Major Research Findings

Eczema, a chronic skin condition characterized by dry skin, intense itching, inflammatory skin lesions, and a significant impact on quality of life, often involves moisturization as a crucial part of treatment. However, the effectiveness of moisturizers remains uncertain. 17

Vulvovaginal itching, a common symptom in postmenopausal women, can be linked to the genitourinary syndrome of menopause but also has a wide range of potential causes, including dermatologic, infectious, and autoimmune factors. Thorough evaluation is critical to avoid inappropriate treatments that might delay a correct diagnosis. In many cases, a clear cause cannot be identified, and the primary goal of management is symptom control. 1

Traditionally, the worsening of skin diseases accompanied by itching and dryness is addressed using antihistamines, indifferent ointments (sometimes combined with topical corticosteroids), and antipruritic local agents. For ongoing use during periods between relapses, patients typically receive various lipid-recovery beauty creams, ointments, and emulsions. However, these measures often have a limited impact on the severity of itching and can be quite expensive. Based on this, we propose an alternative approach involving a combination of psychophysical therapy methods (dotted self-massage) and paravertebral UV irradiation alongside topical emollients for managing chronic dermatoses characterized by dryness and itching. Research involving a study group of patients, compared to a control group receiving traditional treatment, showed that the primary symptoms (dryness, a feeling of tightening skin, itching) subsided considerably faster (an average of 5 days). 85% of patients in the study group reported improvements in their overall emotional state, with a decrease in the severity of depression related to their skin condition, indicating a clear improvement in their quality of life. After 3 weeks of using the drug "Secalia," a noticeable reduction in the severity of skin flaking was observed. By the end of the observation period (1.5 months), patients in the primary group showed no recurrence of itching or worsening of their skin. A key advantage of this method is its absolute safety, as there are no contraindications (except for general contraindications for physiotherapy procedures) and no unwanted side effects. It demonstrates excellent tolerability, simplicity, and ease of use. Unlike other physiotherapy methods, the complex of psycho-physical exercises can be performed at home. The accessibility, simplicity, and possibility of home use, absolute safety, and effectiveness against dryness and itching relief of the proposed method make it a recommendable tool for continuous use in patients with dermatoses accompanied by dryness and itching, both in combination with other basic medications and as a monotherapy. 12

This study investigated the severity and frequency of uremic pruritus and itch-associated insomnia in patients with end-stage renal disease (ESRD) or chronic kidney disease (CKD). 5

Primary biliary cholangitis (PBC) is typically associated with elevated serum bile acid levels and pruritus, but pruritus is often refractory to treatment with existing therapies. This phase 2 study assessed the efficacy and safety of maralixibat, a selective, ileal, apical, sodium-dependent, bile acid transporter inhibitor, in adults with PBC and pruritus. Adults with PBC and pruritus who had received ursodeoxycholic acid (UDCA) for ≥6 months or were intolerant to UDCA were randomized 2:1 to maralixibat (10 or 20 mg/day) or placebo for 13 weeks in combination with UDCA (when tolerated). The primary outcome was change in Adult Itch Reported Outcome (ItchRO®) average weekly sum score (0, no itching; 70, maximum itching) from baseline to week 13/early termination (ET). The study enrolled 66 patients (maralixibat [both doses combined], n = 42; placebo, n = 24). Mean ItchRO® weekly sum scores decreased from baseline to week 13/ET with maralixibat (-26.5; 95% confidence interval [CI], -31.8, -21.2) and placebo (-23.4; 95% CI, -30.3, -16.4). The difference between groups was not significant (*P* = 0.48). In the maralixibat and placebo groups, adverse events (AEs) were reported in 97.6% and 70.8% of patients, respectively. Gastrointestinal disorders were the most frequently reported AEs (maralixibat, 78.6%; placebo, 50.0%). *Conclusion:* Reductions in pruritus did not differ significantly between maralixibat and placebo. However, a large placebo effect may have confounded assessment of pruritus. Lessons learned from this rigorously designed and executed trial are indispensable for understanding how to approach trials assessing pruritus as the primary endpoint and the therapeutic window of bile acid uptake inhibition as a therapeutic strategy in PBC. 6

Pruritus ani (PA) is defined as intense chronic itching affecting perianal skin. 16

A 73-year-old Japanese man developed chronic intractable itching due to prurigo nodularis. High-dose glucocorticoid ointment failed, and the treatment resulted in poor glycemic control. Repeated scratching caused hematogenous bacterial dissemination via cutaneous injuries, resulting in the formation of iliopsoas and spinal epidural abscesses that required long-term antibiotic treatment. Pregabalin was administered to treat the pruritus, and a considerable improvement was observed. A reduction in the dose and intensity of the topical corticosteroids improved the patient's glycemic control, resulting in the complete resolution of the abscesses. Pregabalin significantly improved the patient's pruritus and decreased the risk of infection. 8

To determine whether ocular itching associated with ocular demodicosis can be treated by lid massage with 5% tea tree oil ointment (TTOO). 10

treatmentまとめ

Moisturizers are often used to treat eczema, but their effectiveness is unclear. 17

Treating vulvovaginal itching in postmenopausal women may involve controlling symptoms, as finding a clear cause is not always possible. 1

An alternative treatment for chronic dermatoses involves a combination of psychophysical therapy methods (dotted self-massage) and paravertebral UV irradiation alongside topical emollients. 12

Maralixibat may be a potential treatment for itching associated with primary biliary cholangitis, but a phase 2 study showed no significant difference in effectiveness compared to placebo. 6

Topical tacrolimus might be effective in treating persistent pruritus ani in patients with atopic dermatitis. 16

Pregabalin demonstrated significant improvement in a patient with chronic intractable itching due to prurigo nodularis, reducing itching and decreasing the risk of infection. 8

5% tea tree oil ointment is being explored as a potential treatment for ocular itching associated with ocular demodicosis. 10

Benefits and Risks

Benefit Summary

A combination of psychophysical therapy methods and paravertebral UV irradiation, alongside topical emollients, may effectively reduce itching associated with chronic dermatoses. 12

Pregabalin has shown significant improvement in a patient with chronic intractable itching, reducing itching and decreasing the risk of infection. 8

Risk Summary

Maralixibat may lead to side effects such as gastrointestinal disorders. 6

Comparison Between Studies

Commonalities Between Studies

Many studies focus on developing treatments to alleviate itching. They emphasize the significant impact itching can have on quality of life.

Differences Between Studies

Directly comparing study results is challenging due to variations in study populations, treatment methods, and evaluation techniques.

Consistency and Contradictions in Results

The effectiveness of maralixibat has shown inconsistent results across studies. While some studies suggest potential benefits, others have not found significant differences compared to placebo.

Practical Implications and Considerations

The causes and symptoms of itching can vary significantly from person to person. Therefore, the most appropriate treatment approach is unique to each individual. Consulting a physician for proper diagnosis and treatment is crucial. Lifestyle modifications can also play a role in managing itching.

Limitations of Current Research

Research on itching treatment is still in its early stages and more studies are needed to gain a comprehensive understanding of the condition.

Future Research Directions

Further research is needed to elucidate the mechanisms and causes of itching, as well as to identify effective treatments.

Conclusion

Itching can be a distressing symptom for many people. It is essential to choose appropriate treatment options and improve quality of life.

Treatment List

Moisturizers, antihistamines, topical corticosteroids, antipruritic local agents, psychophysical therapy methods (dotted self-massage), paravertebral UV irradiation, maralixibat, topical tacrolimus, pregabalin, 5% tea tree oil ointment