Current topical and systemic therapies for itch

Tabi Anika Leslie, Malcolm W. Greaves, Gil Yosipovitch

Research output: Contribution to journalArticle

34 Scopus citations

Abstract

Itch is a common distressing symptom which may be caused by multifactorial aetiologies including inflammatory skin diseases, systemic diseases, neuropathic conditions and psychogenic disorders. Itch is a term used synonymously with pruritus and is defined as acute if it lasts less than 6 weeks or chronic if it persists for more than 6 weeks. It can have the same impact on the quality of life as chronic pain and shares many of the same pathophysiological pathways. Depending on the aetiology of the itch, different pathogenic mechanisms have been postulated with a number of mediators identified. These include histamine, leukotrienes, proteases, neuropeptides, cytokines and opioids, which may activate peripheral itch-mediating C-fibres via receptors on the nerve terminals and central neuronal pathways. Therefore, there is no single universally effective anti-itch treatment available. First-line treatments for itch include topical therapies, such as emollients, mild cleansers (low pH), topical anaesthetics, steroids, calcineurin inhibitors and coolants (menthol). Treatment with systemic therapies can vary according to the aetiology of the chronic itch. Non-sedating antihistamines are helpful in conditions such as urticaria where the itch is primarily histamine mediated. Although the itch of eczema is not mediated by histamine, sedating antihistamines at night are helpful to break the itch-scratch cycle. Chronic itch may also be treated with other systemic therapies, such as anticonvulsants, antidepressants as well as mu-opioid antagonists, kappa-opioid agonists and phototherapy, depending on the cause of the itch. This article summarises the topical and systemic therapies available with our current understanding of the pathophysiology of itch.

Original languageEnglish (US)
Pages (from-to)337-356
Number of pages20
JournalHandbook of experimental pharmacology
Volume226
DOIs
StatePublished - 2015

Keywords

  • Acute
  • Anticonvulsants
  • Antidepressants
  • Antihistamines
  • C-fibres
  • Capsaicin
  • Central neuronal pathways
  • Chronic
  • Emollients
  • Glucocorticoids
  • Itch
  • Menthol
  • Opioids
  • Pain
  • Peripheral neuronal pathways
  • Phototherapy
  • Pruritus
  • Systemic
  • Topical

ASJC Scopus subject areas

  • Biochemistry
  • Pharmacology, Toxicology and Pharmaceutics(all)

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