Abstract
Atopic dermatitis (AD) is a disease that affects millions of patients worldwide and is characterized by debilitating itch. The pathophysiology of pruritus in AD consists of multiple players, including pruritogens, unique receptors, and ion channels found on unmyelinated C-nerve fibers. The sensation of the itch is also perpetuated by the disrupted epidermal skin barrier characterizing this disease, as well as sensitization phenomena in both the peripheral and central nervous systems. Thankfully, treatment options for atopic itch are abundant. These range from topical therapies, to systemic immunomodulators, to systemic therapies, which attenuate itch transmission in the nervous system. Topical treatment of itch includes a variety of medications including corticosteroids, calcineurin antagonists, and phosphodiesterase-4 inhibitors. Systemic treatment includes oral prednisone, methotrexate, cyclosporine, azathioprine, and mycophenolate mofetil. Moisturizing topical treatments remain one of the mainstays of treatment. Emerging therapies, such as novel monoclonal antibodies that are directed against itch mediators, such as interleukin-31, as well as drugs targeting the Janus kinase-STAT system, are promising treatments that will hopefully improve the lives of many patients.