Peter Lio, MD: Managing and Treating Itch

The treatments for itch can be just as numerous as the underlying causes.

In the latest episode of Derm Discussions, Peter Lio, MD, Clinical Assistant Professor of Dermatology & Pediatrics, Northwestern University Feinberg School of Medicine, discussed the different ways itch can be treated.

“I think the first thing is that we want to see as best we can to try to understand what is mediating itch,” Lio said. “In those 4 categories, is there an underlying dermatologic disease—particularly inflammatory disease—that we can approach? Is there some kind of a neuropathy? Do we need to focus on nerves? Is it psychogenic? Is it systemic?”

He acknowledged that treatment can be especially difficult if the clinician is faced with pruritis sin materia — or itch without a rash.

In this instance, work-up and screenings are warranted; and even then, patients may still find themselves in a position where the symptom cannot be managed.

Lio described his therapeutic ladder, which begins with topical medications and proceeds with “safe systemics” and more powerful systemics.

He also explained his approach as integrative, sometimes incorporating topical corticosteroids if the underlying cause is mediated by inflammation or the immune system. Depending on cause, other options include calcineurin inhibitors and topical anesthetics.

Options for systemic chronic itch include antihistamines, gabapentin, antidepressants, NK1 inhibitors, opioid modulators, and naltrexone.

Listen to the full podcast episode below: