The Itch-Scratch Cycle: A Neuroimmune Perspective

Trends Immunol. 2018 Dec;39(12):980-991. doi: 10.1016/ Epub 2018 Nov 21.


Relentless, repetitive itching and scratching is a debilitating feature of many chronic inflammatory skin disorders such as atopic dermatitis. While well known clinically, this itch-scratch cycle has historically lacked in-depth mechanistic understanding. However, recent advances at the interface of itch neurobiology and skin immunology have shed new light on this phenomenon. In this review, we highlight recent advances in our understanding of the neuroimmunology of chronic itch centered around three key points of entry into the itch-scratch cycle: the epithelial barrier, the immune system, and the peripheral nervous system. Furthermore, we explore novel neuro-epithelial-immune interactions that may represent promising therapeutic paradigms.

Keywords: atopic dermatitis; cytokines; itch; neuroimmunity; proteases; scratch; skin barrier.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Humans
  • Peripheral Nervous System / immunology*
  • Peripheral Nervous System / pathology
  • Pruritus / immunology*
  • Pruritus / pathology