Abstract
Chronic itch afflicts a substantial part of the population and represents a crux medicorum for physicians. It is the most frequent symptom of patients with skin diseases, but it can also be a symptom of severe internal, neurological or psychiatric diseases.
Pathophysiology is still not sufficiently elucidated. It is based on complex processes in the skin, where the interaction of keratinocytes, mastocytes and other immune cells with sensoric nerves plays a role, both in the induction and the regulation of itch.
Treatment and management should be comprehensively conceived and designed individually, based on the clinical type and possible pathophysiology of pruritus in a particular patient. All available possibilities should be utilized, including suitable topical therapy and skin care that has made progress in both active substances and comfortable compounded forms.
It proceeds step by step, from simpler to more demanding, combined procedures, taking into account the severity of pruritus, co-morbidity, age, medications used, and the benefits of the treatment under consideration to its risks. In addition to non-sedating H1 antihistamines, which usually do not have sufficient effect, other options are anticonvulsants, antidepressants, opioids and UV light phototherapy.
Research on new drugs is underway, H4 antihistamines and neurokinin 1 receptor antagonists are promising.