Facing the Challenges of Chronic Pruritus: A Report From a Multi-disciplinary Medical Itch Centre in Germany

Abstract

The complex nature and difficult-to-establish aetiology of chronic pruritus (CP) makes it challenging to provide medical care for patients with CP. This challenge can only be met with a multidisciplinary approach. The first multidisciplinary Itch Centre in Germany was established at the University of Münster in 2002 to meet the needs of this patient population. More than 2,500 outpatients and 400 inpatients are diagnosed and receive treatment each year. To ensure evidence-based medical care, an electronic system for medical documentation and patient-reported outcomes was established. Automated data transfer to a research database enables comprehensive data analysis. Our translational research has characterized peripheral and central itch mechanisms, provided novel clustering of CP patients, and identified novel target-specific therapies (e.g. neurokinin 1 receptor-antagonist). The multidisciplinary approach, combined with basic, clinical and translational research, enables comprehensive medical care of patients as well as implementation of high-quality experimental and clinical studies.

Prevalence and Characteristics of Pruritus: A One-Week Cross-sectional Study in a German Dermatology Practice

“…This observation, particularly in the context of the high burden of these patients, points to a weakness in the current quality of medical care for patients with pruritus, an issue that needs to be urgently addressed. This is a well-known clinical problem for several reasons: the lack of availability and use (especially by non-pruritus experts) of novel and potent antipruritic therapies and the lack of area-wide specialized itch centers (12); the use of weak or non-effective therapies, such as OTC drugs taken either as self-medication or applied by caregivers (as physicians may tend to underestimate the severity and resistance of pruritus), promotes the maintenance of the symptoms. However, the failure to show improvement might also be due to a lack of patient compliance.…”

Prurigo Activity Score (PAS): validity and reliability of a new instrument to monitor chronic prurigo

“…PRUNOSI evaluated the type (papules, nodules, lichenification, excoriations and crusts) and percentage of lesions in affected body areas versus the whole body area. In one of these studies, we compared atopic dermatitis to CPG and detected a significant difference in the score between these two groups . In the other double‐blind, randomised, controlled study, in which the antipruritic effect of topical pimecrolimus versus topical hydrocortisone in non‐atopic CPG was evaluated, PRUNOSI showed a significant score difference before and after the therapy .…”

“…However, none of these scales were validated or used in subsequent trials. So far, we used preliminary versions of a prurigo score (PRUNOSI, Scratch Symptom Score (SSS)) in two clinical studies (ClinicalTrials.gov: NCT00507832, German Register Clinical Trials: DRKS00005284) . PRUNOSI evaluated the type (papules, nodules, lichenification, excoriations and crusts) and percentage of lesions in affected body areas versus the whole body area.…”

Emerging drugs for the treatment of pruritus

“…As of yet, no study has investigated the economic burden of CP in affected patients or in insurances [11]. Given the facts of prolonged treatment with weakly effective therapies, insurances cover high costs for these low effective treatments [12].…”

“…The majority of patients with CP have a long history of suffering extending over 9 --12 months, and some even for years [11].…”