Chronic kidney disease-associated pruritus (CKD-aP) is a highly prevalent and debilitating symptom in patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD), severely impairing quality of life, sleep quality, mental health, and clinical outcomes. Its pathogenesis is multifactorial and remains incompletely understood, involving chronic inflammation, immune imbalance, abnormal neuro-opioid pathways, mineral metabolism disorders and skin barrier damage. The kidney-gut-skin axis has attracted increasing attention as a novel theoretical framework to elucidate the roles of gut microbiota dysbiosis, gut-derived uremic toxins, intestinal barrier impairment and systemic inflammation in the development of CKD-aP. This review summarizes the traditional pathogenic mechanisms of CKD-aP, reviews recent advances linking gut microbial alterations to pruritus-related pathways, and systematically evaluates gut-targeted and metabolism-targeted interventions, including probiotics, prebiotics, synbiotics, AST-120, fecal microbiota transplantation, phytochemicals, Uremia Clearance Granules, and vitamin D-related strategies. Current evidence is mostly associative and is mainly derived from general CKD/ESKD populations, animal models, and in vitro studies; specific clinical validation in CKD-aP cohorts remains limited. Accordingly, gut microbiome-related mechanisms and interventions remain hypothetical and adjunctive, without established causal relationships or validated standard therapies for CKD-aP. Future studies are required to identify CKD-aP-specific pathological alterations, adopt longitudinal design and multi-omics analysis, conduct mechanistic verification, and perform randomized controlled trials with pruritus as a predefined primary endpoint.

Adverse food reactions (AFR) are a common cause of chronic pruritus in dogs and often present as atopic dermatitis. However, the threshold dose of dietary protein required to trigger clinical signs of AFR, as well as the time to onset of those signs, remain poorly defined.

Chronic pruritus is a debilitating symptom accompanying numerous inflammatory skin diseases and remains a major therapeutic challenge. Neurogenic inflammation plays a central role in its pathogenesis, with the tachykinin substance P acting as a key mediator at the interface of the nervous system, immune cells, and cutaneous tissues. While substantial research has focused on substance P signaling via the neurokinin-1 receptor, clinical trials targeting this pathway have yielded inconsistent results, suggesting an incomplete understanding of substance P-mediated mechanisms in pruritic disorders. This review broadens the current perspective by highlighting the importance of substance P metabolism and the biological activity of its metabolites in pruritus-related diseases. Many C-terminal substance P metabolites retain neurokinin 1-receptor affinity but induce biased intracellular signaling. In contrast, N-terminal metabolites can activate alternative receptors such as mas-related G protein-coupled receptor X2, promoting mast cell degranulation, neurogenic inflammation, and itch, or exert counter-regulatory effects via yet unidentified targets. Importantly, the expression and activity of substance P-degrading proteases are altered in pruritic skin diseases, shifting the balance toward biologically active, pruritogenic metabolites. In conclusion, substance P, its metabolites, receptor isoforms, and metabolizing enzymes form a complex regulatory network that fine-tunes itch, pain, and inflammatory signaling. A deeper understanding of this interplay may explain the limited efficacy of current therapeutic approaches and might offer novel targeted treatment strategies in chronic pruritus.

This case series describes the treatment of 2 patients with chronic plaque psoriasis refractory to conventional topical corticosteroid therapy. Both patients declined additional topical and systemic treatments and were subsequently treated monotherapy with a 1,064nm neodymium-doped yttrium aluminium garnet laser (Aerolase Neo Elite; Aerolase, Tarrytown, New York). When pruritus returned and worsened, both subjects trialed roflumilast cream 0.3% as combination therapy alongside the ongoing laser treatments. The addition of roflumilast cream greatly improved each of their symptoms, ultimately leading to resolution of pruritus and significant improvement of plaque size and texture.

Post-burn itching is an important symptom that negatively affects patients during both the treatment and rehabilitation processes. Understanding patients' lived experiences regarding post-burn itching is essential to improving patient care. This qualitative study was conducted using a phenomenological approach. In-depth, face-to-face interviews were held with 10 patients who experienced itching after burn injuries. Data collection occurred between January and May 2024. Thematic analysis was employed to evaluate the data. Analysis of the data revealed four main themes and 13 sub-themes. The main themes identified were: (1) the psychological burden of itching, (2) the bodily experience of itching, (3) difficulties in daily life, and (4) coping strategies. The study findings provide detailed insights into the experiences of patients suffering from post-burn itching. These results enhance current knowledge in this area and may inform the development of holistic, patient-centred, and community-based care strategies tailored to patient needs.