Ann Dermatol.  2011 Feb;23(1):1-11. 10.5021/ad.2011.23.1.1.

Chronic Pruritus: Clinics and Treatment

• Grundmann
• Stander S

• KMID: 2171945
• DOI: http://doi.org/10.5021/ad.2011.23.1.1

Abstract

Chronic pruritus, one of the main symptoms in dermatology, is often intractable and has a high impact on patient's quality of life. Beyond dermatologic disorders, chronic pruritus is associated with systemic, neurologic as well as psychologic diseases. The pathogenesis of acute and chronic (>6 weeks duration) pruritus is complex and involves in the skin a network of resident (e.g., sensory neurons) and transient inflammatory cells (e.g., lymphocytes). In the skin, several classes of histamine-sensitive or histamine-insensitve C-fibers are involved in itch transmission. Specific receptors have been discovered on cutaneous and spinal neurons to be exclusively involved in the processing of pruritic signals. Chronic pruritus is notoriously difficult to treat. Newer insights into the underlying pathogenesis of pruritus have enabled novel treatment approaches that target the pruritus-specific pathophysiological mechanism. For example, neurokinin-1 antagonists have been found to relieve chronic pruritus.

Keyword

Atopic dermatitis; Itch; Pathophysiology; Pruritus; Therapy

MeSH Terms

Dermatitis, Atopic
Dermatology
Neurons
Pruritus
Quality of Life
Skin

Figure

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  Fig. 1 Clinical groups of patients with chronic pruritus. Chronic pruritus occurs on primarily diseased skin (i.e., dermatosis, group 1) or on normal skin (group 2). Chronic scratch lesions may be predominant and alter the clinical picture (group 3).

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  Fig. 2 Clinical classification in the management of chronic pruritus patients (1). As a first step, patients were grouped according to the clinical picture. Subsequent clinical, laboratory and radiological investigation enables categorization of patient concerning the underlying origin. If several diseases were found (e.g., dry skin and chronic renal insufficiency) the patient has a mixed (multifactorial) origin. If no causal disease is identified, the patient has a pruritus of unknown/undetermined origin (PUO).

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