ABSTRACT
This chapter provides an overview of the pathophysiology of pruritus associated with atopic dermatitis and reviews current and emerging treatment options. Major advances have been made in the neurophysiology of pruritus. Central processing of itch has also been demonstrated using neuroimaging techniques such as positron emission tomography and functional magnetic resonance imaging in healthy humans. Central sensitization of itch signaling systems is a key feature of chronic itch states, including atopic dermatitis. Proteases play a major role in neurogenic inflammation, pain perception, secretory and motor functions, and the response to nerve injury. Neurotrophins have also been implicated in the pathophysiology of pruritus associated with atopic dermatitis. Topical corticosteroids remain the cornerstone of therapy of atopic dermatitis. Oral antihistamines have traditionally been the cornerstone of pruritus treatment in atopic dermatitis. The opioidergic system may play an important role in the pathophysiology of pruritus in atopic dermatitis.
