Neurophysiological and neurochemical basis of modern pruritus treatment.
Chronic pruritus of any origin is a frequent discomfort in daily medical practice, and its therapy is challenging. Frequently, the underlying origin may not be identified and symptomatic therapy is necessary. Conventional treatment modalities such as antihistamines often lack efficacy, and hence new therapeutic strategies are necessary. The neuronal mechanisms underlying chronic pruritus have been partly identified during the past years and offer new therapeutic strategies. For example, mast cell degranulation, activation of neuroreceptors on sensory nerve fibres and neurogenic inflammation have been identified to be involved in induction and chronification of the symptom. Accordingly, controlling neuroreceptors such as cannabinoid receptors by agonists or antagonists showed high antipruritic efficacy. Pruritus is transmitted to the central nervous system by specialized nerve fibres and sensory receptors. It has been demonstrated that pruritus and pain have their own neuronal pathways with broad interactions. Accordingly, classical analgesics for neuropathic pain (gabapentin, antidepressants) also exhibit antipruritic efficacy upon clinical use. In summary, these recent developments show that highlighting the basis of pruritus offers modern neurophysiological and neurochemical therapeutic models and the possibility to treat patients with refractory itching of different origin.
Ständer
Sonja
S
Clinical Neurodermatology, Department of Dermatology, University of Muenster, Muenster, Germany. sonja.staender@uni-muenster.de
Weisshaar
Elke
E
Luger
Thomas A
TA
D000818:Animals; D000982:Antipruritics / Q000627:therapeutic use*; D002491:Central Nervous System Agents / Q000627:therapeutic use*; D003879:Dermatologic Agents / Q000627:therapeutic use; D006634:Histamine H1 Antagonists / Q000627:therapeutic use; D006801:Humans; D011537:Pruritus / Q000145:classification / Q000188:drug therapy* / Q000503:physiopathology; D011984:Sensory Receptor Cells / Q000187:drug effects / Q000502:physiology / Q000503:physiopathology*; D012867:Skin / Q000187:drug effects / Q000503:physiopathology*; D012879:Skin Physiological Phenomena
D000982:Antipruritics; D002491:Central Nervous System Agents; D003879:Dermatologic Agents; D006634:Histamine H1 Antagonists