Chronic Itch: Clinical Pearls

Gil Yosipovitch, MD

Dr Yosipovitch provides us with key takeaway points for managing patients with chronic itch…

• Chronic itch is a disease on its own right and requires adequate treatment.
• Anti histamines in most cases do not work for chronic itch
• There are different types of chronic itch that include dermatologic, neuropathic systemic and psychogenic that require different treatment approaches.
• Chronic itch is associated with peripheral and central nerve sensitization.
• There is an imbalance of Mu opioids that over expressed versus kappa opioids in chronic itch and therefore drugs that are kappa opioid agonists and mu antagonists are effective for severe cases of itch.
• Drugs that reduce nerve fiber sensitization such as gabapentin and pregablin and Selective serotonin and neuroepinephrine re- uptake inhibitors are effective for treatment of chronic itch.
• Stress aggravates chronic itch and treatments that reduce stress including holistic approaches are important adjunct therapies for chronic itch.