Chronic itch management: therapies beyond those targeting the immune system

Chronic itch can be a debilitating, unrelenting symptom. Over the years, we have advanced our knowledge about immune-mediated itch (eg, atopic dermatitis) and have developed several treatments targeting these immune pathways. Chronic itch that is noninflammatory in nature is more elusive. However, we have gained some understanding of the neural component mediating itch and have made progress in treating this challenging symptom.

A comprehensive literature search was conducted, and data and literature were reviewed on the topics of chronic itch, its pathophysiology, and nonimmunological treatments for chronic itch that work on the nerves.

Basic science papers, review articles, case reports, and clinical trial data were considered.

A variety of topical and systemic therapies targeting the nerves have shown effectiveness in treating patients with chronic itch of different types.

Treating chronic itch may be challenging, but an arsenal of treatments are available and many are on the horizon as we expand our knowledge of mechanisms of itch and the neural receptors involved.