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Nonpharmacologic interventions for chronic pruritus

Chronic pruritus, traditionally defined as itch persisting for >6 weeks, is a common affliction that can be associated with cutaneous or systemic disease, or may be idiopathic in nature. It affects patients of all ages and backgrounds and seems to have no predilection for sex or socioeconomic status. The lifetime prevalence has been estimated between 22% and 26%. It accounts for millions of outpatient clinic encounters every year. Pruritus is associated with significant morbidity ranging from sleep disturbance to suicidal ideation in both pediatric and adult patients. The pathophysiology of pruritus is complex and multifactorial. An intricate and incompletely understood interplay between cytokines, sensory neurons, and a variety of cutaneous and central nervous system receptors and effector cells are responsible for the development of itch. Scores of therapies exist, with enormous variation in efficacy, for the amelioration of itch. Drugs aimed at virtually all of the aforementioned pathogenic factors in pruritus have been trialed or are being developed. Nonpharmacologic therapies for chronic pruritus encompass a variety of methods for altering itch signaling or for changing the patient’s perception of pruritus. Although some of these interventions may be used as monotherapy, they are usually best utilized in combination with more conventional pharmacologic antipruritic therapies. This review evaluates the current understanding of the mechanisms and efficacy of these nonpharmacologic interventions and serves to expand the dermatologist's armamentarium against chronic pruritus.