Pruritus in atopic dermatitis—comparative evaluation of novel treatment approaches

Abstract

Chronic pruritus (duration ≥ 6 weeks) affects about 91% of patients suffering from atopic dermatitis (AD). Pruritus is often accompanied by sensations such as pain, burning, stinging, and heat, resulting in a high burden of affected patients; sleep and quality of life may be severely impaired. An important pillar of AD treatment is also to achieve sufficient control of pruritus. In addition to intensively used emollients, corticosteroids and calcineurin inhibitors have proven effective. In case of eczema affecting a large part of the body surface area (BSA), phototherapy may contribute to the healing of eczema and the relief of atopic pruritus. As to systemic therapies, several approved biologics (dupilumab, tralokinumab) and small molecules (baricitinib, upadacitinib, abrocitinib) lead to a rapid improvement of pruritus by interfering with the signal transduction of proinflammatory cytokines. While Janus kinase inhibitors initially lead to a faster relief of pruritus than biologics, the antipruritic efficacy of biologics and Janus kinase inhibitors seems to be similar in long-term use.