Pruriplastic Itch-A Novel Pathogenic Concept in Chronic Pruritus

The International Association for the Study of Pain (IASP) defined three descriptors for pain: nociceptive pain is "pain that arises from actual or threatened damage to non neural tissue and is due to the activation of nociceptors"; neuropathic pain is "pain caused by a lesion or disease of the somatosensory nervous system"; and nociplastic pain is "pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain." Based on clinical and pathophysiological arguments, a similar definition of "pruriplastic pruritus" should be made. Pruriplastic pruritus would include psychogenic pruritus, as well as some cases of pruritus ani, vulvar pruritus, sensitive skin or other poorly understood cases of pruritus. This new descriptor of itch could serve as systematic screening for altered pruriceptive function in patients who suffer from chronic itch and it may also help in defining better tailored treatment by identifying patients who are likely to respond better to centrally rather than to peripherally targeted therapies.