Similarities and differences in peripheral itch and pain pathways in atopic dermatitis

Atopic dermatitis (AD) is predominantly characterized by intense itching, but concomitant skin pain is experienced by more than 40% of patients. Patients with AD display considerable somatosensory aberrations including increased nerve sensitivity to itch stimuli (hyperknesis), perception of itch from innocuous stimuli (alloknesis), or perception of pain from innocuous stimuli (allodynia). This review summarizes the current understanding of the similarities and differences in the peripheral mechanisms underlying itch and pain in atopic dermatitis. These distinct yet reciprocal sensations share many similarities in the peripheral nervous system including common mediators (such as serotonin [5-HT], endothelin-1 [ET-1], interleukin-33 [IL-33], and thymic stromal lymphopoietin [TSLP]), receptors (such as members of the G protein-coupled receptor [GCPR] family and toll-like receptors [TLRs]), and ion channels for signal transduction (such as certain members of the transient receptor potential [TRP] cation channels). Itch-responding neurons are also sensitive to pain stimuli. However, there are distinct differences between itch and pain signaling. For example, specific immune responses are associated with pain (type 1 and/or type 3 cytokines and certain chemokine C–C [CCL2, CCL5] and C–X–C motif ligands [CXCL]) and itch (type 2 cytokines, including IL-31, and periostin). The TRP melastatin channels TRPM2 and TRPM3 have a role in pain but no known role in itch. Activation of mu-opioid receptors is known to alleviate pain but exacerbate itch. Understanding the connection between itch and pain mechanisms may offer new insights into the treatment of chronic pain and itch in atopic dermatitis.