ORLANDO – Dr. Shawn G. Kwatra, speaking at the annual ODAC Dermatology conference, emphasized the importance of itch treatment for patients who have experienced little relief from traditional therapies. He noted that while itch may not be as glamorous as Mohs surgery or aesthetic procedures, it significantly impacts patients‘ quality of life.
Chronic itch is a common and bothersome condition, and many patients have already tried over-the-counter and prescription treatments before seeking help from a dermatologist. Given the difficulty in determining the optimal approach for each individual, Kwatra stressed the frustration providers may experience when patients present with complaints of itch that aren’t visually evident. Despite this, effectively alleviating patients‘ itch can make a significant difference in their lives, he noted.
Novel Approaches to Itch Relief
Kwatra highlighted several non-traditional tools in the itch management toolkit. Cooling agents, topical capsaicin, topical anesthetics like pramoxine 1%, various forms of lidocaine, strontium, opioid modulators like naltrexone, Janus kinase (JAK) inhibitors, and medical marijuana are among the „exceptional“ options available.
Topical ruxolitinib, roflumilast, and tapinarof, approved for dermatological conditions, along with biologics like dupilumab and tralokinumab, are all being considered for their potential to address itch, although their use for this indication is not currently approved. There are also oral JAK inhibitors and even off-label use of naltrexone, demonstrating the expanding armamentarium for itch treatment.
Consider Coolants and Topical Anesthetics
Kwatra suggested considering topical treatments like menthol, camphor, or calamine to reduce the activity of itch-related channels in the skin. Additionally, topical capsaicin, pramoxine 1%, and lidocaine were recommended for their ability to desensitize nerve fibers and reduce itch.
Devices and Future Directions
Beyond traditional therapies, Kwatra also discussed the use of devices such as electrical neurostimulation to reduce localized itch. He cited promising research that suggests electrical neurostimulation may be effective in reducing itch and even mentioned a case study on the use of injected botulinum toxin in managing chronic itch.
Kwatra is a consultant or advisory board member for several pharmaceutical companies. Damian McNamara is a freelance journalist based in Miami, covering a broad range of medical specialties. Follow Damian on Twitter: