United States expert panel consensus on uniform nomenclature and diagnosis for neuropathic pruritus

Kwatra, Shawn G. MDa; Elmariah, Sarina MD, PhD, MPHb; Chisolm, Sarah MDc; Mollanazar, Nicholas MDd; Fassett, Marlys MD, PhDe; Cole, Emily F. MDc; Chen, Suephy MDf; Lerner, Ethan MD, PhDb; Berger, Timothy MDe; Yosipovitch, Gil MDg. Itch 9(1):e0073, January-March 2024. | DOI: 10.1097/itx.0000000000000073

Abstract

Importance: 

Neuropathic pruritus is a debilitating condition lacking a uniform approach to nomenclature and diagnosis.

Objective: 

A panel of dermatologist experts in pruritus was convened to develop definitions, diagnostic recommendations, and treatment guidelines for neuropathic pruritus.

Evidence review: 

A roundtable discussion of 10 experts was conducted on November 3, 2021, via the Zoom platform. This study follows the Standards for Reporting Qualitative Research reporting guidelines for qualitative studies. A systematic review of prior literature on the definition, scope, diagnostic, and treatment was performed, looking at sources of treatment from 1991 to 2021. Consensus was defined as >70% agreement for acceptance of a definition or recommendation. A draft of evidence was subjected to revision by all participants and was endorsed by all participants.

Findings: 

Diagnostic workup of neuropathic pruritus.

The roundtable identified definitions for neuropathic pruritus, which included different forms of the condition based on cause and presentation such as brachioradial pruritus, notalgia paresthetica, and scalp pruritus. Diagnostic and treatment guidelines were also established. Limitations of this process included lack of randomized controlled studies. These recommendations are also based on expert consensus and must be further supported by evidence-based outcomes research.

Conclusions: 

Neuropathic pruritus contains numerous subtypes, causes, diagnostic methods, and treatment modalities. The recommendations developed by this panel are meant to serve as shared nomenclature for future clinical studies.

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