Challenges with symptom characterization, management
“This is an important study for both patients and clinicians,” said Justin Abbatemarco, MD, of Cleveland Clinic’s Mellen Center for Multiple Sclerosis, in a written comment. “As the authors mention, many of our patients experience transient symptoms, including many different types of sensory disturbance (that is, pins & needles, burning, electrical shocks, and itching). These symptoms can be really distressing for patients and their caregivers.”
While Dr. Abbatemarco has encountered severe itching in “several patients” with MS, he maintained that it is “relatively uncommon” and noted that MS symptomatology is an inherently cloudy subject.
Dr. Justin Abbatemarco
“I think it is difficult to be definite in any opinion on this topic,” Dr. Abbatemarco said. “How patients experience these symptoms is very subjective and can be difficult to describe/characterize.”
Dr. Abbatemarco emphasized that transient symptoms “do not usually represent MS relapse/flare or new inflammatory disease activity. Instead, we believe these symptoms are related to old areas of injury or demyelination.”
Symptom management can be challenging, he added. He recommended setting realistic expectations, and in the case of pruritus, asking dermatologists to rule out other causes of itch, and to offer “unique treatment approaches.”
Cool the itch?
Noting how heat appears to aggravate itch in patients with MS, Dr. Yosipovitch suggested that one of those unique – and simple – treatment approaches may be cooling itchy areas. Alternatively, clinicians may consider oral agents, like gabapentin to dampen neural transmission, or compounded formulations applied to the skin to reduce neural sensitivity, such as topical ketamine. Finally, Dr. Yosipovitch speculated that newer antibody agents for MS could potentially reduce itch.
All these treatment suggestions are purely hypothetical, he said, and require further investigation before they can be recommended with confidence.
The investigators disclosed relationships with Galderma, Pfizer, Novartis, and others. Dr. Abbatemarco disclosed no conflicts of interest.
Correction, 9/19/22: An earlier version of this article misidentified the photo of Dr. Justin Abbatemarco.