This article has been peer reviewed and approved by Michael Fisher, MD, Professor of Medicine, Albert Einstein College of Medicine. Review date: September 2009.
Drs. Galatian, Stearns, and Grau report no conflict of interest. The authors discuss off-label use of active charcoal, cholestyramine, dronabinol, etanercept, gabapentin, mirtazapine, nalmefene hydrochloride, naloxone hydrochloride, naltrexone hydrochloride, paroxetine hydrochloride, rifampicin, sertraline hydrochloride, tacrolimus ointment, thalidomide, ursodeoxycholic acid, UVA1 therapy, and UVB phototherapy for pruritus. Dr. Fisher reports no conflict of interest. The staff of CCME of Albert Einstein College of Medicine and Cutis® have no conflicts of interest with commercial interest related directly or indirectly to this educational activity. Dr. Galatian was a student, Dr. Stearns was an intern, and Dr. Grau was Assistant Clinical Professor, all from the Department of Dermatology, The University of Oklahoma, Oklahoma City. Dr. Galatian currently is a resident, The University of Oklahoma. Dr. Stearns currently is a resident, State University of New York, Syracuse. Dr. Grau currently is a dermtologist, Saints Dermatology, Oklahoma City, and Volunteer Assistant Clinical Professor, The University of Oklahoma.
Pruritus is a common symptom reported in connective tissue and other common systemic disease states. Unfortunately, the unique pathophysiologic etiology of the often chronic and severe pruritus that is a debilitating component of many connective tissue disorders makes treatment with conventional anti-itch agents difficult. As the underlying mechanisms of pruritus have been identified, treatment strategies have evolved. Considering the diversity of available antipruritic therapies and the variability of underlying factors specific to disease states, individualized therapy recommendations are necessary. Important new areas of treatment target the central and peripheral mechanisms of pruritus and include anticonvulsants, antidepressants, opioid antagonists, and phototherapy. Further research is necessary to quantify the role of new and novel antipruritic therapies.
