Further treatment that positively influenced pruritus in hypertrophic scar tissue was rehabilitation massage therapy, containing effleurage, friction, and petrissage techniques (p = 0.001).30 The observed moderate effect of massage therapy on pruritus (Hedges'g = −0.61) might be explained by the gate theory by Melzack and Wall56 or due to the release of beta endorphin levels.57 No positive effects were observed for the use of moisturizing creams (including proteases) in the reduction of pruritus in burn scar tissue (p > 0.05).41 This evidence concerns the gene POMC and Pruritus.