Therapy of chronic itch has moved beyond antihistamines.
Most of chronic itch is nonhistaminergic.
There is a need to understand that chronic itch can arise out of dermatologic, systemic neuropathic and psychogenic causes and amultidimensional approach is often required.
There is no universally effective treatment for various kinds of itch, a combination of topical and systemic therapies addressing peripheral mediators is required. A top down approach should target brain and spinal cord.
Neural hypersensitization down regulation should be attempted with drugs like gabapentin and pregabalin.
Specific neuropeptides such as neurokinin-1 are a promising target.
Targeted biologic agents such as IL-31 inhibitors and IL-4 and IL-13 inhibitors may be useful in treating pruritis of inflammatory disorders.
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