Forum Fall 2013 - page 10

Cutaneous Lymphoma Foundation
10
CLF Board Member
and Nurse Practitioner,
Marianne Tawa, RN,
MSN, ANP represented
the Foundation at the 7th
World Congress on Itch
held on September 21-
23 at the Seaport Hotel
and World Trade Center
in Boston, MA. The
240 participants from
18 countries included
scientists and medical
specialists across multiple
disciplines, all interested
in unraveling the mystery
of why people itch. They
were joined by industry
representatives interested in skin barrier function and itch
reduction, plus patient advocacy organizations including
the Cutaneous Lymphoma Foundation. This varied group of
attendees is a testimony to the bench-to-bedside connection
forged when there is a shared problem and quest for a
solution.
By best guess, millions upon millions of people are plagued
with the burden of itch, yet many healthcare providers
disregard the symptom as there is perceived to be few
existing options to treat it. But, the good news is, according
to the conference brochure, now “is the most exciting
time to be in the itch field. Rapid progress is occurring in
therapeutics, clinical research and insights into the basic
mechanisms that underlie the sensation of itch.”
General points of interest from the conference included:
• Diseases prominently linked with itch include liver
and kidney disease, inflammatory skin diseases such as
eczematous dermatitis, some cancers such as Hodgkin’s
and Non-Hodgkin’s lymphomas, burns and wounds.
• According to Dr. Gil Yosipovitch, “Itch cannot be
divorced from scratch.”
• Contagious itch occurs when there are visual cues
suggesting one should scratch despite lack of itch
sensation.
• Dr. Stephen Katz, Director of the National Institute of
Arthritis and Musculoskeletal and Skin Disease urged
the researchers to apply for federal grants to study
itch, even in the lean times where research monies
are scarce. He hoped the conference would stimulate
further scientific interest and new collaborations.
Neurological Connections to Itch
• Itch is now thought to be much more than immune
response to an irritant on the skin, but rather a
neurological problem. This speaks to the challenge of
why putting a topical agent on the skin does not address
the brain connection.
• The Central Nervous system is becoming a target for
itch treatment. Not all itch sensation arises from the
skin. Neuropathic itch can coincide with pain.
• Professor Earl Carstens, UC Davis-Department
of Neurobiology, Physiology and Behavior spoke
eloquently on the topic of itch as a specific sensation.
He created questions surrounding whether itch is
perceptually distinct from pain, as both serve protective
functions, partially or overlapping pathways.
• Research in itch is increasing. According to Dr. Ethan
Lerner, a Massachusetts General Hospital dermatologist
and Program Chair, the growing participation by
neuroscientists (some of whom stumbled upon itch
pathways while studying pain), has served to propel
research forward. Additionally, scholarly journals such
as
Cell and Nature
have recently published papers on
the topic of itch.
Potential Treatment Approaches
• Clifford Woolf, Professor of Neurology and
Neurobiology at Children’s Hospital Medical Center
and Harvard Medical School, Boston presented cutting
edge scientific research on silencing itch pathways
as a therapeutic strategy. As a pioneer in preventative
anesthesia, Dr. Woolf and colleagues looked at
mechanisms for delivering a sodium channel blocker to
produce pain and itch specific local anesthesia. Could
these translate to a local anti-pruritic?
• Cognitive approaches for treating itch include
acupuncture and healing touch.
• Interleukin 31 (TH2 cytokine) is over expressed
in patients with CTCL with itch. This cytokine is
becoming a major target for treatment.
Itch Questionnaires - Tools for Measuring Itch
• There were several clinical sessions dedicated to itch
questionnaires. The need for questionnaires is based
upon the high burden of itch worldwide.
• Pruritus (itch) is the most common symptom in
dermatology care, systemic illness, and neurological
diseases. It has a high impact on Quality of Life yet
there are inadequate tools for its measurement.
• Cultural aspects need to be considered in
questionnaires.
Highlights from the 7th World Congress on Itch
1,2,3,4,5,6,7,8,9 11,12
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