Beyond the Surface: Updates in Itch Treatment
At one time dismissed or misunderstood, chronic itch has emerged in recent years as a significant focus in dermatology, thanks to advancements in research and treatment.
"Itch is finally going mainstream," said dermatologist Dr. Shawn Kwatra (pictured), the Joseph W. Burnett Endowed Professor and Chairman of the department of dermatology at the University of Maryland, in his talk. “But I’ll tell you, several years ago, it was not that way.”
Addressing attendees of the 2025 Masterclasses in Dermatology conference in Sarasota, Dr. Kwatra said that patients with chronic itch often experience severe quality-of-life impacts, highlighting an analysis where patients with chronic itch self-reported a quality of life worse than those who lived with conditions resulting from a stroke.
Targeting Itch Pathways
Dr. Kwatra described the itch-scratch cycle is not merely a surface phenomenon, but as a dynamic process involving thinly myelinated A-delta fibers and unmyelinated C-fibers transmitting signals from the skin to the brain and back, along with an interplay with the immune system.
"Stress and immune responses can exacerbate the cycle," he added.
He also pointed out that recent breakthroughs in understanding inflammatory pathways have opened doors for more targeted therapies. By targeting these pathways (such as IL-4, IL-13, IL-22, and IL-31, as well as targeting JAK-1), dermatologists can offer relief to patients previously considered untreatable.
Treating Prurigo Nodularis
Dr. Kwatra highlighted the two FDA-approved treatments for prurigo nodularis as useful tools in the anti-itch armamentarium. He first highlighted the IL-4 receptor antagonist dupilumab, which he noted has demonstrated significant efficacy in reducing itch. Dr. Kwatra’s group also showed reduction in inflammatory circulating blood mediators of inflammation with in prurigo nodularis patients treated with dupilumab.1 He also pointed to the IL-31 inhibitor nemolizumab, which involved Dr. Kwatra as the global multicenter Principal Investigator and first author on the OLYMPIA 2 study published in the New England Journal of Medicine demonstrating rapid itch reduction in prurigo nodularis.2
Other Approaches to Itch Treatment
Dr. Kwatra also addressed previously understudied forms of chronic itch. He discussed his group’s work identifying the etiology of immune stimulus exposure as a trigger for the development of chronic pruritus of unknown origin (CPUO), a disease his group focused on studying. His team recently published a paper documenting the successful use of abrocitinib in recalcitrant CPUO patients.3
"Our group also discovered a role for circulating blood biomarkers of type 2 inflammation, such as blood TARC levels as well as IgE and blood eosinophils in CPUO,” he said.
Dr. Kwatra also shared new nomenclature from the recent consensus paper on neuropathic itch he led as the first author.4 He also described a novel technique performed by his group involving greater occipital nerve blocks for scalp itch and subsequent occipital nerve ablation resulting in a cure for the patient’s itch.
"We are at a great frontier of new itch treatments," he remarked, describing the rapidly changing landscape. “It’s an exciting time.” -by Eric Raible
Source: Kwatra S. Updates in itch. Presented at: Masterclasses in Dermatology, Sarasota, FL, USA; February 20–23, 2025
References
- Bao A, Ma E, Cornman H, et al. Dupilumab therapy modulates circulating inflammatory mediators in patients with prurigo nodularis. JID Innov. 2024;4(4):100281. Doi: 10.1016/j.xjidi.2024.100281
- Kwatra S, Yosipovitch G, Legat F, et al. Phase 3 trial of nemolizumab in patients with prurigo nodularis. N Engl J Med. 2023;389:1579-89. Do:10.1056/NEJMoa2301333
- Kwatra S, Bordeaux A, Parthasarathy V, et al. Efficacy and safety of abrocitinib in prurigo nodularis and chronic pruritus of unknown origin: A nonrandomized controlled trial. JAMA Dermatology. 2024. Doi:10.1001/jamadermatol.2024.1464
- Kwatra S, Elmariah S, Chisolm S, et al. United States expert panel consensus on uniform nomenclature and diagnosis for neuropathic pruritic. Itch. 2024;9(1):e0073
