Management of Itch in Atopic Dermatitis

Atopic dermatitis is a common, pruritic, inflammatory skin disorder.Chronic, localized, or even generalized pruritus is the diagnostic hallmark of atopic dermatitis, and its management remains a challenge for physicians.The threshold for itch and alloknesis is markedly reduced in these patients, and infections can promote exacerbation and thereby increase the itch.Modern management consists of anti-inflammatory, occasionally antiseptic, as well as antipruritic therapies to address the epidermal barrier as well as immunomodulation or infection.Mild forms of atopic dermatitis may be controlled with topical therapies, but moderate-to-severe forms often require a combination of systemic treatments consisting of antipruritic and immunosuppressive drugs, phototherapy, and topical compounds.In addition, patient education and a therapeutic regimen to help the patient cope with the itch and eczema are important adjuvant strategies for optimized long-term management.This review highlights various topical, systemic, and complementary and alternative therapies, as well as provide a therapeutic ladder for optimized long-term control of itch in atopic dermatitis.Pruritus or itch, which is defined as an unpleasant sensation that elicits an urge to scratch, 1 is such an integral part of atopic dermatitis (AD) that it is a major characteristic in the diagnostic criteria and a hallmark of AD. 2 AD has been called the "itch that rashes," 3 which reflects how important it is to pay attention to pruritus in the management of AD.Pruritus can lead patients to scratch until they are bleeding, and scratching in turn can aggravate the skin disease.Nocturnal scratching is a common issue that can result in sleep disturbances and a dramatic impairment in the quality of life in these patients.In addition, psychological disturbances, such as stigmatization and social isolation, 4 are also detriments to quality of life. 5In this article we briefly summarize current knowledge of the pathophysiology and trigger factors of AD and focus in-depth on the various types of treatments for short-term and long-term management of itch in AD. Pathophysiology of Itch in ADThe sensation of pruritus can be triggered by endogenous and exogenous stimuli, which activate specific peripheral un-myelinated C-fiber nerve endings in the epidermis and dermis.The pruritogenic stimulus is then signaled along the dorsal root ganglion (which