Atopic Itch Research Articles

The Analysis Study of Effect of Acupuncture on the Treatment of Atopic Itch: A Comprehensive Systematic Review

Background: Atopic dermatitis is a common inflammatory skin disorder characterized by recurrent eczematous lesions and severe itching. Given its chronic nature and association with persistent pruritus, exploring therapies like acupuncture may offer valuable relief and enhance patient outcomes. This systematic review aims to explore the efficacy and mechanisms of acupuncture as a treatment for atopic pruritus based on the literature of the last decade. Methods: The study followed PRISMA 2020 guidelines, reviewing English-language publications from 2014 to 2024. Editorials, duplicate reviews from the same journal, and papers lacking a DOI were excluded. The literature search was conducted using PubMed, SagePub, SpringerLink, and Google Scholar. Result: A total of 630 articles were initially identified through online databases (PubMed, SagePub, SpringerLink, and Google Scholar). After three rounds of screening, eight relevant studies were selected for full-text analysis. Conclusion: Acupuncture shows potential as a noninvasive and effective treatment for reducing pruritus and associated symptoms in patients with atopic dermatitis and other pruritic conditions. The observed benefits, such as decreased itch intensity, improved quality of life, and reduced medication use, underline its value as an adjunct therapy.

RECOMMENDATION FOR ITCH ASSESSMENT FROM THE ATOPIC ITCH CONSENSUS MEETING (AICOM)

Itch is the most troublesome symptom of atopic dermatitis, and it is important to assess it appropriately for optimal treatment. We discussed issues regarding itch and the most appropriate methods of assessment at the Atopic Itch Consensus Meeting (AICOM), attended by physicians and researchers with expertise in itch treatment and research. The AICOM participants prepared a draft consensus statement that addressed the most appropriate itch assessment methods for age groups <2 years, 2-6 years, 7-14 years, and ≥15 years. Consensus was defined as agreement by ≥80% of the participants. Votes were cast by 20 participants (8 dermatologists, 7 pediatricians, and 5 researchers), and a consensus on the best current methods of itch assessment was reached with 95% agreement. For infants and preschool children, because subjective evaluation is difficult, a checklist for itch assessment was developed for caregivers. For itch assessment, we recommend subjective evaluation by the patient using a rating scale. For infants and preschoolers, evaluation should be done by the caregiver using a checklist, combined with objective evaluation (of skin lesions, for example) by a physician. We anticipate that more objective itch assessment indices will be established in the future.

The relationship between atopic dermatitis and atopic itch in children and the psychosocial functioning of their mothers: A cross-sectional study.

Atopic dermatitis is a chronic inflammatory skin disease significantly affecting patients' and their parents' lives. Mothers are mostly responsible for the long-term treatment and their wellbeing is essential. The major objective of this cross-sectional study was to investigate the relationship between atopic dermatitis in children, especially concomitant itch, and the quality of life, stress, sleep quality, anxiety, and depression of their mothers. The study included 88 mothers of children with atopic dermatitis and 52 mothers of children without atopic dermatitis. All mothers completed sociodemographic questionnaire, the Perceived Stress Scale, the Athens Insomnia Scale and the Hospital Anxiety and Depression Scale. Additionally, mothers of children with atopic dermatitis filled in the Family Dermatology Life Quality Index. The severity of atopic dermatitis and pruritus intensity were evaluated by the Scoring Atopic Dermatitis Index and the Numerical Rating Scale, respectively. The severity of atopic dermatitis and itch significantly correlated with the quality of life, insomnia, and perceived stress of the mothers. Mothers whose children had had atopic dermatitis for more than 6 months had significantly higher scores of anxiety and depression. The results highlight the importance of screening mothers for functional impairment to provide adequate support. More attention should be directed to the standardization of stepped care interventions addressing factors resulting in the impaired functioning of mothers.

An Open Trial on the Feasibility and Efficacy of a Mindfulness-Based Intervention with Psychoeducational Elements on Atopic Eczema and Chronic Itch

(1) Background: Mindfulness-based interventions (MBI) are psychological group interventions conducted over several weeks. Their effects on reducing stress and improving physical and psychological health have been proven in various clinical populations. Growing evidence suggests that MBIs might be beneficial for dermatology patients. This article reports on a novel Mindfulness-based Training for chronic Skin Conditions (MBTSC) with psychoeducational elements that was developed with the goal of improving self-regulation including stress management and emotion regulation in patients and to help in coping with disease symptoms such as itch and scratching. The intervention was tested in a pilot efficacy trial in order to examine feasibility and to collect preliminary data on the effectiveness of the intervention on disease severity including itch perception and on psychological distress in an atopic dermatitis (AD) sample. (2) Methods: Following an uncontrolled pre-test-post-test design based on standardized self-report measures, nine adult AD patients were recruited from a dermatology clinic. Data were collected at baseline, post-treatment and 3 month follow-up. Patients completed questionnaires assessing disease severity, itch perception, stress, anxiety and depression, mindfulness and intervention acceptability. The 7 week intervention included seven weekly sessions and a daily home-practice requirement, supported by guided audio-meditations and reading material. (3) Results: Quantitative data showed improvements in disease severity, itch perception and stress levels with small to medium effect sizes. Psychological distress increased at post-treatment—significantly in the case of depression. Qualitative data highlighted the mixed effects of MBTSC on symptoms. Treatment acceptability was high and 100% of the participants completed the intervention; (4) Conclusions: These data indicate that MBTSC is feasible and that it might be a useful tool as adjunct therapy for AD. Further studies with larger samples and control groups are needed.

When topical therapy of atopic dermatitis fails: a guide for the clinician

ABSTRACT Introduction While topical medications are the first line of treatment for mild-to-moderate atopic dermatitis, they are ineffective in individuals with diffuse disease and moderate-to-severe atopic itch. For these individuals, as well as those who do not respond to topical treatments, systemic medicines are typically essential and helpful. Areas Covered We conducted a review of the literature to identify established systemic therapies, novel biologic agents, and recent advances in the pathophysiology of atopic dermatitis. The review discusses these data, which show that the majority of atopic itch medications now in development target the type 2 immune axis and brain sensitization, two main etiologies of atopic itch. We emphasize the evidence, efficacy, and side effect profiles of currently available systemic medications for atopic itch, as well as future potential for tailored therapy. Expert Opinion We give our professional opinion on the current state of knowledge about atopic eczema pathogenesis and the innovative targets and therapies for atopic itch that include MRGPRX2, periostin, gabaergic medicines, and JAK/STAT inhibitors. Additionally, we discuss patient populations that stand to benefit the most from targeting these molecules or utilizing these drugs, as well as those who may face a disproportionate weight of adverse effects.

Current Clinical Options for the Management of Itch in Atopic Dermatitis.

Pruritus is the most burdensome and prevalent symptom in patients suffering from atopic dermatitis. Treating atopic itch has historically been a challenge due to multiple underlying mechanisms within its pathogenesis and an incomplete understanding of them. In recent years, our understanding of these mechanisms have increased tremendously and subsequently, new treatments have reached the market that target the pathophysiology of atopic itch from different angles. In addition, there are several promising new treatments currently in development and trials. In the current article, we discuss these currently available treatment options, their available evidence and efficacy, and highlight some of the more recent advancements in the field.

Thermal Stability Kinetics and Shelf Life Estimation of the Redox-Active Therapeutic and Mimic of Superoxide Dismutase Enzyme, Mn(III) meso-Tetrakis(N-ethylpyridinium-2-yl)porphyrin Chloride (MnTE-2-PyPCl5, BMX-010).

Mn(III) meso-tetrakis(N-ethylpyridinium-2-yl)porphyrin chloride (MnTE-2-PyPCl5, BMX-010, and AEOL10113) is among the most studied superoxide dismutase (SOD) mimics and redox-active therapeutics, being currently tested as a drug candidate in a phase II clinical trial on atopic dermatitis and itch. The thermal stability of active pharmaceutical ingredients (API) is useful for estimating the expiration date and shelf life of pharmaceutical products under various storage and handling conditions. The thermal decomposition and kinetic parameters of MnTE-2-PyPCl5 were determined by thermogravimetry (TG) under nonisothermal and isothermal conditions. The first thermal degradation pathway affecting Mn-porphyrin structural integrity and, thus, activity and bioavailability was associated with loss of ethyl chloride via N-dealkylation reaction. The thermal stability kinetics of the N-dealkylation process leading to MnTE-2-PyPCl5 decomposition was investigated by using isoconversional models and artificial neural network. The new multilayer perceptron (MLP) artificial neural network approach allowed the simultaneous study of ten solid-state kinetic models and showed that MnTE-2-PyPCl5 degradation is better explained by a combination of various mechanisms, with major contributions from the contraction models R1 and R2. The calculated activation energy values from isothermal and nonisothermal data were about 90 kJ mol–1 on average and agreed with one another. According to the R1 modelling of the isothermal decomposition data, the estimated shelf life value for 10% decomposition (t90%) of MnTE-2-PyPCl5 at 25°C was approximately 17 years, which is consistent with the high solid-state stability of the compound. These results represent the first study on the solid-state decomposition kinetics of Mn(III) 2-N-alkylpyridylporphyrins, contributing to the development of this class of redox-active therapeutics and SOD mimics and providing supporting data to protocols on purification, handling, storage, formulation, expiration date, and general use of these compounds.

Loss of S1PR3 attenuates scratching behaviors in mice in the imiquimod model of psoriasis, but not in the MC903 model of atopic dermatitis

Here we examine the role of sphingosine 1-phosphate receptor 3 (S1PR3) in chronic itch. We used 2 mouse models—the MC903 model of atopic dermatitis and the imiquimod model of psoriasis—to examine the contribution of S1PR3 to chronic itch. We measured scratching behaviors in these mouse models in S1PR3−/−, +/−, and +/+ animals. Whereas we observed no effect of loss of S1PR3 on itch behaviors in the MC903 model, imiquimod-evoked itch behaviors were reduced in S1PR3−/− animals. Overall, the data support a role for S1PR3 signaling in the development of psoriatic but not atopic itch.

Neuroimmune interactions in chronic itch of atopic dermatitis.

Itch is a defining symptom of atopic dermatitis. Crosstalk between keratinocytes, the immune system and non‐histaminergic sensory nerves is responsible for the pathophysiology of chronic itch in atopic dermatitis. An expanding understanding of the contribution of the nervous system and its interaction with immune pathways in atopic itch are helping to identify new therapeutic strategies.

Investigations on the expression and relevance of nerve growth factor in dogs with atopic dermatitis

Introduction: Human atopic dermatitis (AD) keratinocytes overexpress nerve growth factor (NGF). Its inhibition, or that of its receptor, reduces itch in a mouse model of AD. In this study, we evaluated the expression of NGF in canine AD and assessed the effect of a caninized anti-NGF monoclonal antibody to delay flares of itch in dogs with natural AD. Methods: We used archived frozen skin biopsies from 6 house dust mite–sensitized atopic dogs after allergen challenge, 4 dogs with spontaneous AD and 1 dog with normal skin. The expression of NGF was evaluated by immunofluorescence. We also conducted a pilot crossover trial with 8 dogs with glucocorticoid-responsive AD. In both phases, the dogs were first treated for 28 days with oral prednisolone at 0.5 mg/kg/d. On the first day of the first phase, they received a saline subcutaneous injection, while on that of the second phase, they were injected with 0.2 mg/kg once of the caninized anti-dog NGF ranevetmab. The primary outcome measure was the time-to-flare, defined as the number of days between that of the last prednisolone administration and the day when the pruritus reached a score of at least 5.5/10, or 8 weeks, whichever came first. Results: In normal canine skin, the highest intensity of NGF staining was in stratum granulosum keratinocytes. After allergen challenge and in atopic canine skin, the NGF expression also extended downward to the upper stratum spinosum. In the pilot trial, the time-to-flare after prednisolone cessation was not significantly different between saline and ranevetmab-treated dogs. Discussion: While NGF is overexpressed in the atopic canine epidermis and after allergen challenge in sensitized dogs, the anti-NGF antibody ranevetmab did not delay pruritus flares after the discontinuation of prednisolone. Further studies are needed to assess if NGF is a relevant contributor for canine atopic itch.

When managing atopic dermatitis-related itch, use a step-wise approach, address barrier repair and educate patients

When managing atopic dermatitis-related itch, use a step-wise approach, address barrier repair and educate patients

Acupuncture for the treatment of atopic itch—A systematic literature review

Acupuncture for the treatment of atopic itch—A systematic literature review

Cytokine modulation of atopic itch.

Atopic dermatitis (AD) is an inflammatory skin disease characterized by two primary features: relapsing skin lesions and chronic itch. Major advances in our understanding of type 2 immunity have led to new insights into the critical factors that promote the development and persistence of AD-associated skin inflammation. Although inflammation is strongly associated with the development of atopic itch, the precise mechanisms by which itch arises in AD are poorly understood. In this review, we highlight recent studies that have started to unveil how various proinflammatory factors released within the skin can elicit sensations of itch and discuss the therapeutic potential of targeting these neuroimmunologic processes.

Management of Itch in Atopic Dermatitis.

Atopic dermatitis (AD) is the most common itchy dermatosis that affects millions of children and adults worldwide. Chronic itch in this condition has significant impact on measures of quality of life, such as sleep. Treating itch in AD has been challenging for decades, but new drugs have emerged in the last year with significant anti-pruritic effect. The optimal treatment regimen for atopic itch addresses barrier dysfunction, inflammation, neural hypersensitivity, and the itch-scratch cycle. Topical moisturizers remain the foundation of treatment and should be used by all patients with AD-associated pruritus. Step-wise therapy, from topical anti-inflammatory creams to systemic monoclonal antibodies and immunosuppressants, is recommended. There are multiple adjuvant therapies that can be used, especially to target itch in the setting of minimal skin inflammation. Finally, patient education, sleep management, and stress relief are important components to optimize outcomes. This review assesses the latest advances and treatment recommendations for pruritus in AD. Finally, suggested therapeutic ladders and emerging treatments are discussed.

Atopic Dermatitis, The Skin-Disease.

The main function of the skin is to constitute an interface between the human body and its environment. Among skin diseases, some are due to structural defects of the skin itself (i.e. epidermolysis bullosa), some originate in internal organs (i.e. lupus erythematosus), and others are due to the environment (i.e. infectious diseases, photodermatoses). A review of the literature on atopic dermatitis shows that pathogenic factors pertaining to these three categories are implicated in its pathogenesis. Atopic dermatitis could so be considered as a clinical condition secondary to skin abnormalities, internal disturbances and environmental influences. To express this view, I propose the term ‘Skin-Disease’. This term is modelled on ‘Skin-Ego’,1 a psychoanalytic concept expressing the fact that the Ego is shaped following early cutaneous contacts between the newborn and his/her mother. The Ego envelops the psyche, just as the skin envelops the body. The Skin-Ego possesses many properties of the skin; similarly, these properties are involved in the pathogenesis of atopic dermatitis. Many structural defects, whether genetic or acquired, have been discovered in atopic dermatitis skin: diminution of filaggrin expression,2 impairment of tight junctions,3 excess of proteases activity,4 decrease in ceramides.5 The resulting deficiency in the epidermal barrier function is considered by many authors as the primary event in atopic dermatitis. Consequently, the improvement in barrier function brought by emollient therapy can significantly decrease the prevalence of the disease.6 Atopic dermatitis belongs to the atopic diathesis, which includes diseases of the respiratory and digestive tracts. Atopy is an immunologic disease, characterized mainly by a predominance of TH2 responses to environmental antigens. It is beyond the scope of this commentary to try and summarize the current knowledge on the immunologic component of atopic dermatitis. Recent data indicate that a targeted inhibition of TH2 cytokines has the potential of improving atopic dermatitis symptoms.7, 8 An additional consequence of the complex immunologic imbalance of AD can be found in the study by Kim et al.9 published in this issue of JEADV: in adult Korean individuals, these authors found an inverse association between AD and chronic HBV infection. In addition to this immunologic disease, atopic dermatitis is closely linked to digestive disturbances, although this link and its clinical consequences still need to be clarified. The nervous system is also involved, as itch is the main clinical symptom of atopic dermatitis. Atopic itch involves many mediators including IL31 and TSLP, which directly stimulate neurons.10 The systemic dimension of atopic dermatitis has been reviewed recently.11 Although atopic dermatitis is not an infectious disease, bacteria are involved in its clinical expression and their role is still poorly understood, in spite of many studies. Imbalances in the digestive12 and in the cutaneous13 microbiomes have been described. Their importance is still under investigation and could lead to innovative therapeutic approaches.14 Atopic individuals are often sensitized to environmental aeroallergens, but the significance of this sensitization and its relationship with the course of atopic dermatitis is not clear. In practice, this means that except in selected cases there is no benefit in performing allergy tests or in attempting allergic treatments in patients with atopic dermatitis. Epidermal chemical aggressions may provoke lesions in atopic dermatitis patients. More distant environmental factors may also affect atopic patients. Studies indicate that the humidity, UV irradiation and temperature may modulate atopic dermatitis prevalence.15 Psychologically stressful events are one of the major causes of atopic dermatitis flares.16 Consequently, therapeutic education and psychological interventions are now considered as an important part of the management of atopic dermatitis patients.17 To conclude, this brief, non-comprehensive review of the literature shows that atopic dermatitis appears as the cutaneous consequence of an impressive variety of factors: intrinsic abnormalities, internal dysfunctions, external influences. No other dermatosis is concerned at such extent by all the properties of the skin. The term ‘The Skin-Disease’ expresses this unique nosologic situation of atopic dermatitis.

Emerging role of interleukin-31 and interleukin-31 receptor in pruritus in atopic dermatitis.

Atopic dermatitis (AD) is a chronic or chronically relapsing, eczematous, severely pruritic skin disorder associated with skin barrier dysfunction. The lesional skin of AD exhibits T helper 2 (TH 2)-deviated immune reactions. Interleukin-31 (IL-31), preferentially produced from TH 2 cells, is a potent pruritogenic cytokine, and its systemic and local administration induces scratching behavior in rodents, dogs and monkeys. Recent clinical trials have revealed that administration of an anti-IL-31 receptor antibody significantly alleviates pruritus in patients with AD. In this review, we summarize recent topics related to IL-31 and its receptor with special references to atopic itch.

Development of an Allergen-induced Atopic Itch Model in Dogs: A Preliminary Report.

Development of an Allergen-induced Atopic Itch Model in Dogs: A Preliminary Report.

Drug utilization study of atopic dermatitis in a tertiary care hospital

Background: Atopic dermatitis is a chronic relapsing hypersensitivity manifestation of the skin which has shown an increasing prevalence world over. It ranges from a mild atopic itch to an unrelenting chronic eczema. Its prevalence which is on the rise necessitates a rational approach to the diagnosis and treatment. Methods: A prospective study was conducted for a period of six months and 245 prescriptions were collected after obtaining requisite permission and a proper informed consent. The data was analysed by using WHO drug use indicators. Results: Of the 245 prescriptions analysed, there was a female predominance with a female to male ratio of 1.63:1. Age group presenting more with the symptoms of atopic dermatitis was 20 to 29 years. Antihistamines were the most commonly prescribed medication (221), Emollients were present in 193 prescriptions. Topical steroids were received by 150 patients of whom 51 were prescribed as an FDC. Tacrolimus was given to 17 patients. Conclusions: It is essential to rule out helminthic infestation, scabies and seborrhoea dermatitis to make a proper diagnosis of atopic dermatitis. More generic prescribing wherever possible might help to reduce the cost per patient.

Mediators of Chronic Pruritus in Atopic Dermatitis: Getting the Itch Out?

For centuries, itch was categorized as a submodality of pain. Recent research over the last decade has led to the realization that itch is in fact a separate and distinct, albeit closely related, sensation. Chronic itch is a common complaint and has numerous etiologies. Various receptors (TRPA1, TRPV1, PAR2, gastrin-releasing peptide receptor (GRPR), Mas-related G proteins), secreted molecules (histamine, nerve growth factor (NGF), substance P (SP), proteases), and cytokines/chemokines (thymic stromal lymphopoietin (TSLP), IL-2, IL-4, IL-13, and IL-31) are implicated as mediators of chronic pruritus. While much remains unknown regarding the mechanisms of chronic itch, this much is certain: there is no singular cause of itch. Rather, itch is caused by a complex interface between skin, keratinocytes, cutaneous nerve fibers, pruritogenic molecules, and the peripheral and central nervous systems. Atopic dermatitis is one of the most itchy skin dermatoses and affects millions worldwide. The sensation of atopic itch is mediated by the interplay between epidermal barrier dysfunction, upregulated immune cascades, and the activation of structures in the central nervous system. Clinicians are in possession of an arsenal of different treatment options ranging from moisturizers, topical immunomodulators, topical anesthetic ion channel inhibitors, systemic immunomodulators, as well as oral drugs capable of reducing neural hypersensitization. Emerging targeted therapies on the horizon, such as dupilumab, promise to usher in a new era of highly specific and efficacious treatments. Alternative medicine, stress reduction techniques, and patient education are also important treatment modalities. This review will focus on the mediators of chronic pruritus mainly associated with atopic dermatitis (atopic itch), as well as numerous different therapeutic options.

Atopic itch in dogs: pharmacology and modeling.

Itch is the most common clinical problem seen in dogs with skin diseases. Although an etiological classification of canine pruritus does not yet exist, most causes would likely fall into the IFSI class I (dermatological) itch. One of the most common causes of canine itch is that associated with atopic dermatitis, and there is randomized controlled trial grade evidence of the efficacy of several antipruritic interventions. At this time, the mainstay of treatment of canine atopic itch relies principally on the use of topical and/or oral glucocorticoids and oral cyclosporine. Type 1 receptor antihistamines are notorious in their inconsistency in reducing pruritus in atopic dogs. A new Janus kinase (JAK)-1 inhibitor has recently been approved for treatment of allergic itch in dogs, and its onset of efficacy is remarkably fast. Modeling itch in dogs can be achieved by allergen sensitization (fleas, house dust mites), and challenges that elicit pruritic manifestation can be used for mechanistic studies as well as for testing of novel anti-itch modalities.