Abstract
In infants, pruritus is frequently considered as absent because they do not scratch themselves. Because pruritus could induce severe adverse effects in this vulnerable population, we aimed to review existing evidence on the ability of young infants to experience itch and on how to assess itch-related discomfort in this population. A literature review was performed (Pubmed, Google Scholar). Neurological itch pathways are well described. Skin development starts early during gestation. At 34 weeks of gestation, skin is almost complete while skin adaptations occur after birth. Newborn skin is neurologically functional, including the ability for young infants to feel pain. Similarities and interactions between pain and pruritus support the hypothesis that infants could feel pruritus. However, the existence of pruritus in infants has never been evidenced. Many itchy conditions can affect them, suggesting non-negligible prevalence of infant pruritus among which atopic dermatitis (AD) is the most studied disease. Studies reported a negative impact of AD on children and their families. There is no existing validated method to assess pruritus in infants, although they may feel pruritus and chronic pruritus can lead to serious adverse effects. To appropriately diagnose pruritus appears of great interest among young infants. Development of a method is required to this aim.
Highlights
Pruritus is an unpleasant sensation that leads to the need to scratch
Nerve endings involved in pruritus are mainly C-fibers located in the epidermis
C-fibers can be separated into two itch pathways: a histamine-sensitive pathway, which involves histamine-receptors 1 and 4 (H1R, H4R), and a histamine-independent pathway with G protein-coupled receptors (GPCRs), cytokine receptors, transient receptor potential (TRP) ion channels and voltagegated sodium channels
Summary
Pruritus (itch) is an unpleasant sensation that leads to the need to scratch. This definition has been established since the 17th century but research became dynamic in the 1990s. Scratching movements are not observed in infants, especially before 6 months of age, while manual approaching and reaching behaviors, which are a prerequisite for scratching, are not effective before 5–6 months of age. In this vulnerable population, discomfort related to pruritus could induce serious adverse effects, on neurodevelopment. Characterizing and assessing pruritus in infants is of great interest
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