Display options
Cite
Andrade A, Kuah CY, Martin-Lopez JE, et al. Interventions for chronic pruritus of unknown origin. Cochrane Database Syst Rev. 2020;1:CD013128doi: 10.1002/14651858.CD013128.pub2.
Andrade, A., Kuah, C. Y., Martin-Lopez, J. E., Chua, S., Shpadaruk, V., Sanclemente, G., & Franco, J. V. (2020). Interventions for chronic pruritus of unknown origin. The Cochrane database of systematic reviews, 1CD013128. https://doi.org/10.1002/14651858.CD013128.pub2
Andrade, Andrea, et al. "Interventions for chronic pruritus of unknown origin." The Cochrane database of systematic reviews vol. 1 (2020): CD013128. doi: https://doi.org/10.1002/14651858.CD013128.pub2
Andrade A, Kuah CY, Martin-Lopez JE, Chua S, Shpadaruk V, Sanclemente G, Franco JV. Interventions for chronic pruritus of unknown origin. Cochrane Database Syst Rev. 2020 Jan 25;1:CD013128. doi: 10.1002/14651858.CD013128.pub2. PMID: 31981369; PMCID: PMC6984650.
Copy Download .nbib Format: NLM
Share it on

Cochrane Database Syst Rev. 2020 Jan 25;1:CD013128. doi: 10.1002/14651858.CD013128.pub2.

Interventions for chronic pruritus of unknown origin.

The Cochrane database of systematic reviews

Andrea Andrade, Chii Yang Kuah, Juliana Esther Martin-Lopez, Shunjie Chua, Volha Shpadaruk, Gloria Sanclemente, Juan Va Franco

Affiliations

  1. Hospital Italiano de Buenos Aires, Department of Dermatology, Tte. Peron 4230, Buenos Aires, Argentina, 1199.
  2. Instituto Universitario Hospital Italiano, Argentine Cochrane Centre, Potosi 4234, Buenos Aires, Buenos Aires, Argentina, C1199ACL.
  3. King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK, SE5 9RS.
  4. Andalusian Public Foundation for Progress and Health, Department of Research for Health Technology Assessment Service, Seville, Spain.
  5. urong East St21 Blk288A #03-358, Singapore, Singapore, 601288.
  6. University Hospitals of Leicester, Department of Dermatology, Leicester Royal Infirmary, OPD3 Balmoral Building, Leicester, UK, LE1 5WW.
  7. Universidad de Antioquia, Grupo de Investigación Dermatológica (GRID), Carrera 25 A #1 A Sur 45, Of 2026, Torre Medica El Tesoro, Medellín, Colombia.
  8. Hospital Italiano de Buenos Aires, Family and Community Medicine Service, Tte. Gral. Juan Domingo Perón 4190, Buenos Aires, Buenos Aires, Argentina, C1199ABB.

PMID: 31981369 PMCID: PMC6984650 DOI: 10.1002/14651858.CD013128.pub2

Abstract

BACKGROUND: Pruritus is a sensation that leads to the desire to scratch; its origin is unknown in 8% to 15% of affected patients. The prevalence of chronic pruritus of unknown origin (CPUO) in individuals with generalised pruritus ranges from 3.6% to 44.5%, with highest prevalence among the elderly. When the origin of pruritus is known, its management may be straightforward if an effective treatment for the causal disease is available. Treatment of CPUO is particularly difficult due to its unknown pathophysiology.

OBJECTIVES: To assess the effects of interventions for CPUO in adults and children.

SEARCH METHODS: We searched the following up to July 2019: Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, and trials registries. We checked the reference lists of included studies for additional references to relevant trials.

SELECTION CRITERIA: We sought to include randomised controlled trials and quasi-randomised controlled trials that assessed interventions for CPUO, as defined in category VI ('Other pruritus of undetermined origin, or chronic pruritus of unknown origin') of the International Forum for the Study of Itch (IFSI) classification, in children and adults. Eligible interventions were non-pharmacological or topical or systemic pharmacological interventions, and eligible comparators were another active treatment, placebo, sham procedures, or no treatment or equivalent (e.g. waiting list).

DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Our primary outcomes were 'Patient- or parent-reported pruritus intensity' and 'Adverse events'. Our secondary outcomes were 'Health-related quality of life', 'Sleep disturbances', 'Depression', and 'Patient satisfaction'. We used GRADE to assess the certainty of evidence.

MAIN RESULTS: We found there was an absence of evidence for the main interventions of interest: emollient creams, cooling lotions, topical corticosteroids, topical antidepressants, systemic antihistamines, systemic antidepressants, systemic anticonvulsants, and phototherapy. We included one study with 257 randomised (253 analysed) participants, aged 18 to 65 years; 60.6% were female. This study investigated the safety and efficacy of three different doses of oral serlopitant (5 mg, 1 mg, and 0.25 mg, once daily for six weeks) compared to placebo for severe chronic pruritus; 25 US centres participated (clinical research centres and universities). All outcomes were measured at the end of treatment (six weeks from baseline), except adverse events, which were monitored throughout. A pharmaceutical company funded this study. Fifty-five per cent of participants suffered from CPUO, and approximately 45% presented a dermatological diagnosis (atopic dermatitis/eczema 37.3%, psoriasis 6.7%, acne 3.6%, among other diagnoses). We unsuccessfully attempted to retrieve outcome data from study authors for the subgroup of participants with CPUO. Participants had pruritus for six weeks or longer. Total study duration was 10 weeks. Participants who received serlopitant 5 mg may have a greater rate of relief of patient-reported pruritus intensity as measured by the visual analogue scale (VAS; a reduction in VAS score indicates improvement) compared to placebo (126 participants, risk ratio (RR) 2.06, 95% confidence interval (CI) 1.27 to 3.35; low-certainty evidence). We are uncertain of the effects of serlopitant 5 mg compared to placebo on the following outcomes due to very low-certainty evidence: adverse events (127 participants; RR 1.48, 95% CI 0.87 to 2.50); health-related quality of life (as measured by the Dermatology Life Quality Index (DLQI); a higher score indicates greater impairment; 127 participants; mean difference (MD) -4.20, 95% CI -11.68 to 3.28); and sleep disturbances (people with insomnia measured by the Pittsburgh Sleep Symptom Questionnaire-Insomnia (PSSQ-I), a dichotomous measure; 128 participants; RR 0.49, 95% CI 0.24 to 1.01). Participants who received serlopitant 1 mg may have a greater rate of relief of patient-reported pruritus intensity as measured by VAS compared to placebo; however, the 95% CI indicates that there may also be little to no difference between groups (126 participants; RR 1.50, 95% CI 0.89 to 2.54; low-certainty evidence). We are uncertain of the effects of serlopitant 1 mg compared to placebo on the following outcomes due to very low-certainty evidence: adverse events (128 participants; RR 1.45, 95% CI 0.86 to 2.47); health-related quality of life (DLQI; 128 participants; MD -6.90, 95% CI -14.38 to 0.58); and sleep disturbances (PSSQ-I; 128 participants; RR 0.38, 95% CI 0.17 to 0.84). Participants who received serlopitant 0.25 mg may have a greater rate of relief of patient-reported pruritus intensity as measured by VAS compared to placebo; however, the 95% CI indicates that there may also be little to no difference between groups (127 participants; RR 1.66, 95% CI 1.00 to 2.77; low-certainty evidence). We are uncertain of the effects of serlopitant 0.25 mg compared to placebo on the following outcomes due to very low-certainty evidence: adverse events (127 participants; RR 1.29, 95% CI 0.75 to 2.24); health-related quality of life (DLQI; 127 participants; MD -5.70, 95% CI -13.18 to 1.78); and sleep disturbances (PSSQ-I; 127 participants; RR 0.60, 95% CI 0.31 to 1.17). The most commonly reported adverse events were somnolence, diarrhoea, headache, and nasopharyngitis, among others. Our included study did not measure depression or patient satisfaction. We downgraded the certainty of evidence for all outcomes due to indirectness (only 55% of study participants had CPUO) and imprecision. We downgraded outcomes other than patient-reported pruritus intensity a further level due to concerns regarding risk of bias in selection of the reported result and some concerns with risk of bias due to missing outcome data (sleep disturbances only). We deemed risk of bias to be generally low.

AUTHORS' CONCLUSIONS: We found lack of evidence to address our review question: for most of our interventions of interest, we found no eligible studies. The neurokinin 1 receptor (NK1R) antagonist serlopitant was the only intervention that we could assess. One study provided low-certainty evidence suggesting that serlopitant may reduce pruritus intensity when compared with placebo. We are uncertain of the effects of serlopitant on other outcomes, as certainty of the evidence is very low. More studies with larger sample sizes, focused on patients with CPUO, are needed. Healthcare professionals, patients, and other stakeholders may have to rely on indirect evidence related to other forms of chronic pruritus when deciding between the main interventions currently used for this condition.

Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

References

  1. Arch Dermatol Res. 1998 Jun;290(6):306-11 - PubMed
  2. Br J Dermatol. 2013 Aug;169(2):398-405 - PubMed
  3. N Engl J Med. 2013 Apr 25;368(17):1625-34 - PubMed
  4. Health Qual Life Outcomes. 2010 Oct 11;8:116 - PubMed
  5. Control Clin Trials. 1986 Sep;7(3):177-88 - PubMed
  6. Int Arch Allergy Immunol. 2007;144(1):1-9 - PubMed
  7. Br J Dermatol. 2018 Jan;178(1):34-60 - PubMed
  8. J Pain Symptom Manage. 2008 Jun;35(6):571-2 - PubMed
  9. Clin Dermatol. 2000 Mar-Apr;18(2):149-52 - PubMed
  10. Arch Dermatol. 2005 Dec;141(12):1507-9 - PubMed
  11. J Allergy Clin Immunol. 2017 Jul;140(1):306-309.e3 - PubMed
  12. Curr Med Res Opin. 1997;13(9):529-37 - PubMed
  13. Exp Dermatol. 2014 Dec;23(12):922-3 - PubMed
  14. JAMA. 1968 Feb 5;203(6):418-9 - PubMed
  15. Curr Probl Dermatol. 2016;49:112-22 - PubMed
  16. J Am Acad Dermatol. 2016 Dec;75(6):1162-1170.e3 - PubMed
  17. Pharmazie. 1970 Feb 2;25(2):108-11 - PubMed
  18. Lancet. 1963 Mar 2;1(7279):471-2 - PubMed
  19. Nord Med. 1962 May 10;67:605-7 - PubMed
  20. Drugs. 2014 Sep;74(14):1693-9 - PubMed
  21. Acta Derm Venereol. 1970;50(3):225-7 - PubMed
  22. Br J Dermatol. 1961 Oct;73:351-8 - PubMed
  23. Dermatol Ther. 2015 Jul-Aug;28(4):210-5 - PubMed
  24. Cutis. 1978 May;21(5):695-8 - PubMed
  25. J Am Acad Dermatol. 2007 Jun;56(6):979-88 - PubMed
  26. J Am Acad Dermatol. 2002 Apr;46(4):617-9 - PubMed
  27. Cochrane Database Syst Rev. 2012 Mar 14;(3):CD008596 - PubMed
  28. Cochrane Database Syst Rev. 2018 Jan 26;1:CD012551 - PubMed
  29. PLoS Med. 2009 Jul 21;6(7):e1000100 - PubMed
  30. Expert Opin Emerg Drugs. 2015 Sep;20(3):515-21 - PubMed
  31. Ann Dermatol. 2016 Feb;28(1):124-5 - PubMed
  32. Biomed Res Int. 2017;2017:4790810 - PubMed
  33. Acta Derm Venereol. 1961;41:471-80 - PubMed
  34. Allergol Int. 2017 Jan;66(1):3-7 - PubMed
  35. Pharmacol Rev. 2017 Apr;69(2):200-235 - PubMed
  36. Acta Derm Venereol. 2011 Oct;91(6):674-9 - PubMed
  37. Arch Dermatol. 2007 Aug;143(8):980-2 - PubMed
  38. Skin Res Technol. 2016 Feb;22(1):40-5 - PubMed
  39. J Clin Invest. 2016 Jun 1;126(6):2064-76 - PubMed
  40. Hautarzt. 2006 Sep;57(9):801-7 - PubMed
  41. Minerva Dermatol. 1966 Oct;41(10):372-3 - PubMed
  42. Sov Med. 1966 Apr;29(4):125-8 - PubMed
  43. Acta Allergol. 1974 Dec;29(6):462-8 - PubMed
  44. Dialogues Clin Neurosci. 2007;9(4):413-30 - PubMed
  45. Clin Med (Northfield). 1963 Sep;70:1657-60 - PubMed
  46. Acta Derm Venereol. 2009;89(1):45-51 - PubMed
  47. Cochrane Database Syst Rev. 2016 Nov 16;11:CD008320 - PubMed
  48. J Urol. 2005 Sep;174(3):977-82; discussion 982-3 - PubMed
  49. Hautarzt. 1961 Apr;12:183-6 - PubMed
  50. J Am Acad Dermatol. 1996 Jul;35(1):118-20 - PubMed
  51. Clin Exp Dermatol. 1994 May;19(3):210-6 - PubMed
  52. J Am Acad Dermatol. 2017 Apr;76(4):760-761 - PubMed
  53. Nat Rev Neurosci. 2006 Jul;7(7):535-47 - PubMed
  54. BMJ. 2005 Mar 5;330(7490):516 - PubMed
  55. J Am Acad Dermatol. 2017 Dec;77(6):1068-1073.e7 - PubMed
  56. J Am Acad Dermatol. 2016 Sep;75(3):619-625.e6 - PubMed
  57. Int J Dermatol. 2002 Aug;41(8):494-9 - PubMed
  58. Dermatol Ther. 2008 Jan-Feb;21(1):32-41 - PubMed
  59. Allergy. 2005 May;60(5):693-6 - PubMed
  60. Appl Ther. 1966 Apr;8(4):346-9 - PubMed
  61. Am J Nephrol. 2012;36(2):175-83 - PubMed
  62. J Small Anim Pract. 2004 Jun;45(6):293-7 - PubMed
  63. J Drugs Dermatol. 2010 Aug;9(8):992-7 - PubMed
  64. J Pain Symptom Manage. 2003 Mar;25(3):288-91 - PubMed
  65. Ann N Y Acad Sci. 1999 Oct 20;885:430-2 - PubMed
  66. J Burn Care Rehabil. 2004 May-Jun;25(3):236-40 - PubMed
  67. Handb Exp Pharmacol. 2015;226:337-56 - PubMed
  68. J Pediatr Pharmacol Ther. 2013 Jul;18(3):241-6 - PubMed
  69. Dermatol Nurs. 2006 Jun;18(3):227-33 - PubMed
  70. Am J Clin Dermatol. 2008;9(1):39-44 - PubMed
  71. Clin Cosmet Investig Dermatol. 2016 Oct 11;9:333-338 - PubMed
  72. J Tradit Chin Med. 2000 Dec;20(4):287-8 - PubMed
  73. Skinmed. 2007 Mar-Apr;6(2):70-2 - PubMed
  74. J Korean Med Sci. 2003 Apr;18(2):255-61 - PubMed
  75. Wien Med Wochenschr. 1969 Sep 20;119(38):630-2 - PubMed
  76. J Dtsch Dermatol Ges. 2014 Jul;12(7):557-9 - PubMed
  77. Dermatol Ther. 2013 Mar-Apr;26(2):110-9 - PubMed
  78. Acta Derm Venereol. 1978;58(2):131-4 - PubMed
  79. PLoS One. 2010 Jun 04;5(6):e10968 - PubMed
  80. Ann Dermatol. 2011 Feb;23(1):1-11 - PubMed
  81. Clin Investig. 1993 Aug;71(8):659-62 - PubMed
  82. Eur Rev Med Pharmacol Sci. 2013 Oct;17(19):2668-74 - PubMed
  83. Dermatol Ther. 2013 Mar-Apr;26(2):84-91 - PubMed
  84. Ther Clin Risk Manag. 2006 Jun;2(2):213-8 - PubMed
  85. Int J Colorectal Dis. 2007 Dec;22(12):1463 - PubMed
  86. J Am Acad Dermatol. 2004 Jun;50(6):889-91 - PubMed
  87. J Laryngol Otol. 2010 Feb;124(2):147-51 - PubMed
  88. J Am Acad Dermatol. 2016 Feb;74(2):363-9 - PubMed
  89. Br J Pharmacol. 2014 Nov;171(22):5049-58 - PubMed
  90. Ann Hematol. 2016 Jun;95(7):1185-9 - PubMed
  91. Anaesthesist. 2009 Jan;58(1):61-5 - PubMed
  92. J Invest Dermatol. 2018 Jun;138(6):1391-1399 - PubMed
  93. J Allergy Clin Immunol. 2017 Aug;140(2):447-453.e3 - PubMed
  94. J Clin Epidemiol. 2011 Dec;64(12):1283-93 - PubMed
  95. Dermatology. 2005;211(2):174-87 - PubMed
  96. Skin Therapy Lett. 2010 Sep;15(8):5-9 - PubMed
  97. Dermatol Ther. 2017 Mar;30(2): - PubMed
  98. BMJ. 1997 Sep 13;315(7109):629-34 - PubMed
  99. Syst Rev. 2017 Apr 11;6(1):77 - PubMed
  100. Acta Derm Venereol. 2007;87(4):291-4 - PubMed
  101. J Clin Pharm Ther. 2013 Feb;38(1):16-8 - PubMed
  102. Allergy. 2010 Jul;65(7):903-10 - PubMed
  103. J Pain Symptom Manage. 2003 Dec;26(6):1105-12 - PubMed
  104. Arch Dermatol. 1979 Nov;115(11):1366-7 - PubMed
  105. Dermatol Ther. 2005 Jul-Aug;18(4):341-3 - PubMed
  106. Iran J Pharm Res. 2012 Fall;11(4):1073-7 - PubMed
  107. N Engl J Med. 2017 May 25;376(21):2093 - PubMed
  108. Sven Lakartidn. 1953 Feb 13;50(7):341-55 - PubMed
  109. Int J Dermatol. 2010 Jun;49(6):623-30 - PubMed
  110. Acta Derm Venereol. 2009;89(4):339-50 - PubMed
  111. J Am Acad Dermatol. 2018 May;78(5):882-891.e10 - PubMed
  112. BMJ. 2019 Aug 28;366:l4898 - PubMed
  113. Dermatologica. 1984;169(6):348-53 - PubMed
  114. Clin Exp Dermatol. 1988 Nov;13(6):418-9 - PubMed
  115. J Burn Care Rehabil. 2001 Jul-Aug;22(4):263-8 - PubMed
  116. J Am Acad Dermatol. 2011 May;64(5):936-49 - PubMed
  117. Evid Based Complement Alternat Med. 2013;2013:581203 - PubMed
  118. J Clin Epidemiol. 2016 Jun;74:119-23 - PubMed
  119. Br J Dermatol. 2002 Dec;147(6):1212-7 - PubMed
  120. Exp Physiol. 2002 Mar;87(2):239-44 - PubMed
  121. J Dtsch Dermatol Ges. 2008 Dec;6(12):1098-9 - PubMed
  122. Chem Senses. 2013 Sep;38(7):563-75 - PubMed
  123. J Am Acad Dermatol. 2008 Aug;59(2):234-44 - PubMed
  124. J Eur Acad Dermatol Venereol. 2017 Jun;31(6):1064-1068 - PubMed
  125. J Drugs Dermatol. 2010 May;9(5):488-98 - PubMed
  126. J Am Acad Dermatol. 2016 Sep;75(3):494-503.e6 - PubMed
  127. Cochrane Database Syst Rev. 2017 Feb 06;2:CD012119 - PubMed
  128. An Bras Dermatol. 2016 Nov-Dec;91(6):791-798 - PubMed
  129. Hautarzt. 2005 Apr;56(4):312 - PubMed
  130. Dermatitis. 2004 Sep;15(3):109-16 - PubMed
  131. Acta Derm Venereol. 2016 Jan;96(1):50-5 - PubMed
  132. Cell. 2017 Sep 21;171(1):217-228.e13 - PubMed
  133. Neurosci Lett. 1995 Mar 10;187(3):157-60 - PubMed
  134. J Am Acad Dermatol. 2013 Aug;69(2):320-1 - PubMed
  135. J Am Acad Dermatol. 2010 Oct;63(4):680-8 - PubMed
  136. J Am Acad Dermatol. 2007 Nov;57(5):873-8 - PubMed
  137. J Eur Acad Dermatol Venereol. 2013 Mar;27(3):324-31 - PubMed
  138. Indian J Dermatol Venereol Leprol. 2012 Mar-Apr;78(2):142-5 - PubMed
  139. Int J Risk Saf Med. 2012 Jan 1;24(3):147-61 - PubMed
  140. Lancet. 1996 Oct 5;348(9032):938-40 - PubMed
  141. Dermatologica. 1965;130:113-29 - PubMed
  142. J Invest Dermatol. 2018 Jun;138(6):1254-1256 - PubMed
  143. Br J Dermatol. 2013 Jun;168(6):1273-80 - PubMed
  144. F1000 Med Rep. 2010 May 24;2: - PubMed
  145. Br J Prev Soc Med. 1976 Jun;30(2):107-14 - PubMed
  146. Dermatol Ther. 2005 Jul-Aug;18(4):344-54 - PubMed
  147. Acta Derm Venereol. 2012 Sep;92(5):508-14 - PubMed
  148. Cochrane Database Syst Rev. 2016 Feb 19;2:CD011351 - PubMed
  149. Med Decis Making. 2010 Sep-Oct;30(5):566-77 - PubMed
  150. Med Lett Drugs Ther. 1980 Jan 11;22(1):4 - PubMed
  151. JAMA Dermatol. 2013 May;149(5):627-8 - PubMed
  152. J Pediatr (Rio J). 2006 Nov;82(5 Suppl):S166-72 - PubMed
  153. Acta Derm Venereol. 2012 Sep;92(5):497-501 - PubMed
  154. Acta Derm Venereol Suppl (Stockh). 1981;97:1-34 - PubMed
  155. N Engl J Med. 2009 Oct 1;361(14):1415-6 - PubMed
  156. J Am Acad Dermatol. 2017 Oct;77(4):641-649.e5 - PubMed
  157. Dermatol Ther. 2003;16(3):254-9 - PubMed
  158. Skin Pharmacol Physiol. 2005 Sep-Oct;18(5):220-9 - PubMed
  159. Handb Exp Pharmacol. 2015;226:1-14 - PubMed
  160. Br J Dermatol. 2007 Apr;156(4):667-73 - PubMed
  161. J Clin Nurs. 2014 Dec;23(23-24):3356-65 - PubMed
  162. J Am Acad Dermatol. 2017 Jul;77(1):188-190 - PubMed
  163. Nephron. 1994;67(3):270-3 - PubMed
  164. Photochem Photobiol. 1996 Aug;64(2):234-7 - PubMed
  165. J Am Acad Dermatol. 2001 Dec;45(6):910-3 - PubMed
  166. Curr Med Res Opin. 2010 Mar;26(3):633-40 - PubMed
  167. Dermatol Ther. 2005 Jul-Aug;18(4):333-40 - PubMed
  168. Arch Dermatol. 2011 Oct;147(10):1153-6 - PubMed
  169. BMJ. 2008 May 3;336(7651):995-8 - PubMed
  170. Dermatol Online J. 2013 Nov 15;19(11):20392 - PubMed
  171. Phytother Res. 2016 Aug;30(8):1243-64 - PubMed
  172. J Pharm Pharm Sci. 2016 Oct - Dec;19(4):465-474 - PubMed
  173. Int J Dermatol. 2010 Aug;49(8):858-65 - PubMed
  174. Pain. 2003 Sep;105(1-2):133-41 - PubMed
  175. Acta Derm Venereol. 2013 Sep 4;93(5):520-6 - PubMed
  176. Dermatol Online J. 2018 Mar 15;24(3): - PubMed
  177. J Am Acad Dermatol. 2001 Dec;45(6):892-6 - PubMed
  178. Br J Dermatol. 2009 Oct;161(4):737-45 - PubMed

Substances

MeSH terms

Publication Types