Managing Itch in Atopic Dermatitis: Current and Potential Treatments

For patients with itch in atopic dermatitis, a number of effective treatments have become available in recent years and more are in development, researchers reported in Clinical, Cosmetic and Investigational Dermatology.

The investigators reviewed newly available treatment options, recent advances in the field, and new treatments currently being investigated.

Among nonpharmacologic agents, gentle cleansers are recommended for bathing. Topical emollients such as moisturizing creams and lotions should be used at least once daily. Relaxation techniques also have been shown to decrease atopic itch.

Localized atopic itch can frequently be treated with topical or intralesional therapeutic agents. Topical corticosteroids have been used for atopic dermatitis for decades. Pimecrolimus and tacrolimus, topical calcineurin inhibitors, are used as steroid-sparing agents for patients with atopic dermatitis. Phosphodiesterase-4 (PDE-4) inhibitors are an alternative option for topical treatment of pruritis in atopic dermatitis.

Systemic pharmacologic treatments can be beneficial in patients who are unresponsive to topical therapies. Dupilumab has been shown to have antipruritic effects as early as the first week of treatment in patients with atopic dermatitis and is the only FDA-approved biologic agent for treatment atopic dermatitis.

Systemic corticosteroids should be used with caution only in the case of flares and only for several weeks at a time, according to the researchers. Cyclosporine is a second-line option for atopic itch in patients for whom dupilumab is ineffective. Methotrexate has demonstrated antipruritic effects in atopic itch in elderly patients and in those with eczema and lichen amyloidosis.

Oral antihistamines are commonly used for atopic itch, although they may not be the most effective treatment option, noted the study authors. Phototherapy has been shown to be efficacious in targeting atopic itch.

Emerging treatment options include topicals such as tapinarof, which has shown efficacy in patients with atopic dermatitis and psoriasis. New PDE-4 inhibitor topicals, such as roflumilast once daily, are in phase 3 trials in atopic eczema. The Janus kinase (JAK) signal transducer and activator of transcription (STAT) pathway has been shown to have a role in atopic dermatitis, and several JAK-STAT inhibitors are in development for the treatment of atopic dermatitis and atopic itch. Systemic therapies such as abrocitinib, upadacitinib, and baricitinib have also shown promise in recent trials.

Tralokinumab and lebrikizumab, monoclonal antibodies targeting interleukin 13 alone, are in phase 3 clinical trials. BLU-5937, a P2X3 agonist, is in a phase 2 clinical evaluation for use in atopic dermatitis.

“While treatment of atopic itch is challenging, advancements in the last several years have provided physicians with multiple options to choose from, ranging from topical agents to systemic therapies,” stated the investigators. “In addition, newer treatments on the horizon have shown great promise. Overall, improved treatment of atopic itch will improve not only atopic dermatitis symptoms, but also quality of life in many patients across the globe.”

Disclosure: One of the study authors declared affiliations with pharmaceutical companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Lipman ZM, Labib A, Yosipovitch G. Current clinical options for the management of itch in atopic dermatitis. Clin Cosmet Investig Dermatol. Published online August 3, 2021. doi:10.2147/CCID.S289716