evaluation of the Antipruritic effects of topical pimecrolimus in non atopic prurigo nodularis results of a randomized hydrocortisone controlled double blind phase ii trial

Background: In the treatment of atopic dermatitis, pimecrolimus has high Antipruritic effects. Objective: To investigate the efficacy of 1% pimecrolimus cream in comparison to 1% hydrocortisone cream in non-atopic prurigo nodularis (PN). Methods: A randomized, controlled, double-blind study with intraindividual randomization was done in 30 patients (17 females, 13 males; mean age 58.5 years) with PN. Results: Pruritus intensity decreased significantly (p Conclusion: The results suggest that the non-steroid pimecrolimus is an effective alternative for PN treatment.

Antipruritic treatment with systemic μ opioid receptor antagonists a review

During the past two decades, systemic μ-opioid receptor antagonists (MORA) have been used in the treatment of various forms of chronic pruritus. In a number of case reports, case series, and controlled trials, treatment with MORA has demonstrated considerable Antipruritic effects. In double-blind controlled studies, significant Antipruritic relief has been achieved by MORA in cholestatic pruritus, chronic urticaria, and atopic dermatitis. In case reports and case series, Antipruritic efficacy of MORA has been reported in prurigo nodularis, mycosis fungoides, postburn pruritus, aquagenic pruritus, hydroxyethyl starch-induced pruritus, and pruritus of unknown origin. However, most of the evidence remains anecdotal, the design of these trials varies, and comparison of results is difficult. In this review we aim to present an overview of these reports and to assess the evidence for the Antipruritic action of the drugs naloxone, nalmefene, and naltrexone, which are currently in use for the treatment of chronic pruritus of different origins. We will also evaluate recommendations for the use of MORA in daily medical practice.

targeting the neurokinin receptor 1 with aprepitant a novel Antipruritic strategy

Background
Chronic pruritus is a global clinical problem with a high impact on the quality of life and lack of specific therapies. It is an excruciating and frequent symptom of e.g. uncurable renal, liver and skin diseases which often does not respond to conventional treatment with e.g. antihistamines. Therefore Antipruritic therapies which target physiological mechanisms of pruritus need to be developed. Substance P (SP) is a major mediator of pruritus. As it binds to the neurokinin receptor 1 (NKR1), we evaluated if the application of a NKR1 antagonist would significantly decrease chronic pruritus.

Methods and Findings
Twenty hitherto untreatable patients with chronic pruritus (12 female, 8 male; mean age, 66.7 years) were treated with the NKR1 antagonist aprepitant 80 mg for one week. 16 of 20 patients (80%) experienced a considerable reduction of itch intensity, as assessed by the visual analog scale (VAS, range 0 to 10). Considering all patients, the mean value of pruritus intensity was significantly reduced from 8.4 VAS points (SD +/−1.7) before treatment to 4.9 VAS points (SD +/−3.2) (p<0.001, CI 1.913–5.187). Patients with dermatological diseases (e.g. atopic diathesis, prurigo nodularis) had the best profit from the treatment. Side-effects were mild (nausea, vertigo, and drowsiness) and only occurred in three patients. Conclusions The high response rate in patients with therapy refractory pruritus suggests that the NKR1 antagonist aprepitant may indeed exhibit Antipruritic effects and may present a novel, effective treatment strategy based on pathophysiology of chronic pruritus. The results are promising enough to warrant confirming the efficacy of NKR1 antagonists in a randomized, controlled clinical trial.

Pruritus in der Schwangerschaft

Pruritus is the leading dermatological symptom during pregnancy. Besides preexisting or acquired dermatoses, there are a number of pregnancy-specific dermatological diseases such as PEP (polymorphic eruption of pregnancy), Pemphigoid (Herpes) gestationis, Pruritus gravidarum that may be accompanied by severe itching and scratching. Because of potential effects on the fetus, the treatment of pruritus in pregnancy requires prudent consideration of whether the severity of the underlying disease warrants treatment and selection of the safest treatments available. The use of topical and systemic treatments depends on the underlying etiology of pruritus and the stage and status of the skin. In general, emollients, topical Antipruritics and topical corticosteroids appear to be the safest options for localized forms of pruritus in pregnancy whereas systemic treatments and/or UV photo therapy are adequate for generalized pruritus. Systemic corticosteroids and a restricted number of antihistamines may be administered. This paper highlights the major etiologies of pruritus during pregnancy and points out the cornerstones of Antipruritic therapy in recognition of our own clinical experiences and the current literature. Pruritus ist das dermatologische Hauptsymptom in der Schwangerschaft. Neben bereits bestehenden oder neu erworbenen Dermatosen gibt es eine Reihe von Schwangerschaftsdermatosen wie z. B. PEP (polymorphe Exantheme der Schwangerschaft), Pemphigoid (Herpes) gestationis und Pruritus gravidarum, welche von starken Juckempfindungen und Kratzen begleitet sind. Durch mögliche fetale Schädigungen muss die Indikation und Auswahl der antipruritogenen Therapie in der Schwangerschaft vorsichtig abgewogen und die sicherste Therapieform gewählt werden. Der Einsatz topischer und systemischer Therapien hängt daher von der zugrunde liegenden Ursache, dem Stadium und dem individuellen Zustand der Haut ab. Für lokalisierte Formen des Pruritus können topische Antipruriginosa und Glukokortikosteroide eingesetzt werden, während bei generalisiertem Pruritus zumeist systemische Therapien und/oder eine UV-Therapie nach sorgfältiger Abwägung durchgeführt werden. Systemische Glukokortikosteroide und eine limitierte Anzahl von Antihistaminika können in schweren Fällen eingesetzt werden. In dieser Arbeit werden die Hauptursachen des Pruritus in der Schwangerschaft und die Eckpunkte der antipruritogenen Therapie dieser herausfordernden Patientengruppe unter Berücksichtigung eigener klinischer Erfahrungen und der aktuellen Literatur dargestellt.

Pruritus in der Schwangerschaft

Pruritus is the leading dermatological symptom during pregnancy. Besides preexisting or acquired dermatoses, there are a number of pregnancy-specific dermatological diseases such as PEP (polymorphic eruption of pregnancy, previously named PUPPP), pemphigoid (herpes) gestationis, and pruritus gravidarum that are accompanied by severe itching and scratching. Because of potential effects on the fetus, the treatment of pruritus in pregnancy requires prudent consideration. The use of topical and systemic treatments depends on the underlying aetiology of pruritus and the stage and status of the skin. In general, emollients, topical Antipruritics and topical corticosteroids appear to be the safest options for localised forms of pruritus in pregnancy whereas systemic treatments and/or UV phototherapy are adequate for generalized pruritus. Systemic corticosteroids and a restricted number of antihistamines may be administered in severe cases. This paper highlights the major aetiologies of pruritus during pregnancy and points out the cornerstones of Antipruritic therapy in recognition of our own clinical experiences and the current literature. Pruritus ist das dermatologische Hauptsymptom in der Schwangerschaft. Neben bereits bestehenden oder neu erworbenen Dermatosen gibt es eine Reihe von Schwangerschaftsdermatosen, wie z. B. PEP (polymorphe Exantheme der Schwangerschaft), Pemphigoid (Herpes) gestationis und Pruritus gravidarum, die von starken Juckempfindungen und Kratzen begleitet sind. Durch mögliche fetale Schädigungen muss die Indikation und Auswahl der antipruritogenen Therapie in der Schwangerschaft vorsichtig abgewogen werden. Der Einsatz topischer und systemischer Therapien hängt von der zugrunde liegenden Ursache, dem Stadium und dem individuellen Zustand der Haut ab. Für lokalisierte Formen des Pruritus können topische Antipruriginosa und Glukokortikosteroide eingesetzt werden, während bei generalisiertem Pruritus zumeist systemische Therapien und/oder eine UV-Therapie nach sorgfältiger Abwägung durchgeführt werden. Systemische Glukokortikosteroide und eine limitierte Anzahl von Antihistaminika können in schweren Fällen eingesetzt werden. In diesem Beitrag werden die Hauptursachen des Pruritus in der Schwangerschaft und die Eckpunkte der antipruritogenen Therapie dieser Patientengruppe unter Berücksichtigung eigener klinischer Erfahrungen und der aktuellen Literatur dargestellt.

Antipruritic effects of two different 5 ht3 receptor antagonists and an antihistamine in haemodialysis patients

:  Pruritus is the most distressing symptom in haemodialysis (HD) patients. Its aetiology has not yet been delineated, and thus there are no good therapeutical options. Case reports and series attribute Antipruritic potency to the serotonin receptor antagonists of the 5-HT3 type in renal pruritus. It was the aim of this study to investigate the Antipruritic effect of two different 5-HT3 receptor antagonists and an antihistamine in 11 patients undergoing HD. Pruritus was induced by iontophoresis with serotonin and histamine and recorded before and after HD. These data were compared to those obtained after oral pretreatment with the 5-HT3 receptor antagonists tropisetron 5 mg and ondansetron 8 mg and the antihistamine cetirizine 10 mg. Ten healthy volunteers served as a control group. Vasocutaneous parameters (wheal and flare), skin temperature and alloknesis were also determined. Itching in HD patients and controls was not significantly diminished by oral pretreatment with the serotonin receptor antagonists. In controls, but not in HD patients, cetirizine significantly reduced itching, skin temperature and vasocutaneous parameters. Our data additionally demonstrate that there are no significant differences in vasocutaneous parameters, itching and alloknesis in HD patients before and after dialysis. We conclude that 5-HT3 receptor blockers such as tropisetron and ondansetron and the antihistamine cetirizine do not sufficiently reduce serotonin- and histamine-induced itching in haemodialyis patients.

antidepressants as Antipruritic agents a review

Pruritus is a concomitant symptom of various underlying disorders viz. dermatological, systemic and psychiatric disorders that provoke the person to scratch the skin. Many natural as well as, Antipruritic therapies are usually practiced in the treatment of pruritus including general preventive measures, topical therapies such as cooling agents, antihistamines, anesthetics, capsaicin, corticosteroids, immunomodulators and; systemic therapies including administration of antihistamines, opioid antagonists/agonists, antiepileptic drugs/neuroleptics (e.g., gabapentin and pregabalin), antidepressants (e.g., doxepin, amitriptyline, paroxetine, fluvoxamine, sertraline, escitalopram and mirtazapine) (Patel and Yosipovitch, 2010; Reich et al., 2011; Martin and Padilla, 2015; Eskeland et al., 2016). Topical therapies are the mainstay of treatment of delicate and localized pruritus while other systemic drug therapies are used to treat stern and generalized pruritus. The reported Antipruritic activity of some antidepressant drugs has intrigued this review to focus on the types of pruritus, pruritus mechanism, the Antipruritic mechanism of antidepressants and to comprehend the role of antidepressants in the management of pruritus.