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An official publication of the ACR and the ARP serving rheumatologists and rheumatology professionals

The Science of Chronic Itch

Shivani V. Tripathi, MD, & Brian S. Kim, MD, MTR  |  Issue: December 2014  |  

Beyond psoriasis, other autoimmune conditions affecting the skin have been associated with decreased QoL due to pruritus, including morphea, systemic sclerosis and dermatomyositis.70-73 In a recent study, among 959 patients with systemic sclerosis, 42.6% reported pruritus, and its presence was significantly associated with skin and gastrointestinal involvement of disease.74 This suggests that pruritus may be an indicator of systemic disease burden. In the context of cutaneous lupus erythematosus (CLE) and dermatomyositis (DM), a recent study demonstrated that DM has a much stronger association with pruritus than lupus and may help to distinguish between those individuals with CLE and DM.73 Further, improvement of DM disease severity is associated with improvement in pruritus and QoL.75 This is consistent with prior studies demonstrating that pruritus is a significant contributor to QoL in DM patients.76,77

Taken together, these studies demonstrate that the burden of chronic pruritus in rheumatologic diseases is significant and multifaceted. A unifying theme of pruritus associated with autoimmune disease is that it is another measure of disease activity and adequate treatment of the underlying process is essential to improvement of the symptom.

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Summary

In summary, we have highlighted five broad categories of itch: 1) systemic, 2) neuropathic, 3) psychogenic, 4) idiopathic and 5) dermatologic. Itch associated with rheumatologic disease is generally manifested in the latter category. The potential causes of chronic pruritus in most patients are multifactorial.

Overall, stratifying the potential causes of pruritus allows for a systematic approach, aiding the provider in developing a better understanding of the underlying diseases, pathophysiology and potential treatments. Emerging studies are revealing previously unrecognized pathways that regulate itch and hold great promise for new, targeted treatments.

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Dr. Tripathi

Shivani V. Tripathi, MD, is a clinical research fellow in the Division of Dermatology at Washington University School of Medicine in St. Louis, Mo.

 

 

 

Dr. Kim

Brian S. Kim, MD, MTR, is assistant professor of medicine (dermatology) in the Department of Medicine/Division of Dermatology at Washington University School of Medicine in St. Louis, Mo.

 

 

 

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