Itch: Pathogenesis and treatment - 09/12/21
Abstract |
Itch pathogenesis is broadly characterized into histaminergic and nonhistaminergic pathways and transmitted via 2 main receptor families: G protein–coupled receptors and transient receptor potential channels. In the skin, itch is primarily transmitted by unmyelinated type C and thinly myelinated type Aδ nerve fibers. Crosstalk between the immune and neural systems modulates itch transmission at the skin, spinal cord, and brain. Among the many known pruritogens, Th2 cytokines, such as interleukin-4, interleukin-13, interleukin-31, and thymic stromal lymphopoietin, are particularly important mediators that signal through shared Janus kinase pathways, representing novel targets for novel itch therapeutics. Emerging evidence has also revealed that the opioidergic system is a potent modulator of itch transmission, with increased μ-opioid activity and decreased κ-opioid activity contributing to itch pathogenesis. Optimal management of itch requires that treatment approaches be tailored to specific etiologic itch subtypes. When the etiology is unknown and patients are given a diagnosis of chronic pruritus of unknown origin, treatment should be guided by the presence of Th2 polarization, often reflected by increased blood eosinophils. In the second article of this 2-part series, we outline our current understanding of itch pathogenesis and discuss available and emerging treatments for itch.
Le texte complet de cet article est disponible en PDF.Key words : itch, management, pathogenesis, pathophysiology, pruritus, therapeutics, treatments
Abbreviations used : CPUO, GRP, GRPR, IL, JAK, PAR, PN, RCT, SP, STAT, TRP, TRPV1
Plan
Funding sources: Dr Kwatra is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under award number K23AR077073. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. |
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IRB approval status: Not applicable. |
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Date of release: January 2022. |
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Expiration date: January 2025. |
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Reprints not available from the authors. |
Vol 86 - N° 1
P. 17-34 - janvier 2022 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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