Perspectives in the treatment of pruritus: Focus on new strategies

Pruritus is a common symptom and the main source of morbidity in dermatologic diseases. Current management has been hampered by our inadequate understanding of the pathomechanisms of pruritus, but recent advances in elucidating the mediators, receptors and neuronal pathways hold promise for the development of new translational therapies. These mediators and receptors in the skin, peripheral nerves, spinal cord and brain form markers that drugs can be directed to inhibit via itch-transmitting pathways. Such targeted therapy is likely to be more effective and produce less side effects. Clinically, the treatment of pruritus should be tailored for different pruritic diseases, individualized for different patients and instituted early before the development of central sensitization. Chronic pruritus is a multidimensional problem and management requires a holistic approach, addressing the peripheral skin and neuronal pathologies, aberrant central processes and psychosocial factors.