Psychological Interventions in the Treatment of Chronic Itch

Abstract

Patients with chronic itch suffer from higher levels of depression and anxiety than their healthy counterparts. Furthermore, psychological factors, such as stress, are known to aggravate itch. The mere act of thinking about itching can induce the sensation. Interventions like habit reversal training and arousal reduction have been shown to have positive effects on itch relief. Yet, there is still limited data on the psychological management to control the itch scratch cycle and a description of methods suitable to address itch. In this review, we describe different psychological interventions shown to be effective in the treatment of chronic itch. We also provide suggestions based on our experience of suitable interventions for patients with different types of itch.

Consensus‐based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part II

“…Behavioural therapy against itch was studied, showing a significant improvement in symptoms after 1 year . Especially habit reversal techniques improve itch in atopic dermatitis …”

Improvement in itch and other psoriasis symptoms with brodalumab in phase 3 randomized controlled trials

“…Up to 75% of the correlation between lesional severity measured by the psoriasis area and severity index (PASI) and patient‐reported outcomes (PROs) measured by the dermatology life quality index is accounted for by itch . However, low correlation between outcomes determined by itch‐specific assessment tools and those evaluated by the PASI or static physician's global assessment (sPGA) has been demonstrated, raising questions about which factors aside from psoriatic inflammation can modulate the subjective perception of itch and how patients can achieve high levels of skin clearance while still experiencing itch …”

Stressed skin? – a molecular psychosomatic update on stress‐causes and effects in dermatologic diseases

“…It is therefore not surprising that psychosocial stress as a consequence of inflammatory skin disorders or skin cancer is a widely acknowledged fact. Many studies show that the intensity of chronic, debilitating skin symptoms such as pruritus correlate with psychopathological conditions such as depression, anxiety, dysfunctional coping behavior, dissociation, withdrawal, and helplessness. Treatment is required, but frequently the necessity to address the psychosocial distress of chronically ill individuals is met by ill acceptance, a phenomenon that seems worth changing both in the medical as well as in the social context.…”