Contact irritant dermatitis and anti-pruritic agents: the need to address the itch.
Contact irritant dermatitis can be defined by four interrelated elements: skin barrier disruption, epidermal skin changes, cytokine release, and nerve ending changes. The predominant symptom of eczema relates to the fourth constituent, which produces pruritic symptoms that are often neglected when using pre-formulated topical steroids and immunomodulators. Although the induction of pruritus with proteinases and cytokines demonstrates the close connections between immune and neurotrophic factors in the pathophysiology of pruritus, agents that specifically affect the cutaneous nerve endings are often beneficial for use in patients affected by dermatitis. Besides avoiding triggering factors, agents such as pramoxine, phenol, camphor, and menthol are extremely valuable in allaying patients' symptoms of pruritus. Indeed, therapeutic remedies, which incorporate anti-pruritic agents in their formulation, may be advantageous for the bulk of patients with contact irritant dermatitis.