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Itch in systemic disease: therapeutic options.

Malcolm W Greaves1

  • 1National Skin Centre, Singapore. mwatsong@hotmail.com

Dermatologic Therapy
|November 22, 2005
PubMed
Summary

This study proposes a new classification for generalized itch, focusing on neurogenic causes and offering diagnostic and management guidelines. It reviews treatments like ultraviolet B (UVB) therapy and medications for systemic diseases.

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Area of Science:

  • Dermatology
  • Neurology
  • Gastroenterology

Background:

  • Generalized itch, particularly neurogenic itch (without visible rash), presents diagnostic and management challenges for clinicians.
  • A pathophysiologically based classification is needed to guide rational diagnosis and treatment of widespread itching.

Purpose of the Study:

  • To propose a new pathophysiologically based classification of generalized itch.
  • To provide guidelines for the diagnosis and management of neurogenic itch and itch associated with systemic diseases.

Main Methods:

  • Review of common causes of neurogenic itch.
  • Proposal of guidelines for laboratory and radiologic investigations.
  • Stepwise approach to managing generalized itch from systemic diseases.
  • Discussion of treatments including ultraviolet B (UVB) phototherapy, doxepin, opioid antagonists, selective serotonin reuptake inhibitors (SSRIs), bright-light phototherapy, molecular adsorbent recirculating system (MARS), and mirtazapine.

Main Results:

  • A new classification framework for generalized itch is presented.
  • Guidelines for investigating and managing neurogenic and systemic itch are proposed.
  • The relative merits and drawbacks of various therapeutic options are considered.

Conclusions:

  • The proposed classification aids clinicians in diagnosing and managing generalized itch.
  • A stepwise approach combined with targeted therapies can effectively manage itch from systemic diseases.
  • Novel treatments show promise for intractable and nocturnal itch.

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