Topical Calcineurin Inhibitors in the Management of Chronic Pruritus in Older Adults: A Research Letter

February 2024 | Volume 23 | Issue 2 | e70 | Copyright © February 2024


Published online January 24, 2024

Janell Tully BSa,b, Daniel C. Butler MDb

aCollege of Medicine, Phoenix, University of Arizona, Phoenix, AZ
bDepartment of Dermatology, University of California, San Francisco, CA

Abstract
In this study, we aimed to analyze the literature to date on the utilization of topical calcineurin inhibitors in the management of pruritus among older adults, ages 65 and older. The 16 studies included in the final analysis demonstrated that topical calcineurin inhibitors are well tolerated across ages and are effective in treating a wide variety of chronic pruritic conditions. Collectively, these findings support that topical calcineurin inhibitors should be considered a safe, plausible option for managing age-associated itch.

J Drugs Dermatol. 2024;23(2):e70-e72.  doi:10.36849/JDD.7190e

INTRODUCTION

Chronic itch is common among older adults, however, without overt serologic or histologic abnormalities, many geriatric patients have no discernible cause of their pruritus. In these cases, it is postulated that itching may be due to age-related immunologic and neuropathic pathophysiologic changes.1 However, in the absence of a cohesive diagnosis, there is significant variability in the therapeutic strategies for managing itch in this population. This often results in undertreatment, exclusionary payer practices, and limited research efforts.

Topical calcineurin inhibitors (TCIs) are approved by the United States Food and Drug Administration for atopic dermatitis and have been reported to provide safe, rapid pruritus relief in these patients.2 In addition to their anti-inflammatory effects, TCIs may also reduce itch by depleting pruritic neuropeptides in cutaneous nerve fibers,3 and therefore, may serve as a therapeutic option for both inflammatory and neuropathic itch.1 

Given the prevalence of itch among older adults and the anti-pruritic effects of TCIs, this study aims to evaluate the literature to date on the utilization of TCIs for pruritus management in older adults with the hopes of exploring another treatment option for age-associated itch.

MATERIALS AND METHODS

In May 2022, a scoping review of PubMed was conducted, limited to the English language, with search terms: "calcineurin inhibitors," "tacrolimus," "pruritus," "itch," "elderly," "older adult," and "geriatric." Studies were limited to those that included participants over the age of 65. The database search yielded a total of 579 articles, including 527 English-language studies.




After removing 174 duplicate records and screening the remaining titles and abstracts for relevance, 48 full-text articles were reviewed (Figure 1).
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