The neuropathic itch: Don't scratch your head too hard!

Aetiology, pathogenesis and management of neuropathic itch: A narrative review with recent updates

Neuropathic itch is a relatively common yet under-reported cause of systemic pruritus. It is a debilitating condition often associated with pain, which impairs the patient's quality of life. Although much literature exists about renal and hepatic pruritus, there is a dearth of information and awareness about neuropathic itch. The pathogenesis of neuropathic itch is complex and can result from an insult at any point along the itch pathway, ranging from the peripheral receptors and nerves until the brain. There are several causes of neuropathic itch, many of which do not produce any skin lesions and are thus, often missed. A detailed history and clinical examination are necessary for the diagnosis, while laboratory and radiologic investigations may be needed in select cases. Several therapeutic strategies currently exist involving both non-pharmacological and pharmacological measures, the latter including topical, systemic, and invasive options. Further research is ongoing to clarify its pathogenesis and to design newer targeted therapies with minimal adverse effects. This narrative review highlights the current understanding of this condition, focusing on its causes, pathogenesis, diagnosis, and management, along with newer investigational drugs.

Post Herpetic Itch Leading to Frictional Alopecia of Eyebrow and Scalp-A Hitherto Undescribed Phenomenon

Post herpetic itch (PHI) is a less commonly reported sequela of herpes zoster. It can begin upon the resolution of the lesions or several weeks later. PHI is neuropathic in nature and is said to be caused by neural injury in the form of demyelination of itch-transmitting nerve fibers in the skin. The majority of PHI resolves over weeks to months with symptomatic treatment. We report a case of PHI resulting in frictional alopecia of eyebrows and scalp due to frequent rubbing of the skin and hairs secondary to bothersome neuropathic itch.