Interventions for chronic pruritus of unknown origin

Miranda, Andrea Andrade; Kuah, Chii Yang; Martín-López, J.E.; Chua, S.; Shpadaruk, Volha; Sanclemente, Gloria; Franco, Juan Víctor Ariel

doi:10.1002/14651858.cd013128.pub2

Cited by 34 publications

(29 citation statements)

References 183 publications

(71 reference statements)

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“…The term ‘chronic pruritus of unknown origin’ (CPUO) (previously known as chronic idiopathic pruritus or pruritus sine materia ) was proposed to define this condition, whose diagnosis is made by exclusion [ 112 ]. CPUO might be localized or generalized, with increased prevalence (from 3.6 to 44.5%) among middle- to old-aged subjects [ 112 , 113 ]. Elderly patients are at an increased risk of CP due to the cumulative effects of aging on the skin barrier and neurotrophic function.…”

Section: The Top Itchy Skin Diseasesmentioning

confidence: 99%

Pruritus as a Distinctive Feature of Type 2 Inflammation

et al. 2021

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Pruritus is a common symptom of several skin diseases, both inflammatory and neoplastic. Pruritus might have a tremendous impact on patients’ quality of life and strongly interfere with sleep, social, and work activities. We review the role of type-2 inflammation and immunity in the pathogenesis of chronic pruritic conditions of the skin. Type 2 cytokines, including IL-4, IL-13, thymic stromal lymphopoietin, periostin, IL-31, IL-25, and IL-33 are released by mast cells, innate lymphoid cells 2, keratinocytes, and type 2 T lymphocytes, and are master regulators of chronic itch. These cytokines might act as direct pruritogen on primary sensory neurons (pruriceptors) or alter the sensitivity to other itch mediators Type 2 inflammation- and immunity-dominated skin diseases, including atopic dermatitis, prurigo nodularis, bullous pemphigoid, scabies, parasitic diseases, urticaria, and Sézary syndrome are indeed conditions associated with most severe pruritus. In contrast, in other skin diseases, such as scleroderma, lupus erythematosus, hidradenitis suppurativa, and acne, type 2 inflammation is less represented, and pruritus is milder or variable. Th2 inflammation and immunity evolved to protect against parasites, and thus, the scratching response evoked by pruritus might have developed to alert about the presence and to remove parasites from the skin surface.

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Section: The Top Itchy Skin Diseasesmentioning

confidence: 99%

Pruritus as a Distinctive Feature of Type 2 Inflammation

et al. 2021

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“…Clinical trials to evaluate serlopitant as a potential therapeutic for AD to reduce itching and pruritus indicated that serlopitant was capable to reduce the pruritus associated with AD. However, the results were not statistically significant, and further studies are required to establish clinical significance [202,203]. Tradipitant (VLY-686) is a small molecule inhibitor of the NK1 receptor that blocks this receptor and prevents interaction with its ligand, substance P (SP), which is released on activation of sensory neurons.…”

Section: Emerging Therapeutic Small Molecules For Admentioning

confidence: 99%

Current Insights into Immunology and Novel Therapeutics of Atopic Dermatitis

Kader

Azeem

Jwayed

et al. 2021

Cells

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Atopic dermatitis (AD) is one of the most prevalent inflammatory disease among non-fatal skin diseases, affecting up to one fifth of the population in developed countries. AD is characterized by recurrent pruritic and localized eczema with seasonal fluctuations. AD initializes the phenomenon of atopic march, during which infant AD patients are predisposed to progressive secondary allergies such as allergic rhinitis, asthma, and food allergies. The pathophysiology of AD is complex; onset of the disease is caused by several factors, including strong genetic predisposition, disrupted epidermal barrier, and immune dysregulation. AD was initially characterized by defects in the innate immune system and a vigorous skewed adaptive Th2 response to environmental agents; there are compelling evidences that the disorder involves multiple immune pathways. Symptomatic palliative treatment is the only strategy to manage the disease and restore skin integrity. Researchers are trying to more precisely define the contribution of different AD genotypes and elucidate the role of various immune axes. In this review, we have summarized the current knowledge about the roles of innate and adaptive immune responsive cells in AD. In addition, current and novel treatment strategies for the management of AD are comprehensively described, including some ongoing clinical trials and promising therapeutic agents. This information will provide an asset towards identifying personalized targets for better therapeutic outcomes.

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“…Both the transformation models can be considered as references when conducting related studies in the future. One Cochrane review on chronic pruritus of unknown origin included studies with different assessment tools to measure the same outcome, using standardized mean differences (SMDs) with 95% CIs to analyze the continuous data [45]. Therefore, we performed data synthesis and analysis with SMDs to analyze different pruritus scores in our study.…”

Section: Outcome Measurementsmentioning

confidence: 99%

Clinical Efficacy and Safety of Sodium Thiosulfate in the Treatment of Uremic Pruritus: A Meta-Analysis of Randomized Controlled Trials

Chuo

Kuo

et al. 2021

Toxins

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Uremic pruritus is a distressful complication of chronic kidney disease and results in impaired quality of life and higher mortality rates. Intravenous sodium thiosulfate has been reported to alleviate pruritus in hemodialysis patients. We performed a systematic review and meta-analysis to estimate the efficacy of intravenous sodium thiosulfate in patients with uremic pruritus. A systematic search of electronic databases up to June 2021 was conducted for randomized controlled trials that evaluated the clinical effects of sodium thiosulfate in the management of patients with uremic pruritus. Two reviewers selected eligible articles and evaluated the risk of bias; the results of pruritus assessment and uremic pruritus-related laboratory parameters in selected studies were analyzed. There are four trials published between 2018 and 2021, which include 222 participants. The sodium thiosulfate group displayed significant decrease in the pruritus score (standardized mean difference = −3.52, 95% confidence interval = −5.63 to −1.41, p = 0.001), without a significant increase in the adverse effects (risk ratio = 2.44, 95% confidence interval = 0.37 to 15.99, p = 0.35) compared to the control group. Administration of sodium thiosulfate is found to be a safe and efficacious complementary therapy in improving uremic pruritus in patients with chronic kidney disease.

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Interventions for chronic pruritus of unknown origin

Abstract: Interventions for chronic pruritus of unknown origin (Review)

Cited by 34 publications

References 183 publications

Pruritus as a Distinctive Feature of Type 2 Inflammation

Pruritus as a Distinctive Feature of Type 2 Inflammation

Current Insights into Immunology and Novel Therapeutics of Atopic Dermatitis

Clinical Efficacy and Safety of Sodium Thiosulfate in the Treatment of Uremic Pruritus: A Meta-Analysis of Randomized Controlled Trials

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