Distinction Between Inflammatory, Neuropathic Pruritis Is Relevant for Care

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Inflammatory pruritus may be more strongly associated with nociceptive symptoms than neuropathic pruritus.
Inflammatory pruritus may be more strongly associated with nociceptive symptoms than neuropathic pruritus.

When treating patients with pruritus, clinicians should be aware of the distinctions between inflammatory and neuropathic forms of the disorder to help guide the diagnostic workup, treatment plan, and choice of the most efficacious classes of medication, according to the results of an analysis of cross-sectional survey data collected from patients with chronic pruritus. The results were published in the Journal of the American Academy of Dermatology.

A total of 267 adult patients were enrolled in the study. Chronic pruritus was defined as an itch that lasted for more than 6 weeks. Those individuals with a single dermatologic diagnosis of atopic dermatitis or psoriasis were classified as having inflammatory itch (n=57) whereas patients with brachioradial pruritus, notalgia paresthetica, unspecified neuropathic itch, or postherpetic neuralgia were classified as having neuropathic itch (n=44). Survey data relative to the extent to which nociceptive characteristics corresponded to each individual's pruritus were recorded on a scale from 0 (not at all) to 4 (to a great extent). 

The average age of patients with inflammatory itch was 48.8 years vs 63 years among patients with neuropathic itch, which was statistically significant (P <.001). When compared with the neuropathic itch group, the inflammatory itch group exhibited a significantly greater mean for the extent to which stinging (P =.035), burning (P =.012), sunburn-like (P =.001), painful (P =.005), and hurting (P =.006) was associated with itch.

Within the neuropathic pruritus arm, no significant difference was observed between patients taking (n=18) or not taking (n=26) neuromodulator medications (eg, gabapentin). Alternately, within the inflammatory pruritus arm, patients taking neuromodulators (n=6) reported a significantly greater mean for the extent to which hurting was associated with itch (P =.04).

The investigators concluded that the study findings suggest that inflammatory pruritus may be more strongly associated with nociceptive symptoms than neuropathic pruritus. Thus, healthcare professionals should be mindful of the distinctions between the 2 types of itch when caring for patients with pruritus.

Reference

Rosen JD, Fostini AC, Chan YH, Nattkemper LA, Yosipovitch G. A cross-sectional study of clinical distinctions between neuropathic and inflammatory pruritus [published online June 1, 2018]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2018.05.1236

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