European S2k Guideline on Chronic Pruritus

Weißhaar, Elke; Szepietowski, Jacek C.; Dalgard, Florence; Garcovich, Simone; Gieler, Uwe; Giménez‐Arnau, Ana; Lambert, Julien; Leslie, Tabi A.; Mettang, Thomas; Miséry, Laurent; Şavk, Ekin; Streit, Markus; Tschachler, Erwin; Wallengren, Joanna; Ständer, Sonja

doi:10.2340/00015555-3164

Cited by 250 publications

(246 citation statements)

References 441 publications

(473 reference statements)

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“…It is not possible to establish the underlying aetiology or trigger of the itch based on the clinical appearance and treating the underlying cause of the pruritus alone may not provide enough relief to chronic prurigo patients . Nevertheless, a diagnostic work‐up should be performed for all patients with chronic prurigo in order to identify possible underlying causes for the itch, which should be treated when possible, as recommended by current guidelines . When treating the underlying cause for the itch does not suffice, additional therapeutic approaches are necessary …”

Section: Chronic Prurigo: Disease In Its Own Rightmentioning

confidence: 99%

“…Nevertheless, a diagnostic work‐up should be performed for all patients with chronic prurigo in order to identify possible underlying causes for the itch, which should be treated when possible, as recommended by current guidelines . When treating the underlying cause for the itch does not suffice, additional therapeutic approaches are necessary …”

Section: Chronic Prurigo: Disease In Its Own Rightmentioning

confidence: 99%

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How to define chronic prurigo?

Pereira

Ständer

2019

Experimental Dermatology

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Chronic prurigo impairs quality of life and is immensely challenging to treat. Until recently, no clear definition or classification system was available for this disease. A European task force specialized in pruritus defined chronic prurigo as a distinct disease characterized by chronic pruritus, a lengthy scratching behaviour and the presence of pruriginous lesions. Papular, nodular, plaque, umbilicated and linear prurigo were identified as clinical subtypes according to the most prominent lesion type observed in the physical examination. Various clinical and pathophysiological aspects, which are common across the range of clinical manifestations of chronic prurigo, argue for chronic prurigo as a disease in its own right. Chronic prurigo should be clearly demarcated from other conditions such as so‐called acute or subacute prurigo forms as well as from psychogenic self‐inflicted skin lesions, since different diagnostic criteria apply for these diseases. This viewpoint essay provides a detailed definition and classification of chronic prurigo including its obligatory and associated diagnostic criteria and discusses chronic prurigo as a distinct disease as well as the demarcation to other relevant conditions.

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Section: Chronic Prurigo: Disease In Its Own Rightmentioning

confidence: 99%

Section: Chronic Prurigo: Disease In Its Own Rightmentioning

confidence: 99%

How to define chronic prurigo?

Pereira

Ständer

2019

Experimental Dermatology

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“…Chronic pruritus can be a symptom of many dermatological and non‐dermatological diseases, and in many of these diseases, the effective therapy of itch is a large unmet medical need. The current European guideline on chronic pruritus recommends treatment algorithms that are specific for the underlying aetiology, although it is often unclear whether the recommended treatment is indeed specific for the respective aetiology or is rather a general anti‐pruritic treatment. The current evidence of anti‐pruritic efficacy of existing drugs and potential future treatments in systemic diseases are reviewed elsewhere, for example, for uraemic and hepatic pruritus .…”

Section: What Can We Learn From Published Trials and Case Series?mentioning

confidence: 99%

“…Wherever possible, we treat an underlying disease or a treatable, aggravating factor of chronic pruritus, according to the guidelines or recommendations of the respective diseases. If this cannot be done, if treatment is not sufficient or if there is no identifiable underlying disease, we follow the current guidelines on the management and treatment of pruritus, which, in most cases, includes treating our patients with gabapentin or pregabalin, or with sertraline or another selective serotonin reuptake inhibitor . Additionally, for every patient in our clinics, we check whether there is the possibility of offering the patient participation in an ongoing, well‐designed, controlled trial.…”

Section: Personal Experiencesmentioning

confidence: 99%

Treatments for chronic pruritus outside of the box

Metz

2019

Experimental Dermatology

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Patients with chronic pruritus are in desperate need of novel treatment options, as current therapeutic possibilities are often not effective, have a poor level of evidence and are mostly off‐label. In recent years, much effort has been put into the identification of potential targets for the treatment of chronic pruritus. More importantly, a number of promising new drugs that are aimed at treating pruritus in different conditions are currently in advanced stages of clinical trials. Here, current pharmacological developments leading to potential new drugs for the treatment of chronic pruritus within various conditions are summarized. Hopefully, these new approaches will result in effective and safe therapies for our patients with chronic pruritus associated with dermatological or non‐dermatological diseases in the near future.

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“…Itch is defined as an unpleasant sensation that elicits the desire or reflex to scratch (Hafenreffer, 1660). Despite its high prevalence, health and economic burden (Tripathi et al, 2019;Schut et al 2019;Weisshaar et al, 2019) chronic itch remains a disease without cure and very ineffective treatments to date (Oetjen et al, 2017). Under physiological conditions, chemical itch is initiated by receptors located in the skin, known as pruriceptors, which react to a plethora of chemical substances (Dong and Dong, 2018).…”

Section: Introductionmentioning

confidence: 99%

Presynaptic inhibition of cutaneous afferents prevents self-generated itch

Escalante

Klein

2019

Preprint

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Chronic itch represents an incapacitating burden on patients suffering a wide spectrum of diseases. Despite recent advances in our understanding of the cells and circuits implicated in the processing of itch information, chronic itch often presents itself without apparent cause. Here, we identify a spinal subpopulation of inhibitory neurons defined by the expression of Ptf1a involved in gating mechanosensory information self-generated during locomotion. These neurons receive tactile and motor input and establish presynaptic inhibitory contacts on mechanosensory afferents. Loss of these neurons leads to increased hairy skin sensitivity and chronic itch, at least partially mediated through the classic GRPR pathway. These findings shed new light on the mechanisms implicated in chronic itch and open novel targets for therapy developments. Methodology: A.E.; Validation: A.E. and R.K.; Formal Analysis: A.E.; Investigation: A.E.; Resources: A.E.; Data Curation: A.E.; Writing-Original Draft: A.E. and R.K.; Writing-Review and Editing: A.E. and R.K.; Visualization: A.E.; Supervision: R.K.; Funding Acquisition: R.K.

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European S2k Guideline on Chronic Pruritus

Cited by 250 publications

References 441 publications

How to define chronic prurigo?

How to define chronic prurigo?

Treatments for chronic pruritus outside of the box

Presynaptic inhibition of cutaneous afferents prevents self-generated itch

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