Novel and existing therapeutic interventions in psychogenic pruritus.

Clinical Snapshot

Key Findings

• P Value: Not applicable for systematic review of case reports

• Effect Size: Not quantifiable due to descriptive nature of included studies

• Primary Outcome: Treatment efficacy for psychogenic pruritus across various pharmacological interventions

• Nnt Or Sensitivity: Complete itch resolution reported with naltrexone in SSRI-refractory case; significant efficacy noted for serlopitant in phase II trial

• Confidence Interval: Not reported

Clinical Application

Limited by availability of some newer agents and need for specialist dermatology/psychiatry input SSRIs and gabapentin readily available on PBS. Naltrexone available but requires special authority. Newer agents like serlopitant not yet TGA approved. Aligns with RACGP guidelines for chronic itch management requiring multidisciplinary approach Patients with confirmed psychogenic pruritus after exclusion of dermatological and systemic causes

Abstract

Psychogenic pruritus (PP) is a chronic itch disorder associated with psychological conditions lacking any dermatological or systemic cause. Diagnosis relies on excluding other aetiologies and identifying psychological stressors. Treatments include dermatological and psychiatric interventions such as topical steroids, selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, antihistamines, antipsychotics and psychotherapy. However, efficacy remains inconsistent, necessitating a systematic review of current and emerging pharmacological options. This study reviews pharmacological treatments for PP published in the past decade, evaluating efficacy and therapeutic potential. A systematic literature search was conducted using PubMed, Embase and Google Scholar (November 2014 to November 2024) following the PRISMA guidelines (PROSPERO: 1000201). In total, 1034 articles were screened by two independent reviewers. Inclusion criteria focused on human studies evaluating pharmacological treatments for PP. Seven studies met the inclusion criteria. Levels of evidence were assessed using the Joanna Briggs Institute critical appraisal checklist. SSRIs, particularly escitalopram, showed symptom improvement in case reports. Naltrexone (an opioid antagonist) led to complete itch resolution in a patient refractory to SSRIs. Gabapentin reduced pruritus severity. A neurokinin-1 receptor (NK-1R) antagonist (serlopitant) demonstrated significant efficacy in a phase II trial. Biologics such as dupilumab showed promise in chronic pruritus. Targeted therapies, including SSRIs, naltrexone, opioid pathway modulators, NK-1R antagonists and biologics, show promise in the clinical management of PP, but further research through randomized controlled trials is necessary to establish their efficacy and optimize treatment strategies.

References

1. 1.Ghani, H., Ghofrani, S., Modanlo, N., Cheedalla, N., & Jafferany, M. (2026). Novel and existing therapeutic interventions in psychogenic pruritus. Clinical and Experimental Dermatology. https://doi.org/10.1093/ced/llag005