were treated and comprised the modified intent‐to‐treat population (MITT), 50 completed 10 weeks of treatment. In the MITT analysis, 8 subjects (44.4%) treated with NAL‐ER162 (P = 0.32) and 6 (27.3%) treated with NAL‐ER81 (P = 0.78) achieved ≥30% reduction from baseline in 7‐day WI‐NRS at Week 10 (primary efficacy endpoint) vs. 8 (36.4%) in the placebo group. Itch reduction was significant among 8/12 (66.7%) subjects completing Week 10 treated with NAL‐ER162 vs. placebo (8/20, 40.0%; P = 0.03). Additionally, 6 subjects (33.3%) treated with NAL‐ER162 and 3 (13.6%) treated with NAL‐ER81 achieved ≥50% reduction from baseline in 7‐day WI‐NRS at Week 10 (coprimary endpoint). Extended open‐label treatment was associated with further improvements in itch reduction and favourable changes in PN lesion activity as assessed by Prurigo Activity Score. Adverse events occurred predominantly during dose titration and were of mild‐to‐moderate severity. The safety profile did not change with extended open‐label treatment. Conclusion: In adult subjects with PN, oral treatment with NAL‐ER 162 mg twice daily provided measurable anti‐pruritic efficacy in subjects completing ≥10 weeks of treatment and was well tolerated (ClinicalTrials.gov: NCT02174419). [ABSTRACT FROM AUTHOR]

The special interest group on sensitive skin of the International Forum for the Study of Itch previously defined sensitive skin as a syndrome defined by the occurrence of unpleasant sensations (stinging, burning, pain, pruritus and tingling sensations) in response to stimuli that normally should not provoke such sensations. This additional paper focuses on the pathophysiology and the management of sensitive skin. Sensitive skin is not an immunological disorder but is related to alterations of the skin nervous system. Skin barrier abnormalities are frequently associated, but there is no cause and direct relationship. Further studies are needed to better understand the pathophysiology of sensitive skin – as well as the inducing factors. Avoidance of possible triggering factors and the use of well‐tolerated cosmetics, especially those containing inhibitors of unpleasant sensations, might be suggested for patients with sensitive skin. The role of psychosocial factors, such as stress or negative expectations, might be relevant for subgroups of patients. To date, there is no clinical trial supporting the use of topical or systemic drugs in sensitive skin. The published data are not sufficient to reach a consensus on sensitive skin management. In general, patients with sensitive skin require a personalized approach, taking into account various biomedical, neural and psychosocial factors affecting sensitive skin. [ABSTRACT FROM AUTHOR]

Background Health-related quality of life ( HRQOL) is widely used as a patient-reported outcome to evaluate clinical trials. In routine care it can also be used to improve treatment strategies or to enhance patients' self-awareness and empowerment. Therefore a disease-specific instrument is needed that assesses in detail all the impairments caused by the disease of interest. For patients with hand eczema ( HE) such an instrument was developed by an international expert group, but its measurement properties are unknown. Objectives To validate the German version of the Quality of Life in Hand Eczema Questionnaire ( QOLHEQ), which covers the domains of (i) symptoms, (ii) emotions, (iii) functioning and (iv) treatment and prevention. Methods The QOLHEQ was assessed up to three times in 316 patients with HE to test reliability and sensitivity to change. To test construct validity we also assessed several reference measures. The scale structure was analysed using the Rasch model for each subscale and a structural equation model was used to test the multi domain structure of the QOLHEQ. Results After minor adaptions of the scoring structure, all four subscales of the QOLHEQ did not significantly misfit the Rasch model (α > 0·05). The fit indices of the structural equation model showed a good fit of the multi domain construct with four subscales assessing HRQOL. Nearly all a priori-defined hypotheses relating to construct validity could be confirmed. The QOLHEQ showed a sensitivity to change that was superior compared with all reference measures. Conclusions The QOLHEQ is ready to be used in its German version as a sensitive outcome measure in clinical trials and for routine monitoring. The treatment-relevant subscales enable its use to enhance patients' self-awareness and to monitor treatment decisions. [ABSTRACT FROM AUTHOR]

Background Health-related quality of life (HRQOL) is widely used as a patient-reported outcome to evaluate clinical trials. In routine care it can also be used to improve treatment strategies or to enhance patients’ self-awareness and empowerment. Therefore a disease-specific instrument is needed that assesses in detail all the impairments caused by the disease of interest. For patients with hand eczema (HE) such an instrument was developed by an international expert group, but its measurement properties are unknown. Objectives To validate the German version of the Quality of Life in Hand Eczema Questionnaire (QOLHEQ), which covers the domains of (i) symptoms, (ii) emotions, (iii) functioning and (iv) treatment and prevention. Methods The QOLHEQ was assessed up to three times in 316 patients with HE to test reliability and sensitivity to change. To test construct validity we also assessed several reference measures. The scale structure was analysed using the Rasch model for each subscale and a structural equation model was used to test the multi domain structure of the QOLHEQ. Results After minor adaptions of the scoring structure, all four subscales of the QOLHEQ did not significantly misfit the Rasch model (α >0 ⋅05). The fit indices of the structural equation model showed a good fit of the multi domain construct with four subscales assessing HRQOL. Nearly all a priori-defined hypotheses relating to construct validity could be confirmed. The QOLHEQ showed a sensitivity to change that was superior compared with all reference measures. Conclusions The QOLHEQ is ready to be used in its German version as a sensitive outcome measure in clinical trials and for routine monitoring. The treatment-relevant subscales enable its use to enhance patients’ self-awareness and to monitor treatment decisions. [ABSTRACT FROM AUTHOR]

Contact dermatitis is defined as a pattern of inflammatory response that may occur as a result of contact with external factors. The two most common causes are irritants and allergens. Very few reliable data on prevalence and incidence of contact dermatitis exist, and data from the few studies that have been carried out cannot be compared because of differences in methodology. Occupational contact dermatitis constitutes up to 30% of all occupational diseases for which compensation is payable and affects sufferers’ home and social lives as well as their working lives. Patients can be advised about the use of personal protective equipment and creams and emollients to avoid or ameliorate their condition, but there is little epidemiological evidence for their efficacy. Patch testing, using the European Standard Series of Allergens, is necessary to determine which agent is responsible for the condition. Fragrances and preservatives used in cosmetics are among the most common allergens in contact allergic dermatitis, although the frequency of contact allergy in the general population is small. It is to be hoped that the European Dermato-Epidemiology Network Fragrance Study will go some way to addressing the need for a large population-based epidemiological study in order that public health organizations can give reliable advice about avoiding and treating contact dermatitis. [ABSTRACT FROM AUTHOR]

Background Pruritus is the most frequent and distressing symptom associated with dermatoses and various internal and neurological diseases. Objectives To investigate two different populations of patients with pruritus, one in Germany and one in Uganda, with a particular focus on clinical characteristics, aetiology and quality of life. Methods We investigated by questionnaire 132 patients (59 men, 73 women, mean age 54·5 years) who were referred to the Department of Dermatology at the University Hospital of Magdeburg, Germany, with the diagnosis of pruritus as a leading symptom. The questionnaire was also applied in 84 patients who consulted the Dermatology Clinic at Mbarara, Uganda for pruritus. The questions referred to personal data and disease history of the individual, history and present occurrence of concomitant diseases, present and past therapy, quality, frequency and triggers of itching and scratching, other disorders and complaints, quality of life and impact on work and disability. Results Seventy-five (57%) of the German patients had pruritus due to dermatoses, 47 patients (36%) had pruritus due to a systemic disease and in 10 patients (8%) pruritus was of unknown origin. Most had a history of pruritus of several months up to years. Pruritus associated with dermatoses mostly affected the whole body and was permanent with an undulatory character. Affective reactions such as aggression and depression occurred more frequently in dermatological patients compared with those with systemic pruritus. The former group felt that pruritus had a greater impact on their lives. Almost all Ugandan patients had pruritus due to dermatoses except for three patients with pruritus of unknown origin. Eczema and prurigo were the most frequently observed dermatoses in both German and Ugandan patients. Patients with pruritus in both populations showed an impaired quality of life. There was no pronounced difference between the populations with regard to feelings of depression and suicidal thoughts. Conclusions A great deal of helpful information in this complex group of patients can be obtained using this questionnaire. Pruritus has a major impact on quality of life and especially impairs those patients with pruritus associated with dermatoses and pruritus of unknown origin. [ABSTRACT FROM AUTHOR]

The background of this study is that 5-HT[sub3] receptor antagonists are reported to have an antipruritic effect in uremic and cholestatic pruritus. Recently. we could not confirm such an effect in heal thy subjects under experimental conditions. Therefore, it was the aim of the present study to further evaluate a possible antipruritic effect of a 5-HT[sub3] receptor antagonist (tropisetron) on serotonin- and histamine-induced itch before and after skin mast cell depletion in 10 healthy subjects. The results were compared to serotonin and histamine iontophoresis in non-pretreated and pretreated skin with an orally applied antihistamine (cetirizine). Skin mast cell depletion was performed by iontophoretical application of com- pound 48/80. Wheals and flares were planimetrically evaluated. Itching a rid burning sensations were rated oil an analog scale over a 24-min period. The test protocol also comprised alloknesis, defined as induction of perifocal itch sensations by a mechanical stimulus. When serotonin was iontophoreticaIly applied alter mast cells had been depleted before, oral tropisetron resulted not only in significantly lower whealing, itching and alloknesis hut also reduced flares. In contrast, after oral pretreatment with tropisetron histamine-induced reactions before and after mast cell depletion did not significantly change. Our study demonstrates that in this model, tropisetron as a 5-HT[sub3] receptor antagonist does not effect histamine-induced itch but has a measurable effect in serotonin-induced reactions when mast cells were depleted before. From these data evidence now exists why tropisetron is to sonic extent effective in certain types of pruritus such as uremic pruritus. known for increased histamine liberation and increased serotonin levels as well as degranulated and diffusely spread mast cells in the skin. [ABSTRACT FROM AUTHOR]

Background: Chronic nodular prurigo (CNPG) is a condition characterized by chronic itch, a prolonged scratching behaviour and the presence of pruriginous nodules. A comprehensive understanding of this condition, especially regarding its clinical characteristics and impact on quality of life is still lacking. Objectives: Aim of this pan‐European multicentre cross‐sectional study was to establish the clinical profile of CNPG, including its associated burden. Methods: Fifteen centres from 12 European countries recruited CNPG patients presenting at the centre or using the centres' own databases. Patients were asked to complete a questionnaire in paper or electronic format. Demography, current co‐morbidities, underlying disease, itch intensity, additional sensory symptoms, quality of life, highest burden and emotional experience of itch were assessed. Results: A total of 509 patients (210 male, median age: 64 years [52; 72]) were enrolled. Of these, 406 reported itch and CNPG lesions in the previous 7 days and qualified to complete the whole questionnaire. We recorded moderate to severe worst itch intensity scores in the previous 24 h. Scores were higher in patients with lower educational levels and those coming from Eastern or Southern Europe. Most patients experience itch often or always (71%) and report that their everyday life is negatively affected (53%). Itch intensity was considered to be the most burdensome aspect of the disease by 49% of the patients, followed by the visibility of skin lesions (21%) and bleeding of lesions (21%). The majority of patients was unaware of an underlying condition contributing to CNPG (64%), while psychiatric diseases were the conditions most often mentioned in association with CNPG (19%). Conclusions: This multicentre cross‐sectional study shows that itch is the dominant symptom in CNPG and reveals that the profile of the disease is similar throughout Europe. [ABSTRACT FROM AUTHOR]

Background: Chronic hand eczema (CHE) is a very common skin disease among the European population. It causes itch and pain and, in more severe cases, seriously impairs hand functioning at work and in private life. Objectives: To explore perspectives of people with lived experience on CHE‐related problems, wishes and goals. Methods: Following a qualitative approach, we conducted topic‐guided interviews in five European countries and applied template analysis to identify recurrent themes among patients with CHE. Results: We interviewed 60 patients in seven outpatient dermatological and occupational medicine clinics in Croatia, Denmark, Germany, the Netherlands and Spain. Five main themes were identified: (1) knowledge about the disease and its course, (2) preventive behaviour, (3) hand eczema therapy, (4) impact on everyday life and (5) attitudes towards CHE and healthcare. Participants did not feel well informed about CHE, especially about causes, triggers and treatment options. Preventive measures were experienced as more or less effective but also cumbersome. Experiences with therapy were diverse. Treatment satisfaction depended on the results and on the perceived support from the treatment teams. Participants found it important to be taken seriously, to receive practical advice, to try out additional treatments or examinations, find new hope and have occupational perspectives. They wished that others could better understand the physical and emotional burden of CHE. Patient support groups were not mentioned. Participants found it important to learn to take care of themselves and accept life with CHE. Conclusions: Due to its annoying symptoms, high visibility and impaired functioning at work and in private life, CHE has a high emotional and social impact. Some people may require support to learn coping with CHE and its prevention. Patients wish for information about causes and triggers. They value physicians who listen to them and keep looking for solutions. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Chronic pruritus: evaluation of patient needs and treatment goals with a special regard to differences according to pruritus classification and sex" that was published in the same issue.

Comparing the CESD-score's symptom categories, registry patients scored highest on sleep, fatigue and agitation. This is in line with previous results.7,8 Patients' reportings on symptom frequency was markedly higher for AD patients having depression as comorbidity compared to patients reporting no depression comorbidity. The presented issue highlight the relevant role of depressive symptoms for a high proportion of adult patients with moderate-to-severe AD. [Extracted from the article]

Background Hand eczema ( HE) is a common occupational skin disease. Tobacco smoking is known to be associated with adverse cutaneous effects. However, its influence on the prognosis of occupational HE has not yet been studied. Objectives To evaluate relations between smoking status, severity and prognosis of occupational HE in patients taking part in an interdisciplinary tertiary individual prevention programme ( TIP). Methods In a prospective, multicentre, cohort study 1608 patients with occupational HE taking part in a TIP were recruited and followed up for 3 years. The clinical and self-reported outcome data of smokers and nonsmokers were compared. Results Nonsmokers and smokers were equally distributed. During the TIP, the average self-reported daily cigarette consumption and the severity of HE decreased significantly ( P < 0·01). However, at all time points HE was significantly more severe in smokers than in nonsmokers. This association was not dependent on the self-reported number of cigarettes smoked daily. Smokers had significantly more days of absence from work due to occupational HE than nonsmokers in the year before the TIP ( P < 0·01) and in the following year ( P = 0·02). After the TIP, smokers reported significantly more often that they had to give up their occupation ( P = 0·02) than nonsmokers. Conclusions The severity of occupational HE is increased in smokers. Tobacco smoking is associated with a higher number of days of absence from work and with not staying in the workforce owing to occupational HE. Thus, smoking confers a worse prognosis and interferes with the outcome of prevention programmes. [ABSTRACT FROM AUTHOR]

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease with a multifactorial genesis including genetic predispositions and environmental risk and trigger factors. One of the latter possibly is smoking, indicated by an increased prevalence of AD in adults and children that are actively or passively exposed to cigarette smoke. Objectives: In this study, AD characteristics and its atopic comorbidities are compared in smoking and non‐smoking AD patients. Methods: TREATgermany is a non‐interventional clinical registry which includes patients with moderate to severe AD in Germany. Baseline data of patients included in TREATgermany from inception in June 2016 to April 2020 in 39 sites across Germany was analysed comparing AD disease characteristics and comorbidities in smokers vs. non‐smokers. Results: Of 921 patients, 908 (male: 58.7%) with a mean age of 41.9 ± 14.4 reported their smoking status. The objective Scoring of Atopic Dermatitis (oSCORAD) did not differ between smokers (n = 352; 38.8%) and non‐smokers, however, lesions' intensity of oozing/crusts and excoriations as well as patient global assessment scores (PGA) of AD severity were higher in smoking as opposed to non‐smoking patients. Smokers reported a lower number of weeks with well‐controlled AD and more severe pruritus than non‐smokers. Total IgE levels were more elevated in smokers and they displayed a younger age at the initial diagnosis of bronchial asthma. After adjustment for potential confounders, the increased intensity of oozing/crusts, the reduced number of weeks with well‐controlled AD and the greater pruritus remained different in smokers compared to non‐smokers. In addition, smoking patients with adult‐onset AD showed a 2.5 times higher chance of involvement of the feet. Conclusions: German registry data indicate that AD patients who smoke have a higher disease burden with a different distribution pattern of lesions in adult‐onset AD. Linked Commentary Valeria Aoki and Raquel Leão Orfali J Eur Acad Dermatol Venereol 2022; 36: 324–325. https://doi.org/10.1111/jdv.17901. [ABSTRACT FROM AUTHOR]

Background Occupational skin disease (OSD) is common. Tertiary individual prevention programmes (TIP) aim at helping individuals with refractory OSD to remain active in the workforce. Evidence exists that these interventions improve skin protection behaviour related cognitions. However, it is not clear whether these effects generalize to all types of OSD. Objective To evaluate whether effects on socio-cognitive determinants of skin protection behaviour vary between patients with work related atopic dermatitis (AD) and other work related skin diseases. Methods A total of 14 inpatients with work related AD and 87 inpatients with other work related skin diseases completed measures on socio-cognitive determinants of skin protection behaviour before and after a 3-week inpatient TIP. Mixed model analyses, using maximum-likelihood estimation tested whether there were differential effects of the intervention on socio-cognitive determinants of skin protection behaviour. Results Although patients with AD reported more favourable cognitions towards skin protection behaviour than patients with other skin diseases at admission, these cognitions deteriorated or remained on the same level. Patients with other forms of OSD on the other hand developed more favourable cognitions during the intervention. Conclusion Professionals working in the field of OSD should not cease to assist AD patients in achieving optimal skin protection behaviour. Tertiary individual prevention measures may need to pay more attention to the needs of individuals with an occupationally relevant AD. This may contribute to their being able to remain active in the workforce. The alternative would entail regular sick leave, poorer quality of life and economic hardship for the AD patient. [ABSTRACT FROM AUTHOR]

Background: Clinical hand eczema trials measure a variety of outcome domains to determine the success of interventions. This considerably limits the comparability and overall confidence in the study results, and thereby the strength of recommendations for clinical practice. Objectives: The Hand Eczema Core Outcome Set (HECOS) initiative aims to develop a core outcome set (COS) for the standardized evaluation of interventions in future hand eczema trials and reviews. This COS will define the minimum that should be measured and reported in controlled and randomized‐controlled trials of therapeutic hand eczema interventions. The objective of this protocol is to specify the methods to develop a core domain set. Methods: In Phase 1, a list of candidate domains will be derived from a systematic literature review concerning previously measured outcomes in hand eczema trials, from qualitative patient interviews and from expert interviews. In Phase 2, a consensus study about core domains will be conducted by an online 3‐round Delphi survey and a face‐to‐face meeting, applying predefined consensus criteria. HECOS involves hand eczema and methods experts as well as patients and further stakeholders with an interest in the initiative. Outlook: When a set of core domains has been defined, HECOS is going to identify appropriate outcome measurement instruments in a development process that will be detailed in another protocol. The COS will considerably enhance the methodological quality, comparability and usefulness of hand eczema trials for clinical decision‐making and the development of new therapeutic options for hand eczema, and also reduce the effort of planning, conducting, and reporting individual hand eczema studies, reviews and meta‐analyses. [ABSTRACT FROM AUTHOR]

Background: The diagnostic significance of the atopy patch test for the management of dermatitis possibly triggered by aeroallergens is still controversial. However, sufficiently large studies with routinely tested standardized aeroallergen patch test preparations in dermatitis patients are lacking. Objective: To evaluate the reaction frequency and the reaction profiles of 10 until mid‐2015 commercially available, standardized aeroallergen patch test preparations of the 'Stallerpatch' test series (Stallergenes, Antony Cedex, France) in a large multicentre patient cohort. Methods: A retrospective data analysis of patients with suspected aeroallergen‐dependent eczematous skin lesions was performed, who were patch tested in 15 Information Network of Departments of Dermatology‐associated clinics between 2000 and 2015. Patients were stratified according to their atopic dermatitis (AD) status. Results: The study group included 3676 patients (median age 41 years, 34.8% males, 54.5% AD). The most common aeroallergens causing positive patch test reactions were Dermatophagoides pteronyssinus (19.6%), Dermatophagoides farinae (16.9%), birch (6.2%), timothy grass (6.0%), cat dander (5.4%), mugwort (4.9%) and dog dander (4.6%). Reactions to other pollen allergen preparations, that is 5 grasses (3.2%), cocksfoot (2.1%) and plantain (1.6%), were less common. Positive patch test reactions to aeroallergens were consistently more frequent in patients with AD. These patients showed proportionally less dubious, follicular, irritant and weak positive reactions. Independent of AD status, a patient history of past or present allergic rhinitis was associated with an increased chance of a positive aeroallergen patch test reaction to pollen allergens. Conclusion: The aeroallergen patch test is a useful add‐on tool in clinical routine, especially in patients with AD and/or respiratory allergy. A patch test series comprising Dermatophagoides pteronyssinus, Dermatophagoides farinae, birch, timothy grass, cat dander and mugwort seems to be suitable. Controlled studies with specific provocation and elimination procedures are required to further evaluate the diagnostic significance of the proposed screening series. [ABSTRACT FROM AUTHOR]

Background: The Atopic Dermatitis (AD) TREATgermany registry was initiated by the German Society for Dermatology (DDG) in 2011 to evaluate the 'real‐life' situation of health care for patients with AD. Objectives: Interim data analysis on baseline characteristics as well as current and prescribed systemic treatments of the TREATgermany registry patients. Methods: Patients (≥18 years) with moderate‐to‐severe AD [objective (o)SCORAD > 20], or with current or previous anti‐inflammatory systemic treatment for AD within 24 months, were included and are followed up over at least 24 months. To assess clinical signs, the eczema area severity index (EASI, 0–72), the oSCORAD (0–83) and the Investigator Global Assessment (IGA; 6‐point scale) were used. The disease severity was globally scored by the patients [Patient Global Assessment (PGA); six‐step Likert scale]. Disease symptoms were assessed by the patient‐oriented eczema measure (POEM, 0–28) and numeric rating scales (NRS, 0–10). Health‐related quality of life was measured using the dermatological life quality index (DLQI, 0–30). Results: A total of 612 patients were recruited across 32 sites between 06/2016 and 01/2019 (mean age: 42.6 ± 14.2 years; mean oSCORAD: 40.8 ± 16.3). The mean POEM score was 16.3 ± 7.5. Pruritus was rated highest among subjective symptoms (NRS: 5.4 ± 2.7). The mean DLQI value was 11.3 ± 7.5. The frequency of arterial hypertension was lower (20.8%) compared with the general population, whilst this was higher for depression (10%). More than 60% of the patients had received systemic glucocorticosteroids, and 36.8% had received cyclosporine A prior to inclusion. Dupilumab was the leading substance documented as either 'current' (12.1%) or 'prescribed' (31.4%) at baseline. Conclusions: These 'real‐life' data clearly demonstrate the substantial disease burden. Most of TREATgermany patients were already treated with or prescribed dupilumab at baseline. Moreover, current findings indicate the urgent need for further alternative agents in order to achieve a perceptible improvement of quality of life of patients with moderate‐to‐severe AD. [ABSTRACT FROM AUTHOR]

Background: Chronic itch (CI) is a frequent symptom in hemodialysis (HD) patients. Previous studies demonstrated great impairments of general well‐being and health‐related quality of life (HRQOL) as well as a higher mortality in those suffering from CI. Objective: The German Epidemiological Hemodialysis Itch Study (GEHIS) is a representative cohort of HD patients in Germany. All patients were followed up 4 years later. The current analyses present data on the course of CI in HD patients, its associated factors including comorbidities, laboratory values and HRQOL. Methods: We assessed sociodemographic data, routine laboratory values, comorbidities, HRQOL (SF‐12), depression and anxiety (HADS), sleep (duration and quality) and in those suffering from CI characteristics, intensity of CI and itch‐related quality of life (ItchyQoL). Those with CI were offered a dermatological examination and CI was classified according to the IFSI classification. Patients were asked if they had consulted a physician about CI. Results: Of the patients who had suffered from CI in 2013 (n = 234), 90.5% (212) patients could be followed up. About 36.3% (n = 85) had died, 9.8% (n = 23) had received a kidney transplant in the meantime. A total of 52 HD patients still suffered from CI, in 52 CI had stopped. Those patients still suffering from CI (n = 52) reported a higher mean itch intensity, lower ItchyQoL, higher levels of anxiety and a lower mean sleeping time in 2013. On the other hand, those who did not suffer from CI anymore showed a significant increase of HRQOL compared to 2013. There was no significant difference in dialysis characteristics and laboratory values except for albumin. Only a minority of patients in HD had consulted a dermatologist because of CI (29.9%). Conclusion: Our data demonstrate that CI is a persisting symptom in 50% of the HD patients and when it disappears HRQOL recovers. We confirm that CI is a disregarded symptom in HD patients. [ABSTRACT FROM AUTHOR]

Summary: Background: Hand eczema has a high incidence and prevalence and has a negative impact on both physical and psychological well‐being, with the risk of persistence as a chronic condition. Epidemiological studies on hand eczema provided mainly descriptive and risk analyses, but pattern analyses of variables associated with hand eczema, in particular chronic hand eczema, have not been explored to date. Objectives: To investigate and display the semantics of associations between variables of hand eczema obtained from the Swiss and German registries of chronic hand eczema (CARPE) to dissect patterns and novel links. Methods: This was a cross‐sectional study on selected variables from the CARPE registries. Associations between variables were analysed by means of an autoassociative system. A semantic connectivity map was generated by using a maximum spanning tree algorithm. Results: Baseline datasets of 1466 patients with chronic hand eczema (Switzerland: 199; Germany: 1267) were analysed. Occupational exposure had the highest impact in the total and country cohorts. We identified two areas of exposure linked to corresponding occupations that clearly demarcated the sexes. Conclusions: This study, using semantic connectivity as a novel method of data analysis, reveals the complexity of features characterizing chronic hand eczema as well as novel association patterns that deserve further investigation. [ABSTRACT FROM AUTHOR]

Background Chronic itch (CI) is a very tormenting symptom in haemodialysis (HD) patients. GEHIS (German Epidemiological Hemodialysis Itch Study) is a representative cross-sectional study showing that current chronic itch (CI) affects 25.2% of haemodialysis (HD) patients. Objective We investigated drug intake and possible associations between CI and medications of HD patients. Methods Eight hundred and sixty HD patients from a randomly selected cluster sample of 25 dialysis units (GEHIS) in Germany were investigated. Statistical analyses were performed using R (version 3.3.0) for Windows. Logistic regression was used to identify influential covariates for prevalence of chronic itch and intensity of itch. Results Taking loop diuretics (furosemide, torasemide) was significantly negatively associated with the occurrence of CI in HD patients meaning that those who had received any type of loop diuretics were significantly less likely to suffer from less CI compared to those who had not taken them. There were no associations of CI with other medications. No correlation was detected between the intensity of itch and the intake of loop diuretics or any other medication. Conclusion Loop diuretics may have an impact on the development of CI in HD patients. As it is most likely that a multifactorial origin may explain CI in HD, future research should also focus on the role of loop diuretics in CI, both on a clinical as well as on a molecular level. [ABSTRACT FROM AUTHOR]

Background: Antihistamines (AH) are often used to treat chronic skin diseases related to allergy and/or pruritus. Data on the use of AH in patients with chronic hand eczema (CHE) is scarce. Objective The objective of this study was to investigate prevalence and determinants of AH use in patients with CHE. Methods: Data were drawn from the German CARPE registry. The relationship of clinical, demographic and treatmentrelated variables with AH use in the past 12 months was analysed by means of logistic regression. Odds ratios (OR) with corresponding 95% confidence intervals (CIs) were computed. Results: A total of 1255 patients with CHE were eligible for analysis (54.1% female; mean age: 47.1 years, standard deviation (SD) 13.6 years). Mean subjective disease severity was 5.0 (SD 2.5). 25% of the sample reported to have used AH in the past 12 months. Significant positive associations with AH use were identified for moderate (OR = 3.05, 95% CI 1.81-5.15) or severe (OR = 4.27, 95% CI 2.40-7.59) pruritus, a history of systemic treatment (e.g. alitretinoin) (OR = 2.85, 95% CI: 2.06-3.96), UV phototherapy (OR = 1.78, 95% CI 1.28-2.46), flexural eczema (OR = 1.89, 95% CI 1.32-2.71), allergic rhinitis/conjunctivitis (OR = 2.41, 95% CI 1.71-3.39) and female gender (OR = 1.58, 95% CI 1.16-2.14) in multivariate analyses (N = 1184). Significant inverse associations were found for an eczema localization besides the hands (OR = 0.66, 95% CI 0.46-0.94) and for patients being recruited in hospital (vs. dermatological practice; OR = 0.47, 95% CI 0.33-0.67). Conclusions: This study suggests that AH use is frequent in patients with CHE and mainly related to female gender, disease severity, pruritus, comorbid atopic disease and treatment centre. [ABSTRACT FROM AUTHOR]

Objectives: Melanoma and non melanoma skin cancer (NMSC) are now the most common types of cancer in the white populations and increasing incidence rates for skin cancer has been a major public health concern. However, the benefit of skin cancer screening is still controversial. The aims of this study were 1) To enhance awareness and early detection of non-melanoma and melanoma skin cancer in a population of factory employees; 2) To identify the proportion of the employees who have an increased risk of developing skin cancer. Methods: In combination with a short questionnaire we offered on-site free skin examinations to the employees of five large companies in Germany. We recorded the demographics, skin cancer risk factors (changing mole, skin-type, family history, size of congnital naevus) and presumptive cancer or cancer-related diagnoses (actinic keratosis (AK), basal cell carcinoma (BCC), squamous cell carcinoma(SCC), dysplastic nevus (DN), and melanoma). Results: In total, we screened 14,553 subjects(10,715 males and 3838 females) with mean age of 40 years, during a series of consecutive sessions. A presumptive diagnosis related to skin cancer was detected in 782 (5%), including 72 (0.5 %) with presumptive AK, 52 (0.4 %) with BCC, 2 (0.01%) with SCC, 634 (4%) with DN, and 22 (0.2%) with possible melanoma. In all, 33% of those examined had at least one risk factor and 8% had at least two risk factors: 13% reported a changing mole, and 22% had skin type I or II. Conclusions: As expected, rates of suspected melanoma and NMSC in the screening was low in this relatively young population. About one third of the screenees who had increased risk for developing skin cancer will benefit from the screening. In the cost-benefit analysis of a factory-based health promotion campaign, increased skin cancer awareness should be taken into account for the rationale to offer such screening programs. We concluded that this skin cancer screening campaign fulfilled the basic principles of screening for diseases. [ABSTRACT FROM AUTHOR]