Pruritus. Pathomechanism, management and novel treatment
DOI:
https://doi.org/10.12775/JEHS.2023.17.01.013Keywords
pruritus, chronic pruritus, pruritus treatment, mechanism of itch, itch managementAbstract
Introduction
Itching is an unpleasant sensation that is commonly experienced in the general population. It accompanies many diseases. This sensory experience is burdensome and significantly reduces the quality of life. The mechanism of itching is complex. It involves receptors, the histaminergic and non-histaminergic pathways, cytokines, neuropeptides, neurotransmitters, proteases, and enzymes. External factors such as temperature or capsaicin also influence itching.
Aim of the study
This review presents the current state of knowledge regarding therapy in the treatment of itching. Also aims to show that it is a complicated process. Pruritus is a very bothersome sensory sensation and is a common symptom.
Material and methods
This review was based on scientific books on human physiology and dermatology were used, which are listed in the bibliography and available data collected in the PubMed and Google Scholar database. Using key words: itch, management, pathogenesis, pathophysiology, pruritus, therapeutics, treatments.
Conclusion
The latest research on itching has led to a better understanding of this complex mechanism. As a result, there is a possibility of discovering new, innovative treatment methods that are targeted at specific elements of this process or work systemically. Understanding the broad etiology assists in identifying the cause and in implementing an appropriate therapeutic strategy. Further research will enable improvements in treatment and enhance patient comfort.
References
Jacek Szepietowski, Wojciech Baran. Terapia w dermatologii. Wydanie I 2020 Warszaw, strona 176.
Zeidler C, Raap U, Witte F, Ständer S. Clinical aspects and management of chronic itch. J Allergy Clin Immunol. 2023 Jul;152(1):1-10. doi: 10.1016/j.jaci.2023.04.018. Epub 2023 May 11. PMID: 37178730.
Weisshaar E, Szepietowski JC, Dalgard FJ, Garcovich S, Gieler U, Giménez-Arnau AM, Lambert J, Leslie T, Mettang T, Misery L, Şavk E, Streit M, Tschachler E, Wallengren J, Ständer S. European S2k Guideline on Chronic Pruritus. Acta Derm Venereol. 2019 Apr 1;99(5):469-506. doi: 10.2340/00015555-3164. PMID: 30931482.
Villa-Arango AM, Velásquez-Lopera MM, Cardona R. Prurito crónico [Chronic pruritus]. Rev Alerg Mex. 2019 Jan-Mar;66(1):85-98. Spanish. doi: 10.29262/ram.v66i1.345. PMID: 31013410.
Dee Unglaub Silverthorn, Ph D. Bruce R. Johnson, Ph. D. Redakcja naukowa wydania polskiego prof. dr hab. n. med. Beata Ponikowska. Fizjologia człowieka zintegrowane podejście. Wydanie I Warszawa 2018. Strona 255.
Kittaka H, Tominaga M. The molecular and cellular mechanisms of itch and the involvement of TRP channels in the peripheral sensory nervous system and skin. Allergol Int. 2017 Jan;66(1):22-30. doi: 10.1016/j.alit.2016.10.003. Epub 2016 Dec 21. PMID: 28012781.
Tóth BI, Oláh A, Szöllősi AG, Bíró T. TRP channels in the skin. Br J Pharmacol. 2014 May;171(10):2568-81. doi: 10.1111/bph.12569. PMID: 24372189; PMCID: PMC4009000.
Ikoma A, Steinhoff M, Ständer S, Yosipovitch G, Schmelz M. The neurobiology of itch. Nat Rev Neurosci. 2006 Jul;7(7):535-47. doi: 10.1038/nrn1950. PMID: 16791143.
YOSIPOVITCH, Gil; BERNHARD, Jeffrey D. Chronic pruritus. New England Journal of Medicine, 2013, 368.17: 1625-1634.
STÄNDER, Sonja, et al. Clinical classification of itch: a position paper of the International Forum for the Study of Itch. Acta dermato-venereologica, 2007, 87.4: 291-294.
Metz M, Ständer S. Chronic pruritus--pathogenesis, clinical aspects and treatment. J Eur Acad Dermatol Venereol. 2010 Nov;24(11):1249-60. doi: 10.1111/j.1468-3083.2010.03850.x. Epub 2010 Sep 15. PMID: 20846147.
Bochenek, Sabina, Anna Partyka, and Anna Wesołowska. “Świąd W Schorzeniach Dermatologicznych – Patogeneza I Leczenie,” n.d.
Elmariah SB, Lerner EA. Topical therapies for pruritus. Semin Cutan Med Surg. 2011 Jun;30(2):118-26. doi: 10.1016/j.sder.2011.04.008. PMID: 21767774; PMCID: PMC3139917.
R. Palkar, S. Ongun, E. Catich, et al.Cooling relief of acute and chronic itch requires TRPM8 channels and neurons J Invest Dermatol, 138 (6) (2018), pp. 1391-1399
Loden M. Role of topical emollients and moisturizers in the treatment of dry skin barrier disorders. Am J Clin Dermatol 2003; 4: 771–788
Elmariah SB, Lerner EA. Topical therapies for pruritus. Semin Cutan Med Surg 2011; 30: 118–126.
H.H. Andersen, L. Arendt-Nielsen, J. Elberling Topical capsaicin 8% for the treatment of neuropathic itch conditions Clin Exp Dermatol, 42 (5) (2017), pp. 596-598
Elmariah SB, Lerner EA. Topical therapies for pruritus. Semin Cutan Med Surg 2011; 30: 118–126.
Tsuda K, Yamanaka K, Kitagawa H, Akeda T, Naka M, Niwa K, et al. Calcineurin inhibitors suppress cytokine produc-tion from memory T cells and differentiation of naive T cells into cytokine-producing mature T cells. PLoS One 2012; 7: e31465
S. Ständer, F. Schürmeyer-Horst, T.A. Luger, E. Weisshaar Treatment of pruritic diseases with topical calcineurin inhibitors Ther Clin Risk Manag, 2 (2) (2006), pp. 213-218, 10.2147/tcrm.2006.2.2.213
Pereira U, Boulais N, Lebonvallet N, Pennec JP, Dorange G, Misery L. Mechanisms of the sensory effects of tacrolimus on the skin. Br J Dermatol. 2010 Jul;163(1):70-7. doi: 10.1111/j.1365-2133.2010.09757.x. Epub 2010 Mar 10. PMID: 20302583.
WOJAS-PELC, Anna; SETKOWICZ, Małgorzata; BOGDASZEWSKA-CZABANOWSKA, Jadwiga. Kortykosteroidy w miejscowej terapii chorób skóry: korzyści i efekty uboczne. Przegląd Lekarski, 2002, 59.3.
Weisshaar E, Szepietowski JC, Dalgard FJ, Garcovich S, Gieler U, Giménez-Arnau AM, et al. European S2k guideline on chronic pruritus. Acta Derm Venereol. 2019 Apr 1; 99(5): 469-506.
Shevchenko A, Valdes-Rodriguez R, Yosipovitch G. Causes, pathophysiology, and treatment of pruritus in the mature patient. Clin Dermatol 2018; 36: 140–151
G. Yosipovitch, L.F. Gold, M.G. Lebwohl, J.I. Silverberg, A.M. Tallman, L.T. Zane Early relief of pruritus in atopic dermatitis with Crisaborole ointment, A non-steroidal phosphodiesterase 4 inhibitor Acta Derm Venereol, 98 (5) (2018), pp. 484-489, 10.2340/00015555-2893
A.S. Paller, W.L. Tom, M.G. Lebwohl, et al. Efficacy and safety of crisaborole ointment, a novel, nonsteroidal phosphodiesterase 4 (PDE4) inhibitor for the topical treatment of atopic dermatitis (AD) in children and adults J Am Acad Dermatol, 75 (3) (2016), pp. 494-503.e6, 10.1016/j.jaad.2016.05.046
P.J. Dunford, K.N. Williams, P.J. Desai, L. Karlsson, D. McQueen, R.L. Thurmond Histamine H4 receptor antagonists are superior to traditional antihistamines in the attenuation of experimental pruritus J Allergy Clin Immunol, 119 (2007), pp. 176-183
L.A. Drake, J.D. Fallon, A. Sober Relief of pruritus in patients with atopic dermatitis after treatment with topical doxepin cream. The doxepin Study Group J Am Acad Dermatol, 31 (4) (1994), pp. 613-616, 10.1016/S0190-9622(94)70225-X
Patel T, Yosipovitch G. Therapy of pruritus. Expert Opin Pharmacother. 2010 Jul; 11(10): 1673-82.
R. Bissonnette, K.A. Papp, Y. Poulin, M. Gooderham, M. Raman, L. Mallbris, et al. Topical tofacitinib for atopic dermatitis: a phase IIa randomized trial Br J Dermatol, 175 (2016), pp. 902-911
H. Nakagawa, O. Nemoto, H. Yamada, T. Nagata, N. Ninomiya Phase 1 studies to assess the safety, tolerability and pharmacokinetics of JTE-052 (a novel Janus kinase inhibitor) ointment in Japanese healthy volunteers and patients with atopic dermatitis J Dermatol, 45 (2018), pp. 701-709
Ikoma A, Steinhoff M, Ständer S, Yosipovitch G, Schmelz M. The neurobiology of itch. Nat Rev Neurosci. 2006 Jul;7(7):535-47. doi: 10.1038/nrn1950. PMID: 16791143.
Dunford PJ, Williams KN, Desai PJ, Karlsson L, McQueen D, Thurmond RL. Histamine H4 receptor antagonists are superior to traditional antihistamines in the attenuation of experimental pruritus. J Allergy Clin Immunol. 2007 Jan;119(1):176-83. doi: 10.1016/j.jaci.2006.08.034. Epub 2006 Oct 13. PMID: 17208599.
Nowak DA, Yeung J. Diagnosis and treatment of pruritus. Can Fam Physician. 2017; 63(12): 918-924.
Weisshaar E, Szepietowski JC, Darsow U, Misery L, Wallengren J, et al. European guideline on chronic pruritus. Acta Derm Venereol. 2012 Sep; 92(5): 563-81.
Cataldi M, Maurer M, Taglialatela M, Church MK. Cardiac safety of second-generation H1 -antihistamines when updosed in chronic spontaneous urticaria. Clin Exp Allergy. 2019 Dec;49(12):1615-1623. doi: 10.1111/cea.13500. Epub 2019 Oct 18. PMID: 31519068.
Leslie TA, Greaves MW, Yosipovitch G. Current topical and systemic therapies for itch. Handb Exp Pharmacol. 2015;226:337-56. doi: 10.1007/978-3-662-44605-8_18. PMID: 25861788.
Cedeno-Laurent F, Singer EM, Wysocka M, Benoit BM, Vittorio CC, Kim EJ, Yosipovitch G, Rook AH. Improved pruritus correlates with lower levels of IL-31 in CTCL patients under different therapeutic modalities. Clin Immunol. 2015 May;158(1):1-7. doi: 10.1016/j.clim.2015.02.014. Epub 2015 Mar 8. PMID: 25762519; PMCID: PMC4420663.
Terg R, Coronel E, Sordá J, Muñoz AE, Findor J. Efficacy and safety of oral naltrexone treatment for pruritus of cholestasis, a crossover, double blind, placebo-controlled study. J Hepatol. 2002 Dec;37(6):717-22. doi: 10.1016/s0168-8278(02)00318-5. PMID: 12445410.
Malekzad F, Arbabi M, Mohtasham N, Toosi P, Jaberian M, Mohajer M, Mohammadi MR, Roodsari MR, Nasiri S. Efficacy of oral naltrexone on pruritus in atopic eczema: a double-blind, placebo-controlled study. J Eur Acad Dermatol Venereol. 2009 Aug;23(8):948-50. doi: 10.1111/j.1468-3083.2009.03129.x. Epub 2009 May 6. PMID: 19453814.
Megna M, Napolitano M, Patruno C, Villani A, Balato A, Monfrecola G, Ayala F, Balato N. Systemic Treatment of Adult Atopic Dermatitis: A Review. Dermatol Ther (Heidelb). 2017 Mar;7(1):1-23. doi: 10.1007/s13555-016-0170-1. Epub 2016 Dec 26. PMID: 28025775; PMCID: PMC5336433.
Roh YS, Khanna R, Patel SP, Gopinath S, Williams KA, Khanna R, Pritchard T, Sutaria N, Choi J, Alphonse MP, Kwatra MM, Kwatra SG. Circulating blood eosinophils as a biomarker for variable clinical presentation and therapeutic response in patients with chronic pruritus of unknown origin. J Allergy Clin Immunol Pract. 2021 Jun;9(6):2513-2516.e2. doi: 10.1016/j.jaip.2021.01.034. Epub 2021 Feb 3. PMID: 33548514.
Steinhoff M, Cevikbas F, Ikoma A, Berger TG. Pruritus: management algorithms and experimental therapies. Semin Cutan Med Surg. 2011 Jun; 30(2): 127-37.
Leslie TA, Greaves MW, Yosipovitch G. Current topical and systemic therapies for itch. Handb Exp Pharmacol. 2015;226:337-56. doi: 10.1007/978-3-662-44605-8_18. PMID: 25861788.
Bockbrader HN, Wesche D, Miller R, Chapel S, Janiczek N, Burger P. A comparison of the pharmacokinetics and pharmacodynamics of pregabalin and gabapentin. Clin Pharmacokinet. 2010 Oct;49(10):661-9. doi: 10.2165/11536200-000000000-00000. PMID: 20818832.
Weisshaar E, Szepietowski JC, Dalgard FJ, Garcovich S, Gieler U, Giménez-Arnau AM, Lambert J, Leslie T, Mettang T, Misery L, Şavk E, Streit M, Tschachler E, Wallengren J, Ständer S. European S2k Guideline on Chronic Pruritus. Acta Derm Venereol. 2019 Apr 1;99(5):469-506. doi: 10.2340/00015555-3164. PMID: 30931482.
Gillman PK. Tricyclic antidepressant pharmacology and therapeutic drug interactions updated. Br J Pharmacol. 2007 Jul;151(6):737-48. doi: 10.1038/sj.bjp.0707253. Epub 2007 Apr 30. PMID: 17471183; PMCID: PMC2014120.
Anttila SA, Leinonen EV. A review of the pharmacological and clinical profile of mirtazapine. CNS Drug Rev. 2001 Fall;7(3):249-64. doi: 10.1111/j.1527-3458.2001.tb00198.x. PMID: 11607047; PMCID: PMC6494141.
Duval A, Dubertret L. Aprepitant as an antipruritic agent? N Engl J Med. 2009 Oct 1;361(14):1415-6. doi: 10.1056/NEJMc0906670. PMID: 19797294.
Santini D, Vincenzi B, Guida FM, Imperatori M, Schiavon G, Venditti O, Frezza AM, Berti P, Tonini G. Aprepitant for management of severe pruritus related to biological cancer treatments: a pilot study. Lancet Oncol. 2012 Oct;13(10):1020-4. doi: 10.1016/S1470-2045(12)70373-X. Epub 2012 Sep 18. PMID: 22995650.
Vincenzi, B., Tonini, G., & Santini, D. (2010). Aprepitant for erlotinib-induced pruritus. New England Journal of Medicine, 363(4), 397-398.
Apremilast w leczeniu łuszczycowego zapalenia stawów — stanowisko ekspertów Polskiego Towarzystwa Reumatologicznego i Polskiego Towarzystwa Dermatologicznego. Eugeniusz J. Kucharz, Marcin Stajszczyk, Bogdan Batko, Anna Kotulska, Piotr Leszczyński, Maria Majdan, Agnieszka Osmola-Mańkowska, Jacek Szepietowski, Piotr Wiland, Zygmunt Adamski, Marek Brzosko, Sławomir Jeka, Włodzimierz Samborski. Forum Reumatol 2016;2(3):97-105
GLIWICZ-MIEDZIŃSKA, Dorota; JANKOWSKA, Irena; PAWŁOWSKA, Joanna. Leczenie świądu w przebiegu chorób wątroby u dzieci.
Rivard J, Lim HW. Ultraviolet phototherapy for pruritus. Dermatol Ther. 2005 Jul-Aug;18(4):344-54. doi: 10.1111/j.1529-8019.2005.00032.x. PMID: 16297008.
Bulat V, Situm M, Dediol I, Ljubicić I, Bradić L. The mechanisms of action of phototherapy in the treatment of the most common dermatoses. Coll Antropol. 2011 Sep;35 Suppl 2:147-51. PMID: 22220423.
TANG, Yi, et al. Acupuncture for the treatment of itch: peripheral and central mechanisms. Frontiers in Neuroscience, 2022, 15: 786892.
BADWY, Moustafa, et al. Electrical neurostimulation for the treatment of chronic pruritus: A systematic review. Experimental Dermatology, 2022, 31.3: 280-289.
W.Y. Tang, L.Y. Chan, K.K. Lo, T.W. Wong Evaluation on the antipruritic role of transcutaneous electrical nerve stimulation in the treatment of pruritic dermatoses Dermatology, 199 (3) (1999), pp. 237-241, 10.1159/000018254
Ju, Teresa BS; Labib, Angelina BS; Vander Does, Ashley BA; Yosipovitch, Gil MD*. Therapeutics in chronic pruritus of unknown origin. Itch 8(1):p e64, January-March 2023. | DOI: 10.1097/itx.0000000000000064
H. van Os-Medendorp, W.J.G. Ros, P.C.M. Eland-de Kok, et al. Effectiveness of the nursing programme “Coping with itch”: a randomized controlled study in adults with chronic pruritic skin disease Br J Dermatol, 156 (6) (2007), pp. 1235-1244, 10.1111/j.1365-2133.2007.07919.x
Andrzej Szczeklik Piotr Gajewski. Interna Szczeklika 2022-2023. Medycyna Praktyczna. Kraków. Rok wydania 2022.
Stefania Jabłońska, Sławomir Majewski. – Choroby skóry i choroby przenoszone drogą płciową. Wdanie I – 13 dodruk. Warszawa 2021r.
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