Abstract
Chronic itch is an unpleasant sensation that triggers a desire to scratch that lasts for six weeks or more. It is a major diagnostic symptom of myriad diseases, including atopic dermatitis for which it is the most prominent feature. Chronic itch can be hugely debilitating for the sufferer, damaging in terms of both the monetary cost of treatment and its socioeconomic effects, and few treatment options exist that can adequately control it. Corticosteroids remain the first line treatment strategy for atopic dermatitis, but due to the risks associated with long-term use of corticosteroids, and the drawbacks of other topical options such as topical calcineurin inhibitors and capsaicin, topical options for itch management that are efficacious and can be used indefinitely are needed. In this review, we detail the pathophysiology of chronic pruritus, its key features, and the disease most commonly associated with it. We also assess the role of the skin and its components in maintaining a healthy barrier function, thus reducing dryness and the itch sensation. Lastly, we briefly detail examples of topical options for the management of chronic pruritus that can be used indefinitely, overcoming the risk associated with long-term use of corticosteroids.
Highlights
Chronic itch is an unpleasant sensation that triggers a desire to scratch that lasts for six weeks or more
A 2008 study by Huang and Chang found that the topical application of emulsions containing one or both of ceramides 1 and 3 improved the composed of a 3:1:1 molar ratio of ceramides, cholesterol and free fatty acids, the authors reported significant improvements in atopic dermatitis (AD) disease severity, transepidermal water loss (TEWL), stratum corneum integrity and skin hydration after treatment [78]
We previously reported that a topical cream containing a 3:1:1 molar ratio of ceramides, cholesterol and free fatty acid (Ego Pharmaceuticals Pty Ltd, Braeside, Victoria, Australia) significantly improved skin hydration and reduced TEWL compared with placebo, with these improvements being significantly greater than those seen with formulations containing pseudoceramides or ceramide precursors [87]
Summary
Formally “pruritus” from the Latin “prurit” (“to itch”), has been defined as “an unpleasant cutaneous sensation which provokes the desire to scratch” [1]. While there are many treatment options available for chronic cutaneous pruritus, most are unsatisfactory due to the complex nature of the itch response and the subjective nature of the problem itself. Successful management strategies ideally should incorporate into the chosen treatment regimen the daily use of -accessible, efficacious topical preparations designed primarily to tackle the itch. The benefits of these products could conceivably be twofold: physically alleviating the itch stimulus while helping to overcome the psychological need to scratch by allowing for the ad libitum application of the product. We briefly detail current topical options designed for the management of itch
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