OBJECTIVES: Pruritus is a cutaneous symptom but could be a manifestation of a wide range of systemic conditions making it difficult to manage. Itch intensity is a measure of symptom severity and can influence management. The objective of this research was to understand the influence of itch intensity on therapeutic management of pruritus in the real-world setting.

METHODS: Patients from 6 specialty dermatology networks within the OMNY Health Database with a 10-point itch intensity assessment associated with pruritus (ICD-10: L27*) from 2017-2023 were included. Percentages of patients with prescriptions for any of the following treatments were tabulated by itch intensity: topical treatments (corticosteroids [TCS], calcineurin inhibitors [TCI], capsaicin, menthol, pramoxine/lidocaine/prilocaine, doxepin), systemic treatments (non-sedative antihistamines [NSAH], sedative antihistamines [SAH], opioid receptor antagonists [ORA], and selective serotonin reuptake inhibitors [SSRI], doxepin).

RESULTS: A total of 7,330 patients and 8,115 associated encounters were included. Distributions of gender (60% female), race (85% White, 8% Black, 7% Other), and age (57% > 60 years, 37% 21-60 years, 5% < 21 years) were tabulated. For 10-point itch intensity groups 0-1, 2-4, 5-7, and 8-10, prescriptions of topical treatments were 12%, 31%, 32%, and 25%, respectively, while prescriptions of systemic treatments were 9%, 22%, 33%, and 36%, respectively. Individual treatment classes followed similar patterns. TCS (45%) and SAH (18%) were the most prescribed topical and systemic treatments, respectively. Proportions of patients with prescriptions for topical menthol, NSAH, SAH, ORA, and systemic doxepin increased monotonically with itch intensity. Topical capsaicin, pramoxine/lidocaine/prilocaine, and SSRI use were negligible over the study period.

CONCLUSIONS: Results provide insights into real-world therapeutic management of pruritus as it relates to itch intensity. Symptom severity was strongly associated with greater prescriptions of most therapy classes. Future analyses would be helpful to understand the landscape of pruritus therapeutic management as it relates to itch intensity and symptom reduction.