Association of Neuropathic Itch With Patients’ Quality of Life

Lipman, Zoe M.; Yap, Qai Ven; Nattkemper, Leigh; Yosipovitch, Gil

doi:10.1001/jamadermatol.2021.2010

Cited by 4 publications

(6 citation statements)

References 8 publications

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“…Neuropathic topical therapies are effective for mild and localized pruritus and have low rates of systemic adverse effects . The antipruritic effects of topical anesthetics result from their effects to reduce nerve activity.…”

Section: Discussionmentioning

confidence: 99%

“…Response to treatment may be delayed. For example, neuropathic itch may require several weeks to months to attain dosing that is effective and well tolerated . Multiple treatments may be needed to achieve optimal symptom control.…”

Section: Discussionmentioning

confidence: 99%

“…Commonly used antipruritic topical anesthetics include pramoxine (1%-2%), lidocaine (2.5%-5%), prilocaine (2.5%), and capsaicin (0.075%-1%), all of which are particularly effective for neuropathic facial and anogenital itch. 41,43 In 66 patients, pramoxine (1%) showed comparable itch reduction scores, as measured by itch severity scores (possible scores, 0-10), when compared with hydrocortisone (1%) (59.7% reduction and 58% reduction, respectively) 8 hours after application. 44 Topical analgesics such as menthol in low concentrations (1%-5%) are used for neuropathic itch, such as brachioradial pruritus, and chronic pruritus of mixed etiology.…”

Section: Topical Agentsmentioning

confidence: 98%

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Chronic Pruritus

Butler,

Berger,

Elmariah

et al. 2024

JAMA

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ImportanceChronic pruritus, defined as itch experienced for 6 weeks or longer, affects approximately 22% of people in their lifetime. Approximately 1% of physician visits are for the chief concern of chronic pruritus. Chronic pruritus is associated with adverse outcomes, including impaired sleep and reduced quality of life.ObservationsChronic pruritus can be categorized by etiology into inflammatory, neuropathic, or a combination of inflammatory and neuropathic pruritus. Chronic pruritus is due to inflammation in approximately 60% of patients and may be caused by eczema, psoriasis, or seborrheic dermatitis. Chronic pruritus is due to a neuropathic or mixed etiology in approximately 25% of patients. Neuropathic causes of chronic pruritus include postherpetic neuralgia and notalgia paresthetica and are typically due to localized or generalized nerve dysregulation. Approximately 15% of people with chronic pruritus have other causes including systemic diseases with secondary itch, such as uremic pruritus and cholestatic pruritus, medication-induced pruritus such as pruritus due to immunotherapy, and infectious etiologies such as tinea corporis and scabies. When few primary changes are present, a thorough history, review of symptoms, and laboratory evaluation should be performed, particularly for people with chronic pruritus lasting less than 1 year. Clinicians should consider the following tests: complete blood cell count, complete metabolic panel, and thyroid function testing to evaluate for hematologic malignancy, liver disease, kidney disease, or thyroid disease. First-line treatment for inflammatory chronic pruritus includes topical anti-inflammatory therapies such as hydrocortisone (2.5%), triamcinolone (0.1%), or tacrolimus ointment. Approximately 10% of patients do not respond to topical therapies. In these patients, referral to dermatology and systemic oral or injectable treatments such as dupilumab or methotrexate may be considered. When no underlying systemic disease associated with pruritus is identified, patients are likely to have neuropathic chronic pruritus or mixed etiology such as chronic pruritus of unknown origin. In these patients, neuropathic topical treatments such as menthol, pramoxine, or lidocaine can be used either alone or in combination with immunomodulatory agents such as topical steroids. Other effective therapies for neuropathic pruritus include gabapentin, antidepressants such as sertraline or doxepin, or opioid receptor agonist/antagonists such as naltrexone or butorphanol.Conclusions and RelevanceChronic pruritus can adversely affect quality of life and can be categorized into inflammatory, neuropathic, or a combined etiology. First-line therapies are topical steroids for inflammatory causes, such as hydrocortisone (2.5%) or triamcinolone (0.1%); topical neuropathic agents for neuropathic causes, such as menthol or pramoxine; and combinations of these therapies for mixed etiologies of chronic pruritus.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Topical Agentsmentioning

confidence: 98%

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Chronic Pruritus

Butler,

Berger,

Elmariah

et al. 2024

JAMA

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“…Neuropathic pruritus may also present as a generalized process due to the phenomenon of central sensitization, in which limited nerve damage leads to heightened neurotransmitter release and hyperexcitable spinal neurons [10,11] . Neuropathic itch has a significant impact on the sleep and quality of life of patients, even when it is localized [12] .…”

Section: Definitionmentioning

confidence: 99%

United States expert panel consensus on uniform nomenclature and diagnosis for neuropathic pruritus

Kwatra,

Elmariah,

Chisolm

et al. 2023

Itch

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Importance: Neuropathic pruritus is a debilitating condition lacking a uniform approach to nomenclature and diagnosis. Objective: A panel of dermatologist experts in pruritus was convened to develop definitions, diagnostic recommendations, and treatment guidelines for neuropathic pruritus. Evidence review: A roundtable discussion of 10 experts was conducted on November 3, 2021, via the Zoom platform. This study follows the Standards for Reporting Qualitative Research reporting guidelines for qualitative studies. A systematic review of prior literature on the definition, scope, diagnostic, and treatment was performed, looking at sources of treatment from 1991 to 2021. Consensus was defined as >70% agreement for acceptance of a definition or recommendation. A draft of evidence was subjected to revision by all participants and was endorsed by all participants. Findings: The roundtable identified definitions for neuropathic pruritus, which included different forms of the condition based on cause and presentation such as brachioradial pruritus, notalgia paresthetica, and scalp pruritus. Diagnostic and treatment guidelines were also established. Limitations of this process included lack of randomized controlled studies. These recommendations are also based on expert consensus and must be further supported by evidence-based outcomes research. Conclusions: Neuropathic pruritus contains numerous subtypes, causes, diagnostic methods, and treatment modalities. The recommendations developed by this panel are meant to serve as shared nomenclature for future clinical studies.

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“… 2 Despite its severe impact on quality of life (QOL), NP currently has no United States Food and Drug Administration (FDA)-approved therapeutic options. 3 …”

Section: Introductionmentioning

confidence: 99%

Bedside greater occipital nerve block with bupivacaine for the treatment of recalcitrant scalp pruritus

Kambala,

Kollhoff,

Wei

et al. 2024

JAAD Case Reports

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Association of Neuropathic Itch With Patients’ Quality of Life

Cited by 4 publications

References 8 publications

Chronic Pruritus

Chronic Pruritus

United States expert panel consensus on uniform nomenclature and diagnosis for neuropathic pruritus

Bedside greater occipital nerve block with bupivacaine for the treatment of recalcitrant scalp pruritus

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