Conflicts of interest M Metz was or is speaker for Abdi Ibrahim, Essex Pharma, Merckle-Recordati, MSD, Novartis Pharma, Uriach Pharma. S Ständer was or is consultant, speaker and/or investigator for Aesca Pharma, Almirall/Hermal, Astellas Pharma, Beiersdorf AG, Birken, Essex Pharma, Pierre Fabre, Maruho, 3M Medica, Mundipharma, Novartis Pharma, Serentis, Serono and Stiefel Laboratorium.
Chronic pruritus – pathogenesis, clinical aspects and treatment
Version of Record online: 15 SEP 2010
© 2010 The Authors. Journal of the European Academy of Dermatology and Venereology © 2010 European Academy of Dermatology and Venereology
Journal of the European Academy of Dermatology and Venereology
Volume 24, Issue 11, pages 1249–1260, November 2010
How to Cite
Metz, M. and Ständer, S. (2010), Chronic pruritus – pathogenesis, clinical aspects and treatment. Journal of the European Academy of Dermatology and Venereology, 24: 1249–1260. doi: 10.1111/j.1468-3083.2010.03850.x
- Issue online: 6 OCT 2010
- Version of Record online: 15 SEP 2010
- Received: 26 May 2010; Accepted: 16 August 2010
- atopic dermatitis;
- mast cell;
Chronic pruritus is a major symptom in numerous dermatological and systemic diseases. Similar to chronic pain, chronic pruritus can have a dramatic impact on the quality of life and can worsen the general condition of the patient considerably. The pathogenesis of itch is diverse and involves a complex network of cutaneous and neuronal cells. In recent years, more and more itch-specific mediators and receptors, such as interleukin-31, gastrin-releasing peptide receptor or histamine H4 receptor have been identified and the concept of itch-specific neurons has been further characterized. Understanding of the basic principles is important for development of target-specific treatment of patients with chronic pruritus. In this review, we summarize the current knowledge about the pathophysiological principles of itch and provide an overview about current and future treatment options.
- •Chronic pruritus is a common problem affecting a large proportion of the population.
- •The pathophysiological mechanisms underlying chronic pruritus are still insufficiently understood.
- •In the skin, diverse and complex interactions of keratinocytes, mast cells and sensory nerves largely determine the occurrence and the control of pruritus.
- •Management of patients with chronic pruritus requires an individually tailored therapy based on the condition of the skin (inflamed or non-inflamed), possible underlying causes and existing co-medication.
- •Systemic treatment with antihistamines often requires up-dosing up to 4-fold of the recommended daily dose.
- •Alternative systemic treatments of chronic pruritus are anticonvulsant drugs, μ-opioid receptor antagonists, antidepressants and UV light therapy.
- •Novel treatment options for chronic pruritus are to be expected in the near future and include H4 receptor antagonists, κ-opioid receptor agonists and neurokinin 1-receptor antagonists.