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Pathophysiology of itch and new treatments

Raap, Ulrike; Ständer, Sonja; Metz, Martin

Current Opinion in Allergy and Clinical Immunology: October 2011 - Volume 11 - Issue 5 - p 420–427
doi: 10.1097/ACI.0b013e32834a41c2
Skin allergy: Edited by Torsten Zuberbier and Thomas Werfel

Purpose of review Itch represents one of the most bothersome symptoms in allergic disorders and numerous dermatological and systemic diseases. Chronic itch has a dramatic impact on the quality of life. The pathophysiology of itch is diverse and involves a complex network of cutaneous and neuronal cells. Thus, we highlight the current pathophysiological aspects of itch together with new treatment options.

Recent findings Apart from histamine, several mediators and receptors including the neurotrophins nerve growth factor (NGF), brain-derived neurotrophic factor, neurokinins/neuropeptides such as substance P, gastrin-releasing peptide, cytokines such as interleukin-31, autotaxin and the histamine H4 receptor have been identified for playing a role in the pathophysiology of itch. In the skin, tissue resident cells such as keratinocytes, mast cells and cells of the inflammatory infiltrate including lymphocytes and eosinophils have been described to interact with neuronal cells, for example via the release of neurotrophins, neuropeptides and cytokines, adding novel regulatory pathways for the modulation of itch. Accordingly, promising treatment strategies such as the neurokinin-1 receptor antagonist aprepitant have been introduced for a successful management of itch.

Summary In this review, we highlight novel key players in the pathophysiology of itch with subsequent introduction of promising, novel and experimental treatment strategies.

aDepartment of Dermatology and Allergy, Hannover Medical School

bCompetence Center Chronic Pruritus, Department of Dermatology, University Hospital Münster

cAllergie-Centrum-Charité, Department of Dermatology and Allergy, Charité – Universitätsmedizin Berlin, Berlin, Germany

Correspondence to Professor Dr med Ulrike Raap, MD, Department of Dermatology and Allergy, Hannover Medical School, Ricklinger Str. 5, 30449 Hannover, GermanyTel: +49 511 9246 233; fax: +49 511 9246 234; e-mail:

Copyright © 2011 Wolters Kluwer Health, Inc. All rights reserved.