Case and Research Letters
Treatment of 2 Patients With Aquagenic Pruritus With UVA/Narrow Band UVB Combined Therapy Once a Year
Tratamiento de 2 pacientes con prurito acuagénico con ciclos de terapia combinada UVA/UVB de banda estrecha una vez por año
D. Morgado-Carrasco
, J. Riera-Monroig, H. Feola, P. Aguilera
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Dermatology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain
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Morgado-Carrasco, J. Riera-Monroig, H. Feola, P. Aguilera" "autores" => array:4 [ 0 => array:4 [ "nombre" => "D." "apellidos" => "Morgado-Carrasco" "email" => array:1 [ 0 => "morgadodaniel8@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Riera-Monroig" ] 2 => array:2 [ "nombre" => "H." "apellidos" => "Feola" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Aguilera" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Dermatology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tratamiento de 2 pacientes con prurito acuagénico con ciclos de terapia combinada UVA/UVB de banda estrecha una vez por año" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Aquagenic pruritus (AP) is characterized by the onset of pruritus after contact with water, with no evident skin lesions unlike aquagenic urticaria. It is an uncommon condition in Spain, but it can affect up to 20% of young adults in African countries.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The disease may have a major negative impact on quality of life<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and management is difficult.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> One of the most effective treatments is phototherapy, but relapses are frequent and maintenance therapy is required.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Cases have been reported in which an annual cycle of UVA and narrow-band UVB combination therapy (UVA/NB-UVB CT) achieved good outcomes.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> Our objective was to assess response to annual cycles of UVA/NB-UVB CT in patients with AP refractory to antihistamine agents.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Long-term clinical response was retrospectively analyzed in patients with AP refractory to high doses of antihistamine agents treated with UVA/NB-UVB CT in a reference hospital in Barcelona, Spain, between January 2010 and January 2019. Two women aged 52 and 31 years were identified. The case of patient 1 had been reported previously<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>; her mother also had AP. Patient 2 had celiac disease. In both cases, symptoms had presented more than 5 years previously and the patients had received multiple treatments (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Laboratory tests (hemogram, erythrocyte sedimentation rate, creatinine levels, liver and lipid profile) were normal in both patients, except for a small increase in IgE. They were treated with UVA/NB-UVB CT 3 times a week (17–34 sessions a year). The starting doses were 4 J/cm<span class="elsevierStyleSup">2</span> (UVA) and 200 mJ/cm<span class="elsevierStyleSup">2</span> (NB-UVB). The maximum doses were 9 J/cm<span class="elsevierStyleSup">2</span> (UVA) and 1.2 J/cm<span class="elsevierStyleSup">2</span> (NB-UVB) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Patient 1 presented complete and prolonged response, remaining free of symptoms for more than 5 years with an annual cycle of UVA/NB-UVB CT (17–26 sessions before the beginning of the summer, 4 cycles in total). The second patient completed 36 sessions of UVA/NB-UVB CT during the first year, with no clinical improvement, and so phototherapy was discontinued.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">AP is generally idiopathic, although up to 30% of cases have been associated with hematological conditions such as polycythemia vera or myelodysplasia,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and 25% of cases may be associated with lactose intolerance. Other known associations include neoplasms, hepatitis C, and drugs such as bupropion and antimalarial agents.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Idiopathic AP occurs more frequently in young women and has a longer duration than AP with a known cause.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> AP may seriously impact activities of daily living; it has been reported that up to 8% of patients may develop phobia of washing.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> One of our patients avoided getting her legs wet for fear of triggering pruritus and burning sensation. The pathophysiology of AP is not fully understood, although it is thought there is increased skin innervation with dysfunctional and hyperexcitable C-nerve fibers, probably caused by defective sodium channels.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The role of histamine is minimal, thus explaining the limited response to antihistamine agents. Treatment of AP is complex and, often, outcomes are disappointing for both the physician and the patient.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Different topical treatments have been used such as increasing the pH of water with sodium bicarbonate, capsaicin, and glycerol trinitrate. Oral drugs such as antihistamine agents, pregabalin, acetylsalicylic acid, beta blockers (propranolol, atenolol), and antidepressant drugs, among others have been tried (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> There have also been reports of patients treated with interferon and omalizumab.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Phototherapy is one of the most effective treatment modalities, including psoralene plus UVA (PUVA) and UVB. However, this is not curative and requires maintenance therapy to achieve symptomatic remission.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> This can be problematic with PUVA, given its carcinogenic potential. NB-UVB has a better safety profile, but evidence for its use in AP is very limited, with only 3 case reports available. In all cases, it was effective in inducing remission. In 2 patients, a weekly dose was required to maintain clinical response for 4 and 6 months, respectively.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> This regimen is associated with substantial logistic issues and expense. The third patient relapsed after suspending phototherapy and this was discontinued; propranolol was initiated with good response.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Including our patients, there are 3 cases reported of treatment with UVA/NB-UVB CT in which an annual cycle is used as maintenance therapy, with excellent response in 2 of them<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> while 1 case was refractory. Phototherapy probably acts as a neuromodulator, reducing the density of skin nerve fibers and levels of neural growth factors,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> in addition to its well-established immunomodulatory effect.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Treatment of AP is difficult. We have reported a new case of treatment with UVA/NB-UVB CT, without clinical response, and long-term follow-up of a female patient treated for more than 5 years (4 cycles of UVA/NB-UVB CT) with complete remission of symptoms. Cycles of UVA/NB-UVB CT once a year may be a good alternative for long-term management of some patients with refractory AP.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0025" class="elsevierStylePara elsevierViewall">This study did not receive any funding.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Discussion" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Funding" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-02-04" "fechaAceptado" => "2019-02-17" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as: Morgado-Carrasco D, Riera-Monroig J, Feola H, Aguilera P. Tratamiento de 2 pacientes con prurito acuagénico con ciclos de terapia combinada UVA/UVB de banda estrecha una vez por año. Actas Dermosifiliogr. 2020;111:889–892.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Abbreviations: F, female; NB UVB, narrow-band UVB; UVA/NB-UVB CT, UVA/narrow-band UVB combined therapy.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Case \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sex/Age, y \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Comorbidities \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Family History \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Duration of Symptoms \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Prior Treatments \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">UVA/NB-UVB CT Induction Dose \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Number of Sessions \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Maximum Dose \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total Number of Cycles of UVA/NB-UVB CT \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Clinical Response \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F/52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes, mother with aquagenic pruritus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">> 5 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Antihistamines, montelukast, beta-carotene \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 J/cm<span class="elsevierStyleSup">2</span> (UVA) and 200 mJ/cm<span class="elsevierStyleSup">2</span> (NB-UVB) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 to 26/year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 J/cm<span class="elsevierStyleSup">2</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> (UVA) and 1.2 J/cm<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Complete \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F/31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Celiac disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">> 5 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Antihistamines, montelukast \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 J/cm<span class="elsevierStyleSup">2</span> (UVA) and 200 mJ/cm<span class="elsevierStyleSup">2</span> (NB-UVB) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 J/cm<span class="elsevierStyleSup">2</span> (UVA) and 1.2 mJ/cm<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No clinical response <a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2469265.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">The maximum dose of UVA was 9 J/cm<span class="elsevierStyleSup">2</span> the first year, and in the following cycles, it did not exceed 5 J/cm<span class="elsevierStyleSup">2</span>. The total dose after 4 cycles of UVA/NB-UVB CT was 266.5 J/cm<span class="elsevierStyleSup">2</span> (UVA) and 89.6 J/cm<span class="elsevierStyleSup">2</span> (NB-UVB).</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Patient 2 discontinued phototherapy after 36 sessions and has not repeated treatment.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical and Epidemiological Characteristics and Therapeutic Response of Patients With Aquagenic Pruritus in UVA and Narrow-Band UVB Combination Therapy.</p>" ] ] 1 => array:9 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Heitkemper et al.,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Cao et al.,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Murphy et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>" "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Abbreviations: UVA/NB-UVB CT, UVA/narrow-band UVB combined therapy; NB UVB, narrow band UVB; PUVA, psoralene with UVA.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Route of Administration \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Agent \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Topical \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Increased bath pH (pH 8) with sodium bicarbonate (0.1−0.6 kg/bath)Capsaicin (0.025% to 1% 3 times a day for 4 weeks)Glycerol trinitrate 2% gelTransdermal scopolamine 3% or 9% in water, acetone, or ethanol before bathing \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Antihistamines (hydroxyzine, astemizole, chlorpheniramine, cetirizine, loratadine, fexofenadine, terfenadine)H2 blockers (cimetidine 900 mg/d)Acetylsalicylic acid 300−500 mg/dPregabalin 150−300 mg/dOpioid receptor antagonists (naltrexone 25−50 mg/d)Serotonin reuptake inhibitors (paroxetine 20 mg/d, fluoxetine 10 mg/d)Interferon-α 2b (week 1: 5 × 3 thousand IU, week 2−4: 3 × 3 thousand IU)Beta blockers (propranolol 10 mg/d, 20−30 min before bathing, or 60 mg/d and atenolol 25 mg/d)CholestyramineMontelukast \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Intramuscular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Triamcinolone \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Subcutaneous \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Omalizumab (300 mg every 4 weeks) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Others \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Transcutaneous electrical nerve stimulationUse of tight-fitting Lycra clothing \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Phototherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PUVAUVBNB-UVBUVA/NB-UVB CT \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2469264.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Drugs and Different Agents Used in the Treatment of Aquagenic Pruritus.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence and characteristics of aquagenic pruritus in a young African population" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T.A. Salami" 1 => "S.O. Samuel" 2 => "K.C. Eze" 3 => "E. Irekpita" 4 => "E. Oziegbe" 5 => "M.O. Momoh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1471-5945-9-4" "Revista" => array:5 [ "tituloSerie" => "BMC Dermatol." "fecha" => "2009" "volumen" => "9" "paginaInicial" => "4" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19374742" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aquagenic pruritus: associated diseases and clinical pruritus characteristics" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T. Heitkemper" 1 => "T. Hofmann" 2 => "N.Q. Phan" 3 => "S. Ständer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1610-0387.2010.07463.x" "Revista" => array:6 [ "tituloSerie" => "J Dtsch Dermatol Ges." 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 5 | 4 | 9 |
| 2024 Octubre | 166 | 50 | 216 |
| 2024 Septiembre | 156 | 40 | 196 |
| 2024 Agosto | 185 | 60 | 245 |
| 2024 Julio | 168 | 27 | 195 |
| 2024 Junio | 143 | 66 | 209 |
| 2024 Mayo | 147 | 53 | 200 |
| 2024 Abril | 139 | 33 | 172 |
| 2024 Marzo | 112 | 27 | 139 |
| 2024 Febrero | 92 | 34 | 126 |
| 2024 Enero | 95 | 40 | 135 |
| 2023 Diciembre | 75 | 22 | 97 |
| 2023 Noviembre | 112 | 46 | 158 |
| 2023 Octubre | 116 | 36 | 152 |
| 2023 Septiembre | 119 | 38 | 157 |
| 2023 Agosto | 103 | 17 | 120 |
| 2023 Julio | 118 | 38 | 156 |
| 2023 Junio | 148 | 24 | 172 |
| 2023 Mayo | 102 | 23 | 125 |
| 2023 Abril | 79 | 28 | 107 |
| 2023 Marzo | 90 | 22 | 112 |
| 2023 Febrero | 88 | 43 | 131 |
| 2023 Enero | 74 | 38 | 112 |
| 2022 Diciembre | 76 | 46 | 122 |
| 2022 Noviembre | 58 | 32 | 90 |
| 2022 Octubre | 72 | 46 | 118 |
| 2022 Septiembre | 49 | 37 | 86 |
| 2022 Agosto | 51 | 52 | 103 |
| 2022 Julio | 25 | 48 | 73 |
| 2022 Junio | 37 | 42 | 79 |
| 2022 Mayo | 131 | 59 | 190 |
| 2022 Abril | 209 | 57 | 266 |
| 2022 Marzo | 183 | 78 | 261 |
| 2022 Febrero | 224 | 41 | 265 |
| 2022 Enero | 330 | 56 | 386 |
| 2021 Diciembre | 290 | 65 | 355 |
| 2021 Noviembre | 281 | 52 | 333 |
| 2021 Octubre | 307 | 62 | 369 |
| 2021 Septiembre | 253 | 54 | 307 |
| 2021 Agosto | 334 | 53 | 387 |
| 2021 Julio | 418 | 47 | 465 |
| 2021 Junio | 231 | 37 | 268 |
| 2021 Mayo | 143 | 54 | 197 |
| 2021 Abril | 204 | 85 | 289 |
| 2021 Marzo | 117 | 50 | 167 |
| 2021 Febrero | 91 | 54 | 145 |
| 2021 Enero | 74 | 46 | 120 |
| 2020 Diciembre | 62 | 32 | 94 |
| 2020 Noviembre | 34 | 11 | 45 |
| 2020 Octubre | 1 | 0 | 1 |
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