Neuropathic itch refers to disorders characterized by chronic itching caused by dysfunction or damage to pruriceptors, nerves involved in itch transmission. In these conditions, itch is not triggered by external stimuli (eg, irritants or allergens), but rather arises spontaneously. Neuropathic itch can occur through nerve damage from mechanical, metabolic, inflammatory, or cytopathic injury. It is often accompanied by neural hypersensitivity manifesting as alloknesis (itch) or dysesthesia (eg, burning, stinging) in response to innocuous mechanical stimuli. Although pruritus arising from nerve damage in the central nervous system can occur, most common itch conditions arise peripherally. Further, although many generalized itch conditions exhibit neuropathic qualities (eg, prurigo nodularis, diabetic itch), the extent to which neuropathy alone is the primary driver remains controversial. Thus, we will focus on the mechanisms underlying and therapeutic management of peripheral sensory itch conditions in this review.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Brian S. Kim, MD, MTR, Icahn Medical Institute, 1425 Madison Ave, Room L12-75A, New York, NY 10029 (firstname.lastname@example.org).
Published Online: September 20, 2023. doi:10.1001/jamadermatol.2023.3384
Conflict of Interest Disclosures: Dr Kim is founder of KliRNA Biotech; he has served as a consultant for 23andMe, ABRAX Japan, AbbVie, Almirall, Amagma Therapeutics, Amgen, Arcutis Biotherapeutics, Arena Pharmaceuticals, argenx, AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Cara Therapeutics, Clexio Biosciences, Eli Lilly and Company, Escient Pharmaceuticals, Evommune, Galderma, Genentech, GlaxoSmithKline, Granular Therapeutics, Incyte Corporation, Innovaderm Research, Janssen, Kiniksa, LEO Pharma, Maruho, Novartis, Pfizer, Recens Medical, Regeneron Pharmaceuticals, Sanofi, Septerna, Teva, Vial, WebMD; he has stock in ABRAX Japan, KliRNA Biotech, Locus Biosciences, and Recens Medical; he holds a patent for the use of JAK1 inhibitors for chronic pruritus; and he has a patent pending for the use of JAK inhibitors for interstitial cystitis. No other disclosures were reported.
Funding/Support: Research in the Kim Lab is funded by National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR070116, R01AR077007) and National Institute of Allergy and Infectious Diseases (R01AI167933, R21AI167047).
Role of the Funder/Sponsor: The funders had no role in the preparation, review, or approval of the manuscript and decision to submit the manuscript for publication.
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