The shift from antihistamines to newer drugs for treating pruritus is rapidly accelerating.
“Antihistamines have a very limited role in chronic itch,” says Gil Yosipovitch, M.D., a professor of dermatology and director of the Miami Itch Center at the University of Miami Miller School of Medicine in Florida.
Dr. Yosipovitch, who spoke about pruritus therapies at the Fall Clinical Dermatology Conference, divided itch into three categories:
- Dermatologic itch related to skin diseases and age, which manifests with primary rashes.
- Neuropathic itch, which does not present with a rash and is associated with nerve damage.
- Itch linked to underlying systemic diseases, such as end-stage renal failure, liver disease and lymphoproliferative disorders.
The topical phosphodiesterase 4 (PDE4) inhibitor crisaborole 2% can reduce itch caused by atopic eczema and hand dermatitis after two days of application.
Even more effective for atopic itch, dupiliumab, an inhibitor of IL-4 and IL-13, quickly decreases itch before the rash disappears, says Dr. Yosipovitch. The IL-17 inhibitors secukinumab and ixekizumab have also shown very strong anti-itch properties for psoriatic pruritus. These injectables are administered typically once every two weeks.
Dr. Yosipovitch is a consultant to several companies developing drugs to treat pruritus. He is also the developer of the compounded formulation mentioned in the story.
Yosipovitch G. What you have been itching to know about pruritis therapies. Presented at: 2019 Fall Clinical Dermatology Conference; October 17, 2019; Las Vegas, NV.