Bedside to Bench: Experts will discuss chronic itch in lymphoma, liver disease, pediatrics, scalp

0313-ResearchPruritus is the No. 1 symptom in dermatology, but when it comes to pathophysiology and treatments, an itch is not an itch is not an itch. “Dermatologists are very much used to looking at itch as one thing, but itch has different flavors and different characteristics,” said Gil Yosipovitch, MD, director of “Chronic Pruritus: Bedside to Bench Perspectives.”

The symposium, which will be presented from 2 to 5 p.m. Saturday in Room 2014, will examine basic science and clinical aspects of hepatic itch, lymphoproliferative itch, pediatric itch, and scalp itch. Itch is the No. 1 item on the Academy’s research agenda.

Cholestatic liver disease can cause an itch so horrible that some patients become suicidal, said Timothy G. Berger, MD, co-director of the symposium. Intractable hepatic itch is an indication for liver transplant and can place a patient higher on the transplant list. Andreas Kremer, MD, will discuss his breakthrough research into autotaxin, a biochemical mediator of cholestatic itch.

“Autotaxin is over-activated in cholestatic disease and its substrate (lysophosphatidic acid) gets accumulated in nerves and is most probably inducing itch in liver disease,” said Dr. Yosipovitch, chair of dermatology at Temple University School of Medicine, Philadelphia. “Dr. Kremer will discuss both basic mechanisms of how this itch occurs and the clinical aspects of how he treats itch.”

Two experts will cover lymphoproliferative itch. Joan Guitart, MD, professor of dermatology and pathology, Feinberg School of Medicine at Northwestern University, Chicago, will discuss the clinical aspects of itch in lymphoma. “One of the most intractable types of itch are CTCL (cutaneous T-cell lymphoma) types,” said Dr. Yosipovitch. “My worst cases of itch are in that domain.”

Alain H. Rook, MD, professor of dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, will talk about research in the mechanisms of CTCL itch. “Dr. Rook will discuss some new findings on the pathophysiology, in particular studies he and my group did on interleukin 31, which we found was involved in the itch of CTCL.”

A team of four experts will discuss itch in pediatric patients. “A lot of us are a little bit uncomfortable treating little children, and these experts do it all the time, so we’re hoping for some practical tips,” said Dr. Berger, who is a professor of clinical dermatology at the University of California, San Francisco. The mechanisms, treatments, and differential diagnosis of atopic eczema will be covered.

Finally, Dr. Yosipovitch will present the topic of scalp itch. “I will discuss the mechanisms of itchy scalp and the work we have done in looking at the skin sensation of and the response to itch stimuli,” he said. “Then I will discuss the common causes of itch in the scalp and treatment approaches.”

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