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The problem of postburn itch has been underevaluated and undertreated in the past. However, recently published data have expanded the evidence base, which provides clinicians and their patients with new evaluation and treatment options that can help reduce and potentially eliminate the prolonged distress experienced by burn survivors faced with postburn itch. Although a gold standard evaluation method has not yet been agreed upon, there are a number of tools that have been published that clinicians can use for assessment. Epidemiological evidence has confirmed that the vast majority of both adult and pediatric burn survivors experience itch for years following injury. At discharge from the acute care hospital, 93% of burn survivors with major burn injuries report postburn itch that is still experienced by 44% of adult burn survivors 30 years postburn. Although larger surface area injuries are more likely to require a multimodal treatment approach to reduce the itch intensity as well as the episode duration and frequency, burn survivors with small surface area injuries also experience itch that needs to be addressed. A number of treatment protocols have been described that commonly call for concurrent administration of both pharmacological and nonpharmacological treatment approaches. These protocols provide clinicians with a structured, systematic approach to treatment decisions that are evidence-based. Although many questions require further investigation, the current state of the science creates an ethical imperative that all burn survivors' itch experience should be quantitatively evaluated and appropriate treatment options explored until satisfactory outcomes are obtained.

The goal of this cross-sectional study was to characterize and describe persistent postburn pruritus. Cause and treatment of postburn itch is elusive. It has been suggested that burn survivors with persistent pruritus should be divided into acute itch (≤6 months postinjury) and chronic itch (>6 months postinjury) because the cause of itch may be different. Cross-sectional data of itch characteristics reported here are from the baseline data of a prospective, randomized, double-blind, controlled pilot study of 23 subjects with frequent and bothersome postburn pruritus. Subjects self-completed validated scales for variables of itch sensation, affect of itch, and severity. Variables of quality of life, frequency, pain and itch intensity, skin condition, scar, and medication were also recorded. Itch frequency revealed that 87% of subjects experienced itching daily, 96% experienced three or more episodes a day, and 52% had episode durations lasting 5 to 30 minutes per incidence. Itch was reported as unbearable by 94% of subjects with chronic itch and by 86% of subjects with acute itch, whereas bothersome was 88 and 100%, respectively. Itch sensation dimension of stinging was 74% in both acute and chronic itch subjects. Crawling and burning sensations were often severe. Potential itch triggers and relief activities were identified. Differences in sensory and affective itch components were detected between acute and chronic itch subjects. Combinations of itch mechanisms probably contribute to the development of and changes in pruritus. Characterizing the sensation and affective itch dimensions in conjunction with inflammation, burn injury, recovery, scar maturation, medication, and psychological status should better elucidate postburn itch.

The objective of this study was to evaluate whether Provase®, a nonprescription moisturizer with a blend of protease enzymes, would reduce postburn itching in adult burn survivors relative to a control moisturizer. This was a prospective, single-center, double-blinded, pilot study where 23 burn survivors were randomized to either the treatment group, who applied Provase, or the control group, who applied the base moisturizer used in Provase every 8 hours for 4 weeks. Twelve were randomized to the treatment and 11 to the control groups with 9 participants in each group completing the study. There was no difference between groups with respect to gender, ethnicity, causative factor, TBSA burned, or time postinjury. Participant's pruritus and scar were reevaluated on a weekly basis for 4 consecutive weeks. Relative to baseline, there was a significant reduction of itch duration in minutes at weeks 3 and 4, the number of days per week that itch was experienced at weeks 2, 3, and 4, and the number of itch episodes per day at week 2 for the treatment group. The itch TBSA reduced significantly relative to baseline for the treatment group at week 1, 2, and 3. The affective itch characteristics were significantly reduced for the treatment group for bothersome at weeks 1, 2, 3, and 4; for annoying at week 4; and for unbearable at weeks 2, 3, and 4. Although this was a pilot study and not powered for statistical differences, there were statistically significant differences for itch duration, weekly frequency, itch episodes per day, itch TBSA, and reported affective burden of itch after treatment. Further investigation is recommended with a larger sample size treated for a longer period of time where participants are stratified based on acute or chronic itch.

Severe pruritus after burn continues to be a clinical challenge that is inadequately addressed by traditional therapies. The success of naltrexone, an opioid antagonist, in treating pruritus in other patient populations, supported the concept that it may also be effective in burn survivors. Thus, burn patients who were dissatisfied with itch relief obtained after a course of traditional therapy were offered naltrexone. Of the 15 subjects included in this case series, 2 discontinued treatment because of side-effects. Of the remaining 13, 72% reported that they were satisfied with the itch relief provided by naltrexone, 69% were able to decrease or stop taking other medications to reduce itch, 85% would recommend it to other burn patients, and 62% divulged that it improved their quality of life. A sub-group (n=8) completed the French-Canadian version of the Questionnaire for Pruritus Assessment before and after a 2-week course of naltrexone treatment. Comparisons of individual responses before and after naltrexone treatment revealed that the affective impact of itch appeared to be less burdensome. The majority reported either a reduction or no change in the frequency of itch experienced. All reported either a decrease or no change in the duration of itch experienced after naltrexone treatment. All items that previously increased itch were less likely to affect itch or there was no change, except with fatigue, physical effort, sweating and eating. There was a statistically significant reduction in their visual analogue scale intensity ratings of itch "at its worst". Thus, naltrexone positively impacted the itch experienced by burn patients in association with a high percentage of patient-satisfaction. Further controlled trials are recommended.

Background: Severe pruritus after burn continues to be a clinical challenge. To address this challenge, thorough documentation of burn survivors' itch experience is required. A "Questionnaire for Pruritus Assessment" has been developed to capture the sensory and affective experiences associated with itch as well as its functional and quality of life implications, but to evaluate the Quebec burn survivor population, a Canadian French version is required. Thus, the purpose of this study was to generate a Canadian French cross-cultural adaptation of the questionnaire suitable for the burn survivor population., Methods: Cross-cultural adaptation followed six steps: forward translation into Canadian French, back translations into English, resolution between the two versions, synthesis of the Canadian French versions, revision by a committee of experts, and testing of the pre-final version., Results: The adaptation process resolved issues surrounding translation, content validity, burn survivor-specific modifications, and format, resulting in a Canadian French pre-final version that was pilot-tested among 32 burn survivors. Content validity of the Canadian French version was assessed by a committee of experts and the participants. The results showed good item completion and adequate distribution of scores without a ceiling or floor effect., Conclusions: This study resulted in a Canadian French version of the "Questionnaire for Pruritus Assessment" that can confidently be compared to other investigations utilizing the same tool. The adapted questionnaire also provides a valuable data collection means, enabling more thorough documentation of the burn survivor itch experience.