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Neuropathic pruritus

Nature Reviews Neurology volume 10, pages 408–416 (2014)Cite this article

Subjects

Key Points

  • Itch—also referred to as pruritus—is an unpleasant sensation that elicits an urge to scratch

  • Neuropathic pruritus is caused by neuronal or glial damage

  • CNS disorders rarely trigger pruritus, but pruritus is commonly associated with peripheral neuropathies and disorders of mixed or undetermined aetiology with neurological involvement

  • Treatment for neuropathic pruritus is similar to that for neuropathic pain, but μ opioids can induce itch and are, therefore, contraindicated

Abstract

Pruritus, also known as itch, is a very common, unpleasant sensation that elicits an urge to scratch. Its origin is not always in the skin, and neuropathic itch that is caused by neuronal or glial damage is common, but poorly understood by both dermatologists and neurologists. Although pruritus has not been considered as serious a symptom as pain, it is difficult to treat and—if chronic—can severely impair quality of life. Neuropathic itch is often associated with other clinical symptoms, most commonly neuropathic pain, and hypersensitization to stimuli is present in both pruritus and pain of neuropathic origin. The shared aetiology can aid in finding suitable treatment for itch in some cases, but more detailed knowledge of the mechanisms of itch, along with standardized, well-controlled trials, is needed. Pruritus research is an emerging but currently very active field, and our understanding of this sensation is rapidly increasing. Here, we review new discoveries regarding the role of the nervous system and the contribution of different pathways in pruritus, discuss the different aetiologies of neuropathic itch, and outline currently available and potential strategies for managing neuropathic pruritus.

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Figure 1: Nerve fibres in the skin.
Figure 2: Brain networks involved in histamine-induced and cowhage-induced itch.
Figure 3: Prurigo nodularis.
Figure 4: Decision tree for the treatment of neuropathic pruritus.

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Authors and Affiliations

  1. Department of Dermatology, Brest University Hospital, 2 Avenue Foch, Brest, 29200, France

    Laurent Misery, Emilie Brenaut & Claire Abasq

  2. Department of Clinical Neurophysiology, Brest University Hospital, 2 Avenue Foch, Brest, 29200, France

    Steeve Genestet

  3. Department of Pathology, Brest University Hospital, 2 Avenue Foch, Brest, 29200, France

    Pascale Marcorelles

  4. Laboratory of Neurosciences Brest, Faculty of Medicine, University of Western Brittany, Avenue Camille Desmoulins, Brest, 29200, France

    Raphaële Le Garrec

  5. Department of Neurology, HIA Clermont-Tonnerre, Due du Colonel Fonferrier, CC41, Brest, 29240, France

    Fabien Zagnoli

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All authors researched the data for the article, provided substantial contributions to discussions of its content, wrote the article and undertook review and/or editing of the manuscript before submission.

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L.M. has consulted for Astellas, Maruho, Novartis and Pierre Fabre. The other authors declare no competing interests.

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Misery, L., Brenaut, E., Le Garrec, R. et al. Neuropathic pruritus. Nat Rev Neurol 10, 408–416 (2014). https://doi.org/10.1038/nrneurol.2014.99

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