Itch

We are happy to announce that Prof. Gil Yosipovitch will give a keynote on „The treatment of chronic itch“. Prof. Sonja Ständer will speak about the „Impairment of quality of life in chronic pruritus“. Prof. Elke Weisshaar will present on „Pruritus in elderly patients“. Prof. Andrea Evers will focus on „Conditioning of itch“.

Prof. Gil Yosipovitch (University of Miami Miller School of Medicine, USA)

Treatment of chronic itch

Gil Yosipovitch MD  Dr Phillip Frost Department of Dermatology and Cutaneous Surgery and the Miami Itch Center

Our growing understanding of mechanisms of chronic itch has significantly advanced  in the last decade. The cross talk of nervous system and immune pathways enables us to identify new therapeutic strategies. This lecture will cover targeted topical and systemic therapies for different types of chronic itch that includes drugs targeting the neural system in the periphery such as  topical drugs targeting TRP channels, Nav1.7,  PDE4, and Systemic drugs such as gabapentenoids, Neurokinin 1 inhibitors  and kappa opioids as well as systemic biologics such dupilumab, IL31 inhibitors and JAK/Stats . Our therapeutic armamentarium for treating chronic itch has expanded in the last five years with developments of topical and systemic treatments targeting the neural and immune systems in the skin, spinal cord and brain.

Prof. Sonja Ständer (University of Münster, GER)

Impairment of quality of life in chronic pruritus

S. Ständer Center for Chronic Pruritus, Department of Dermatology, University Hospital Münster, Germany

Chronic pruritus (CP) is known to be the most common symptom in dermatology. One-third of dermatological patients worldwide are thought to be affected by it. Recent studies have found that its intensity is connected to an impaired mood, decreased social interactions and sleep disturbances. CP thus negatively impacts patients’ health-related quality of life (HRQoL) what is well documented for pruritic skin conditions such as atopic dermatitis, psoriasis and urticaria. Despite not being itch-specific, the Dermatology Life Quality Index (DLQI) is a popular instrument used for documenting the HRQoL of dermatological patients with CP. Another instrument, the ItchyQoL, is a 22-item, pruritus-specific questionnaire designed to improve measurement of CP effects on the HRQoL of affected patients. Recently, the ItchyQoL was validated in seven Europenan countries.  Interestingly, lowest median and mean total ItchyQol score was found in Russia and in Italy; the highest in Poland. Also pruritus duration, frequency, intensity differed between European centers and dermatological diagnoses. In addition, women tend to have higher DLQI and ItchyQoL total scores and subscale scores. In conclusion, the HRQoL is a critical parameter for consideration in the daily routine and clinical trials and should be considered for CP.

Prof. Elke Weisshaar (University of Heidelberg, GER)

Pruritus in elderly patients

Chronic itch (CI) lasting for a minimum of six weeks is a frequent symptom in elderly people. It appears that the etiologies vary according to age. The Heidelberg Pruritus Prevalence Study showed that the risk of CI increased by two percent with each additional year of life and CI was twice as high in retired compared to working individuals. In elderly patients, systemic or mixed CI frequently occurs. Systemic etiologies comprise chronic renal insufficiency, hematological, hepatic or malignant diseases. The latter should always be ruled out. Xerosis cutis may occur in up to 69% of elderly people and may also contribute to CI. Precise diagnostics is necessary to evaluate the underlying etiology, to identify the best treatment available and to improve patients’ care and patients’ quality of life. A sudden onset of itch in the elderly is more likely to be caused by scabies, contact dermatitis or by a drug-induced reaction, whereas a slow beginning is rather caused by systemic disease or Xerosis cutis. A multimodal therapy is necessary including topical, systemic treatment as well as UV-phototherapy. With regard to the demographic situation in Western countries with increasing life expectancy CI is likely to become a great future challenge. 

Prof. Andrea Evers (University of Leiden, NL)

Conditioning of itch

Andrea W.M. Evers Professor of Health Psychology,  Department of Health, Medical and Neuropsychology, Institute of Psychology, Leiden University, Leiden, The Netherlands     

Increasing evidence demonstrates the neurobiological underpinnings and relevance of psychological learning processes in itch for dermatological conditions. For example, physical complaints, such as itch or pain, can be effectively altered by learning processes, particularly conditioning based on previous experience (“Itch already reduces when seeing the itch medication”). This phenomenon have been frequently described in research on placebo effects. The same is true for negative treatments effects which are induced by expectations of a possible unfavorable treatment outcome or side effects (also called nocebo effects). Learning mechanisms also play a role for immune functioning through pharmacological conditioning. In the presentation,  results will be presented to demonstrate the evidence for learning processes of itch in both non-clinical and clinical samples as well as possible innovative treatment methods to alter conditioned itch responses. The results have direct implications for the treatment of dermatology patients. Treatment outcomes might be optimized by using both conscious and automatic strategies, for example, by applying conditioning principles for therapy adherence, adding environmental cues to the preferred outcome strategies or reducing regular pharmacological treatments partly by altered medication dosages that make use of conditioning principles.