Abstract
Atopic dermatitis (AD) is characterized by severe pruritus, which has a negative impact on the quality of life of patients. AD pruritus is usually of high intensity, occurs predominantly during the night and leads to severe scratching. Thus, the therapy has to focus not only on the suppression of the symptom but also on improvement of sleep and therapy of scratch lesions. Today, the therapy of AD pruritus is mainly based on conventional topical and systemic anti-inflammatory drugs and off-label application of mu-opioid receptor antagonists, the antidepressant mirtazapine, and – without evidence from controlled studies – the neurokinin-1 receptor antagonist aprepitant. The pathophysiology of AD-associated pruritus is still not fully understood; however, recent identification of several key mediators and mechanisms might enable development of novel therapies such as receptor antagonists for neurokinin 1, histamine 4, interleukin 31, thymic stromal lymphopoietin (TSLP), and nerve growth factor (NGF). Controlled studies that are currently being carried out can be expected to pave the way for improved treatment options in AD pruritus.
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