Advances in therapeutic strategies for the treatment of pruritus

ABSTRACT

Introduction: Chronic pruritus is a common symptom that arises from both dermatologic and non-dermatologic conditions including chronic kidney disease, cholestasis, lymphoma and neuropathy. Over the past decade, research has elucidated many of the receptors, neuropeptides and cytokines involved in itch sensation and transmission. In addition, the first biomarker for cholestatic itch has been discovered. These findings have led to the development of a host of novel antipruritic medications, both on the market and in the pipeline.

Areas covered: A summary of new and emerging treatments for pruritus, as well as possible targets for future therapeutic development is provided.

Expert opinion: At present, there is no universally effective treatment available for all types of chronic pruritus. A combination of topical and systemic therapies addressing peripheral mediators, and a top-down approach targeting the brain and spinal cord, seems preferable to a single agent approach. Neural hypersensitization plays a significant role in many forms of chronic pruritus and may be downregulated by new treatments. In addition, specific neuropeptides are now targeted by novel antipruritic therapies. Furthermore, targeted biologic agents are anticipated to play a significant role in treating pruritus of inflammatory origin.

KEYWORDS:

• Atopic dermatitis
• antipruritics
• biologics
• autotaxin
• chronic pruritus
• IL-31
• nerve growth factor
• neural hypersensitization
• neuropeptides
• nonhistaminergic itch
• psoriasis

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Erratum

Article highlights.

• There is no single universally effective antipruritic treatment.

• Identifying the underlying etiology of pruritus is crucial in order to appropriately tailor treatment.

• Top-down management should be employed, with consideration of factors that influence itch at the level of the brain, spinal cord and periphery.

• Neural hypersensitization plays a role in pruritus and may be downregulated by new treatments.

• Specific receptors, neuropeptides and cytokines serve as new targets for anti-itch medications.

This box summarizes key points contained in the article.

Declaration of interest

G Yosipovitch is a member of scientific advisory boards for Tigercat, Cosmoderm, Trevi, Creabilis, Pfizer, Regeneron, Chugai, and Anacor. He receives grant support from LEO foundation, GlaxoSmithKline, and Pfizer. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.