Chronic Pruritus in the Absence of Specific Skin Disease: An Update on Pathophysiology, Diagnosis, and Therapy

Nicoletta Cassano; Gianpaolo Tessari; Gino A. Vena; Giampiero Girolomoni

Disclosures

Am J Clin Dermatol. 2010;11(6):399-411. 

In This Article

Abstract and Introduction

Abstract

Chronic pruritus is a major and distressing symptom of many cutaneous and systemic diseases and can significantly impair the patient's quality of life. Pruritus perception is the final result of a complex network involving dedicated nerve pathways and brain areas, and an increasing number of peripheral and central mediators are thought to be involved. Itch is associated with most cutaneous disorders and, in these circumstances, its management overlaps with that of the skin disease. Itch can also occur without associated skin diseases or primary skin lesions, but only with nonspecific lesions secondary to rubbing or scratching. Chronic itch with no or minimal skin changes can be secondary to important diseases, such as neurologic disorders, chronic renal failure, cholestasis, systemic infections, malignancies, and endocrine disorders, and may also result from exposure to some drugs. The search for the cause of pruritus usually requires a meticulous step-by-step assessment involving careful history taking as well as clinical examination and laboratory investigations.
Few evidence-based treatments for pruritus are available. Topical therapy, oral histamine H1 receptor antagonists, and phototherapy with UV radiation can target pruritus elicitation in the skin, whereas antiepileptic drugs, opioid receptor antagonists, and antidepressants can block signal processing in the CNS.

Introduction

Pruritus is defined as an unpleasant sensation inducing the desire to scratch.[1] It is a major and distressing symptom of numerous and diverse cutaneous and systemic diseases. In some instances, pruritus is not associated with skin diseases or specific skin changes, but only with lesions secondary to rubbing or scratching and even with no or minimal skin changes. Chronic itch, defined on the basis of a duration of 6 weeks or more, may be difficult to diagnose and manage, and may have a strong impact on the quality of life of patients.[1] This review focuses on recent advances in understanding the pathophysiology of itch, as well as on the diagnostic and therapeutic management of chronic itch not associated with skin diseases.

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