Clinical management of pruritus

Abstract

SummaryThe care of patients with chronic pruritus as a symptom of a wide variety of underlying diseases continues to confront dermatologists with diagnostic and therapeutic challenges. However, a structured history and a physical examination may already substantially help in narrowing down the number of potential differential diagnoses. Apart form reducing the intensity of pruritus, identification and appropriate treatment of the underlying disease are important needs of patients. If these goals doesn't lead to improvement of itch, current guidelines provide a number of topical and systemic therapies for symptomatic treatment. Various skin lesions (for example, xerosis caused by irritant substances, secondary scratch lesions) prompt patients to consult a dermatologist, but most cases require an interdisciplinary therapeutic approach to identify potential internal medicine, neurologic, or psychosomatic aspects. Although great strides have been made in basic research, specific therapies are still rare, and a precise knowledge of the legal framework for the implementation of guidelines (for example, off-label use) is essential. This CME article gives an overview of the causes of and treatment options for chronic pruritus and discusses both advances in basic research as well as progress in clinical knowledge.

Chronic pruritus: evaluation of patient needs and treatment goals with a special regard to differences according to pruritus classification and sex

“…Recent studies show prevalences of up to 54·4% in dermatological patients . The underlying causes are often multifactorial, which is why diagnosis and treatment are challenging and require interdisciplinary collaboration in specialized centres . CP often results in a reduced quality of life (QoL) because of various emotional burdens, sleep disturbance and impairment in working life and everyday activities …”

Aktuelles zur kutanen Neurobiologie von Pruritus

“…Glukokortikosteroide, H1-Antihistaminika und Immunsuppressiva wie Cyclosporin wirken unter anderem antipruriginös durch die Modulation der von Mastzellen freigesetzten pruritogenen Mediatoren [16,37,39].…”

Emerging drugs for the treatment of pruritus

“…Given the facts of prolonged treatment with weakly effective therapies, insurances cover high costs for these low effective treatments [12]. Taking into account the hurdles of off-label use, CP patients have to carry the burden of high out-of-pocket costs worldwide [12].…”