Is there still a role for UV therapy in itch treatment?

Abstract

Itching is a frequent and greatly distressing symptom related to many skin and systemic diseases. New insights into the pathophysiology of itchy skin and potentially involved mediators have increased the interest in and development of new treatments that specifically act on targets involved in the transmission and perception of itching. Phototherapy has long been known and used as an effective treatment for various kinds of chronic itching. However, despite its well‐known beneficial effects, the mechanisms behind the antipruritic effect of phototherapy are less well‐known. In addition, phototherapy requires the use of expensive equipment in dermatology offices, patients must undergo repeated treatments and no large, randomized, controlled trials have yet supported the antipruritic effect of UV. Therefore, phototherapy is rarely recommended as a treatment method for chronic pruritic diseases or only used as a last recourse. However, the wide range of pruritic conditions that can be successfully treated with phototherapy, together with its low acute side effects, extremely low frequency of interactions with other medications, possibilities to combine phototherapy with other treatment modalities and the fact that patients of almost all ages—from childhood to old age, including women during pregnancy or lactation—can be treated make UV therapy advantageous over other treatments of chronic pruritus. Thus, despite the development of new targeted therapies against pruritus, UV therapy is neither outdated nor the ‘last recourse’, but should be considered early on in the treatment of chronic pruritus.

When life is an itch: What harms, helps, and heals from the patients' perspective? Differences and similarities among skin diseases

“…This may emphasize observations from clinical routine that patients deem conventional itch therapies often unsatisfactory 28,29 and partly explain why they turn to CAM and “other treatments.” The unexpectedly high rating of CAM in our population may also be due to the high proportion of patients with atopic dermatitis, in which frequent use of CAM is well known 30 . In addition to the potent antipruritic effect of light therapy, this modality may also be popular in itch patients because it may have a mood‐enhancing side effect 31,32 . Apart from itch relief, many patients wished that an ideal itch drug would also allow sleep improvement, psychological relaxation, and pain relief.…”

“…30 In addition to the potent antipruritic effect of light therapy, this modality may also be popular in itch patients because it may have a moodenhancing side effect. 31,32 Apart from itch relief, many patients wished that an ideal itch drug would also allow sleep improvement, psychological relaxation, and pain relief. As standard itch therapies…”

Management of Itch in the Elderly: A Review

“…In one retrospective study, Bulur et al demonstrated elimination of pruritus in 80% of their elderly patients receiving narrowband UV-B treatment for chronic idiopathic pruritus [121]. Known risks of phototherapy include an erythematous sunburn reaction, aging of the skin, increased risk for non-melanoma skin cancer, and a paradoxical induction of itch if phototherapy doses are too high [122]. Despite concerns of potential adverse effects due to age-related barrier and immune function, the minimal dose to cause erythema has not been shown to differ significantly between older and younger populations and adverse effects are reported at comparable rates [123, 124].…”

In search of the needle in a haystack: Finding a suitable serum biomarker for monitoring disease activity of systemic sclerosis

“…In contrast to psoriasis, 1‐25 atopic dermatitis 26‐47 and pruritus 21,35,48‐70 whose therapeutic landscapes have dramatically changed over the last few years due to many advances in skin research, scleroderma remains a challenge in many aspects.…”