Novel and existing therapeutic interventions in psychogenic pruritus

Psychogenic pruritus (PP) is a chronic itch disorder associated with psychological conditions lacking any dermatologic or systemic cause. Diagnosis relies on excluding other etiologies and identifying psychological stressors. Treatments include dermatologic and psychiatric interventions such as topical steroids, selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), antihistamines, antipsychotics, and psychotherapy. However, efficacy remains inconsistent, necessitating a systematic review of current and emerging pharmacologic options. This study reviews pharmacologic 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 - November 2024) following PRISMA guidelines (PROSPERO: 1000201). A total of 1034 articles were screened by two independent reviewers. Inclusion criteria focused on human studies evaluating pharmacologic treatments for PP. Seven studies met inclusion criteria. Levels of evidence were assessed using the JBI Critical Appraisal Checklist. SSRIs, particularly escitalopram, showed symptom improvement in case reports. Naltrexone (opioid antagonist) led to complete itch resolution in an SSRI-refractory patient. Gabapentin reduced pruritus severity. NK-1R antagonists (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.