Pruritus: A Review

Abstract

The history, neurophysiology, clinical aspects and treatment of pruritus are reviewed in this article. The different forms of pruritus in dermatological and systemic diseases are described, and the various aetiologies and pathophysiology of pruritus in systemic diseases are discussed. Lack of understanding of the neurophysiology and pathophysiology of pruritus has hampered the development of adequate therapies. Nevertheless, the discovery of primary afferent neurons and, presumably, second-order neurons with typical histamine responses mediating pruritic sensations can be regarded as a breakthrough in our understanding of the mechanisms behind pruritus. The number of experimental and therapeutic studies has greatly increased during the past few years, reflecting an increased interest in this topic. However, further effort is needed to develop new therapeutic concepts and clarify some confusion arising from promising case reports and uncontrolled clinical studies. A precise work-up for evaluating patients with pruritus is proposed, which may help the physician to identify the underlying causes and thus to treat the patient appropriately.

Phototherapy for Generalized Pruritus of Unknown Origin: Single-Center Experience

“…It can also be drug-induced or related to neuropsychiatric disorders. 1,3 Besides causing major discomfort and restlessness, pruritus is associated with decreased quality of life, sleep disturbances, and mood disorders. [4][5][6] Treatment options for generalized pruritus include topical therapies such as crotamiton 10%, topical doxepin and topical corticosteroids (mainly clobetasone butyrate), antihistamine drugs, and tricyclic and selective serotonin reuptake inhibitor antidepressants.…”

Narrowband-ultraviolet B vs Broadband-ultraviolet B in Treatment of Chronic Pruritus: A Randomized, Single-blinded, Non-inferiority Study

“…UV phototherapy is an effective treatment that has long been used for the various pruritic skin diseases and is basically acknowledged to provide an essential contribution in reducing CP ( 13 ). Currently NB-UVB is the preferred treatment modality of phototherapy ( 14 ) and it has been shown to be superior to BB-UVB in the treatment of psoriasis and AD as well as for other pruritic skin disorders ( 15 ).…”

Anti-pruritic effect of L-carnitine against chloroquine-induced pruritus mediated via nitric oxide pathway

“…The pruritic condition of psoriasis causes an increase in the level of NO in the skin. The fact that chloroquine injection causes scratching behavior, which is mediated by the NO pathway, suggests that NO may alter itch in a variety of clinical pruritic diseases [ 10 ]. The itch sensation pathways in the spinal cord, brain and C-fiber all include NOS.…”