Discuss the burden of itch on quality of life

Describe the pathophysiology of itch in atopic dermatitis

Analyze safety and efficacy data for current and emerging biologic therapies that target itch pathways in atopic dermatitis

Demonstrate strategies to individualize care to manage itch with biologic therapies in atopic dermatitis

Preventing Pruritus in Atopic Dermatitis: Are Biologics an Answer? Online CME Activity

Pruritus

WEDNESDAY, Feb. 7, 2024 -- Metformin does not appear to be associated with pruritus, according to a research letter published online Jan. 16 in SKIN.Lauren Sattele, from the Medical University of South Carolina in Charleston, and colleagues conducted a retrospective review of patients taking metformin, canagliflozin, insulin lispro, and insulin glargine between Jan. 1, 2012, and Nov. 14, 2022, using the U.S. Food and Drug Administration Adverse Event Reporting System to examine the association between metformin use and pruritus.The researchers found that the prevalence of pruritus was 0.7, 0.9, 0.4, and 0.6 percent for patients taking metformin, canagliflozin, insulin lispro, and insulin glargine, respectively. Compared with both insulin lispro and glargine, canagliflozin was significantly more likely to cause pruritus. Reports of pruritus among metformin users were not significantly different from those seen for users of the other three medications."Our results suggest that metformin is not significantly associated with pruritus and may be used for the treatment of dermatologic conditions with minimal concern for this adverse event," the authors write. "Canagliflozin, however, was significantly associated with pruritus."

Canagliflozin significantly more likely to cause pruritus than insulin lispro or insulin glargine

Metformin Use Not Significantly Linked to Pruritus

Episode 16 of Derms and Conditions has our host James Q. Del Rosso, DO speaking with Matthew Zirwas, MD about pruritus. Dr. Zirwas discusses the topical treatment of pruritis and offers a unique combination topical regimen that he often uses for his patients. He also presents some tips and tricks for treating Pruritus Ani.

Episode 16 of Derms and Conditions has our host James Q. Del Rosso, DO speaking with Matthew Zirwas, MD about pruritus. Dr. Zirwas discusses the topical treatment of pruritis and offers a unique combination topical regimen that he often uses for his patients. He also presents some tips and tricks for treating Pruritus Ani.&nbsp; Dr. Del Rosso and Dr. Zirwas also discuss a new non-steroidal, topical agent for pruritus. Dr. Zirwas discusses, in detail, the hypothesized mechanism of action for this novel agent and shares his success using it in his clinic. Finally, he briefly mentions some alternative oral agents for the pruritic patient. Financial Disclosures JAMES DEL ROSSO, DO FINANCIAL DISCLOSURES: CONSULTANT/ADVISOR Abbvie, Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), BioFrontera, BioPharmX, Bristol-Myers-Squibb, Cassiopea, Dermata, Dermavant, Encore, EPI Health, Evommune, Ferndale, Galderma, Incyte, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), MC2, Novan, Pfizer, Regeneron, Sanofi-Genzyme, SolGel, Sonoma (IntraDerm), Sun Pharma, Trevi, UCB, Verrica, Vyne (Foamix; Menlo) SPEAKER BUREAU Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), EPI Health, Ferndale, Galderma, Genentech, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), Pfizer, Regeneron, Sanofi-Genzyme, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo) RESEARCH INVESTIGATOR Aclaris, Almirall, Amgen, Anaptys Bio, Arcutis, Athenex, Bausch Health (Ortho Dermatology), BioPharmX, Biorasi, Botanix, Brickell, Cara Therapeutics, Cassiopea, Dermavant, EPI Health, Ferndale, Galderma, Incyte, Leo Pharma, Lilly (Dermira), Novan, Pfizer, Ralexar, Regeneron, SolGel, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo). MATTHEW ZIRWAS, MD FINANCIAL DISCLOSURES: Regeneron / Sanofi - Speaker, consultant, investigator Fit Bit - Consultant Genench / Novartis - Speaker L’Oreal - Consultant Menlo - Consultant AsepticMD - Part Owner Leo - Investigator, Consultant Janssen - Investigator Incyte - Investigator Foamix - Investigator UCB - Investigator Pfizer - Investigator, consultant Lilly - Investigator, consultant Asana - Investigator Avillion - Investigator Ortho Derm - Consultant Abbvie - Investigator Edessa Biotech - Investigator Galderma - Investigator Dermavant - Investigator Arcutis - Investigator, Consultant Sol-Gel - Consultant Bausch Health - Consultant EPI Health - Consultant, Investigator &nbsp;

Derms and Conditions Podcast

Clinical Pearls That You're "Itching" To Hear

New Perspectives on Chronic Pruritus

In this episode of Topical Conversations, Daniel Butler, MD, associate professor of dermatology at the University of Arizona College of Medicine, discusses his <a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jama/article-abstract/2819296">recent publication</a> that reshapes the understanding of chronic pruritus.<h5>Historical neglect and new understanding</h5>The impact of chronic pruritus has been underappreciated by the medical community. As a ubiquitous symptom that everyone experiences at times, the health care system has struggled to adapt to its more severe, chronic forms, leaving many patients without effective treatments for prolonged periods. Dr Butler reexamines the mechanisms of itch, significantly impacting the perception of chronic pruritus by recognizing the role of both the immune system and the nervous system.<h5>Moving beyond a singular entity</h5>Historically, pruritus was viewed as a singular entity—find the right cause, and the symptom can be treated. However, Dr Butler explains that chronic pruritus may be more like a Venn diagram of contributing systems, including barrier dysfunction, immune dysfunction, and neuropathic or nerve dysfunction. This new understanding allows for a more comprehensive approach to treatment. Instead of seeking a singular cause, dermatologists can now consider how to combine treatments to address the various contributing factors. &nbsp;<h5>Advances in personalized treatments</h5>Dr Butler explains that some treatments can target multiple systems simultaneously, like biologics that block IL-4 and IL-13 also profoundly impacting neuropathic itch, or tacrolimus, a classic topical treatment, not only controlling the immune response but also affecting neuropathic pathways, making it highly effective for pruritus. The scaffolding and schematic for understanding chronic pruritus are evolving, and by highlighting the unique pathophysiologic mechanisms involved, each with its own treatment targets, this evolution provides dermatologists with a diverse arsenal of treatments, ranging from topical to systemic, and from neuropathic to immune-based therapies.<h5>A more effective way to manage patients</h5>Dr Butler emphasizes that the most crucial takeaway from his publication is the recognition of chronic pruritus as its own distinct entity. Nearly 1% of all doctor's visits are for chronic pruritus, affecting a wide range of specialties, including primary care, gastroenterology, allergy, and even surgery. By rethinking chronic pruritus not as a singular or secondary disease, but as a complex mix of dysfunctional etiologies and considering various treatment tools that address different aspects of this condition, dermatologists can become more effective in managing these patients with more nuanced and effective strategies.&nbsp;

Pruritus Condition Center

Featured in Pruritus

New Perspectives on Chronic Pruritus

Featured CME on Pruritus

Preventing Pruritus in Atopic Dermatitis: Are Biologics an Answer? Online CME Activity

Pruritus Episodes to Explore

Clinical Pearls That You're "Itching" To Hear

Pruritus News & Research