Chronic Pruritus: The Status Quo and Prospects
Authors:
N. Benáková 1,2
Authors‘ workplace:
Dermatovenerologická klinika 1. LF UK, Praha, přednosta prof. MUDr. Jiří Štork, CSc.
1; Dermato-alergologická ordinace Immuno Flow Praha, vedoucí lékař MUDr. Martin Fuchs
2
Published in:
Čes-slov Derm, 95, 2020, No. 1, p. 3-14
Category:
Reviews (Continuing Medical Education)
Overview
Chronic itch afflicts a substantial part of the population and represents a crux medicorum for physicians. It is the most frequent symptom of patients with skin diseases, but it can also be a symptom of severe internal, neurological or psychiatric diseases. Pathophysiology is still not sufficiently elucidated. It is based on complex processes in the skin, where the interaction of keratinocytes, mastocytes and other immune cells with sensoric nerves plays a role, both in the induction and the regulation of itch. Treatment and management should be comprehensively conceived and designed individually, based on the clinical type and possible pathophysiology of pruritus in a particular patient. All available possibilities should be utilized, including suitable topical therapy and skin care that has made progress in both active substances and comfortable compounded forms. It proceeds step by step, from simpler to more demanding, combined procedures, taking into account the severity of pruritus, co-morbidity, age, medications used, and the benefits of the treatment under consideration to its risks. In addition to non-sedating H1 antihistamines, which usually do not have sufficient effect, other options are anticonvulsants, antidepressants, opioids and UV light phototherapy. Research on new drugs is underway, H4 antihistamines and neurokinin 1 receptor antagonists are promising.
Keywords:
chronic pruritus – pathophysiology – current treatment – prospects
Sources
1. BREANNAN, F. The pathophysiology of pruritus – A review for clinicians. Progress in paliative care, 2016, 24(3), p. 133–147.
2. ELMARIA, S. B., LERNER, E. A. The missing link between itch and inflammation in atopic dermatitis. Cell, 2013, 2, p. 267–269.
3. GRUNDMANN, S., STÄNDER, S. Chronic pruritus: Clinics and treatment. Ann Dermatol, 2011, 23, p. 1–11.
4. HAN, L., DONG, X. Itch Mechanisms and Circuits. Annu Rev Biophys, 2014, 43(6), p. 331–355.
5. HIOM, S., PATEL, G. K., NEWCOMB, R. G. et al. Severe postherpetic neuralgy and other neuropathic pain syndromes alleviated by topical gabapentin. Br J Dermatol, 2015, 173(1), p. 300–302.
6. JAŠKOVÁ, E., TARABA, P. Pruritus- komplexní terapie. Dermatol praxi, 2009, 3, s. 125–130.
7. LEE, Y. W., WON, CH., JUNG, K., NAM, H. J. et al. Efficacy and safety of PAC‐14028 cream – a novel, topical, nonsteroidal, selective TRPV1 antagonist in patients with mild‐to‐moderate atopic dermatitis: a phase IIb randomized trial. Br J Dermatol, 2019. Doi: 10.1111/bjd.17455.
8. MAN, M.Q., ELIAS, P. M. Stratum corneum hydration regulates key epidermal function and serves as an indicator and contributor to other conditions. JEADV, 2019, 33, p. 15–16.
9. METZ, M., STÄNDER, S. Chronic pruritus-pathogenesis, clinical aspects and treatments. JEADV, 2010, 24, p. 1249–1260.
10. MISERY, L., LOSER, K., STÄNDER, S. Sensitive skin. JEADV, 2016, 30(Suppl 1), p. 2–8.
11. MOLLANAZAR, N. K., KOCH, S. D.,YOSIPOVICH, G. Epidemiology of chronic pruritus: Where have we been and where are we going ? Curr Derm Rep, 2015, 4, p. 20–29.
12. NORÉN, P. et al. The positive effects of habit reversal treatment of scratching in children with atopic dermatitis. Br J Dermatol, 2018, 178, p. 665–673.
13. PÁNKOVÁ, R. Diferenciální diagnostika pruritu. Čs Derm, 2012, 87(4), p. 130–135.
14. PEREIRA, M. P., KREMER, A. E., METTANG, T. et al. Chronic pruritus in the absence of skin disease: pathophysiology, diagnosis and treatment. Am J Clin Dermatol, 2016, 17(4), p. 337–348.
15. POTENZIERI, C., UNDEM, B. J. Basic Mechanisms of Itch. Clin Exp Allergy, 2012, 42(1), p. 8–19.
16. SHUMWAY, N. K., COLE, E., FERNANDEZ, K. H. Neurocutaneous disease: Neurocutaneous dysesthesias. J Am Acad Dermatol, 2016, 74(2), p. 215–228.
17. STÄNDER, S., DARSOW, U., METTANG, T. et al. Chronischer Pruritus – Leitlinie der DDG. 2009. Dostupné na www: www.ddg.de.
18. TEY, H. L., YOSIPOVICH, G. Targeted treatment of pruritus: a look into the future. Br J Dermatol, 2011, 165, p. 5–17.
19. WEISSHAAR, E., SZEPIETOWSKI, J. C., DARSOW, J. C. et al. European Guideline on Chronic Pruritus (EDF, EADV). Dostupné na www: www.edf.com.
20. YOSIPOVITCH, G., ROSEN, J. D., HASHIMOTO, T. Itch: from mechanism to (novel) therapeutic approaches. JAACI, 2018, 142(5), p. 1375–1390.
Labels
Dermatology & STDs Paediatric dermatology & STDsArticle was published in
Czech-Slovak Dermatology
2020 Issue 1
Most read in this issue
- Chronic Pruritus: The Status Quo and Prospects
- Registry of Biological/Targeted Therapy BIOREP – Summary Report 2019
- Bazaliom v koincidenci s lentigo maligna melanoma
- Red Maculopapules on the Left Side of the Neck – Tufted Hemangioma.