Imagine a constant, relentless itch that disrupts your sleep, interferes with your daily activities, and impacts your emotional well-being. This is the reality for many burn survivors who experience post-burn itch. This itch comes in two forms: acute wound healing itch and chronic burn scar itch. While the former is a part of the early recovery process, the latter is a long-lasting condition associated with healed burn scars.
Recognizing the lack of consolidated research to guide effective treatment options for this debilitating condition, a team of researchers at the University of Calgary collaborated with colleagues in the United States and India to embark on a comprehensive analysis of existing studies to identify promising interventions and develop new therapeutics to improve outcomes following burns.
Lead author Sarthak Sinha, MD/PhD candidate at the University of Calgary and a 2013 Top 40 Under 40 says, “Over 80 per cent of burn survivors within the first year of their injury and approximately 67 per cent two years post-burn are affected. It's a condition that goes beyond mere discomfort."
Chronic burn scar itch can severely impair sleep, disrupt daily activities, hinder return to work, and negatively impact social and emotional well-being. The relentless itch can lead to irritability, anxiety, and even depression, imposing a significant financial burden on survivors and the health-care system due to increased health-care utilization and loss of productivity.
"Our review uncovered a range of treatments that show promise in alleviating the persistent itch experienced by burn survivors. While allergy medications like antihistamines were often the go-to option, our review provides evidence that neuromodulatory agents such as gabapentin, pregabalin, ondansetron, and doxepin may be more effective at targeting chronic burn-scar itch," explains Sinha.
The research team also found that topical therapies and physical modalities such as massage therapy and extracorporeal shock wave therapy demonstrated potential in reducing both itch and pain. Laser treatments, particularly pulsed high-intensity laser, also likely reduce both itch and pain more effectively than placebo. This review is not only offering hope to burn survivors but also challenges the understanding of post-burn itch.
"It might arise from altered neural circuitry that interprets and responds to itch, which could explain why it responds better to neuromodulatory agents. This perspective shifts our thinking from viewing itch strictly as an immune cell problem to a neuro-immune issue," says Sinha.
The review underlines the need for more robust, high-quality studies to enhance the certainty of evidence and better understand the underlying mechanisms of post-burn itch. However, it stands as the most comprehensive compilation of current evidence, offering valuable insights to guide informed decisions and improve the quality of life for burn survivors.
Dr. Vincent Gabriel, MD, MSc, medical director of the Calgary Firefighters Burn Treatment Centre, says, “a Cochrane Review is a significantly more involved process than most literature reviews. Sarthak has demonstrated his commitment to critical analysis with meaningful impact on practice in completing this work.”
This research not only provides significant social benefits and holds the potential to greatly improve the lives of burn survivors, but also helps to create economic value by paving the way for potential new treatment industries and jobs not only in Calgary but all throughout Canada. The University of Calgary continues to be at the forefront of impactful advancements, driving forward innovations that make a real difference in people’s lives.
