Pruritus in cutaneous graft‐versus‐host disease: A systematic review

Abstract

Pruritus is a common symptom of cutaneous graft-versus-host disease (GVHD) following haematopoietic stem cell transplantation (HSCT). However, little is known about its prevalence, pathophysiology, perceptual characteristics, impact on quality of life and response to antipruritic therapies. The aim of this review was to determine the current knowledge on pruritus in cutaneous GVHD. The review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analyses statement. Of the 338 studies screened, 13 were included. The prevalence of pruritus in cutaneous GVHD was reported in three studies, ranging from 37.0% to 63.8%. Only four trials used pruritus assessment tools. There was little or no information on the intensity of pruritus, its qualitative perception, the location of pruritus and the impact of pruritus on quality of life. Antipruritic treatments for GVHD-associated pruritus were mentioned in five studies (38.5%), including topical ointments (steroids, tacrolimus and calcipotriene), broadband UVB, systemic antihistamines and oral ursodeoxycholic acid. In conclusion, pruritus in cutaneous GVHD appears to be common, but very little is known about the pathophysiology, impact on quality of life and effective treatment options. Basic research and controlled clinical trials are warranted to improve knowledge and management of this important issue.

Novel Topical Treatments for Itch

“…Additionally, topical ruxolitinib has been studied in the management of cutaneous GVHD with good efficacy on disease severity [ 7 ]. Patients with cutaneous GVHD often complain of pruritus, but the pathophysiology of itch in this condition is not well elucidated and the severity of itch has been reported not to be associated with disease severity [ 8 ]. There is a reported association between the reduction of pruritus and a longer failure-free survival in patients with chronic GVHD, pointing to the need for further research in this area [ 8 , 9 ].…”

“…Patients with cutaneous GVHD often complain of pruritus, but the pathophysiology of itch in this condition is not well elucidated and the severity of itch has been reported not to be associated with disease severity [ 8 ]. There is a reported association between the reduction of pruritus and a longer failure-free survival in patients with chronic GVHD, pointing to the need for further research in this area [ 8 , 9 ]. Numerous studies are currently underway to evaluate ruxolitinib’s efficacy in other itchy conditions including prurigo nodularis, lichen sclerosus, and seborrheic dermatitis.…”