Itch is a significant characteristic in hidradenitis suppurativa (HS) although the cause, development, and optimal therapeutic procedures for itch in HS lack thorough understanding, according to findings from a review published in the Journal of Clinical Medicine.

Some patients with HS report reduction in quality of life, most significantly associated with pain and drainage, but reviewers believe itch has been overlooked when considering quality of life despite multiple studies reporting its importance. Pathogenesis theories of itch in HS suggest the presence of mast cells and increased Ig E levels, they wrote. Advanced HS and smoking have been associated with itch intensity increases. Investigators sought to discover prevalence, severity, and possible causes of itch in HS.

They initiated a systematic literature review of the PUBMED database that included 20 articles. More than half of patients with HS presented itch. Itch severity 0 to 10 ratings (with 0 representing no itch) revealed patient scores in these studies ranged from 4.5±3.5 to 5.4±2.5, which suggested HS itch to be mild to moderate. Reviewers found itch frequently co-presented with pain but they believe itch may be misinterpreted in these studies as tickling, stinging, burning, tweaking, and prickling.


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Itch in these studies was associated with depression, impairment in social life, and reduced quality of life. Reviewers found treatment with monoclonal antibody brodalumab often resulted in improvements in quality of life, pain, itch, and depression among patients with moderate to severe HS. Statins were mildly effective in reducing itch. Increases in mTor signaling and mast cells were found in lesional and perilesional skin of patients with HS and suggested as possible causes of itch.

Reviewers concluded that, “Despite a lack of complete understanding of itch in HS, it is an important aspect of the disease, reported in 62% to 75% of patients.” They suggest further studies for itch in HS will help clinicians reduce the quality-of-life impact on patients.

Disclosure: A study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Agarwal P, Lunge SB, Shetty NS, et al. Itch in Hidradenitis Suppurativa/Acne Inversa: A Systematic Review. J Clin Med. Published online June 30, 2022. doi:10.3390/jcm11133813