-Atopic dermatitis is a common skin disease affecting up to 10% of children and approximately 2% of adults. Atopic dermatitis exhibits four major symptoms, including intense itching, dry skin, redness and exudation. The "itch-scratch-itch" cycle is one of the major features in atopic dermatitis. The pathophysiology and neurobiology of pruritus is unclear. Currently there are no single and universally effective pharmacological antipruritic drugs for treatment of atopic dermatitis. Thus, controlling of itch is a very important unmet need in patients suffering from atopic dermatitis. This article will update progress during the past 10 years of research in the field of pruritus of atopic dermatitis, focusing on aspects of pruritogens (including inflammatory lipids, histamine, serotonin, proteinases, proteinase-activating receptors, neurotransmitters, neuropeptides, and opioid peptides), antipruritic therapies, and emerging new targets. Based on recent progress, researchers expect to identify exciting possibilities for improved treatments and to develop new antipruritic drugs acting through novel targets, such as histamine H4 receptor, gastrin-releasing peptide receptor, MrgprA3, thromboxane A2 receptor and the putative SPC receptor.
Keywords: Pruritus, Atopic dermatitis, Pruritogen, Antipruritic therapy, New targetAtopic dermatitis (AD) is a common skin disease that affects up to 10% of children and approximately 2% of adults in the general population (Leung and Soter, 2001). The socio-economic losses resulting from the disease are high; the cost of illness to the third-party payer for AD ranges from US $0.9 billion to US $3.8 billion (Ellis et al., 2002). The quality-of-life is remarkably lowered by AD. The genetic background, in combination with several environmental factors, results in this chronic remittent skin disease. AD exhibits four major symptoms including intense itching (pruritus), dry skin (xerosis), redness (erythema) and exudation. The "itch-scratch-itch" cycle is a common feature of AD. Scratching can cause bleeding, secondary infection (bacterial, fungal and/or viral) and thickening of the skin (lichenification) (Lewis-Jones, 2005). Itching is the predominant symptom of AD and is also an important diagnostic feature of systemic disease (Malekzad et al., 2009).The pathophysiology and neurobiology of pruritus are unclear. Therefore it is not surprising that anti-pruritus therapy is not well established and the choice of therapeutic agents is limited. However, recent progress over the past 10 years has provided insights into the neurophysiology of pruritus and is opening up exciting possibilities for development of new antipruritic drugs (Yosipovitch and Papoiu, 2008;Liu et al., 2009;Sun et al., 2009).Itch can be regarded as a cutaneous sensory perception, which requests excitation of specialized itch receptors in the skin. Increased amounts of neurofilament-, protein gene product (PGP) 9.5-, calcitonin gene-related peptide (CGRP)-, and substance P (SP)-positive nerve fibres have been observe...