What is the role of pharmacologic therapy in the treatment of brachioradial pruritus?

Updated: Oct 05, 2020
  • Author: Julianne Mann, MD; Chief Editor: Dirk M Elston, MD  more...
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Treatment of brachioradial pruritus remains a challenge. Most patients find relief with the application of cold packs that numb the skin; hence, a positive "ice-pack sign" is almost pathognomonic for this condition. [3] Oral antihistamines and topical corticosteroids are only occasionally of value. If potent or superpotent topical corticosteroids are used, care must be taken to avoid cutaneous atrophy from overzealous use. Occasionally, patients are helped with topical anesthetics (eg, lidocaine cream or gel) or with 5% topical doxepin.

Substance P is a neurotransmitter important in the transmission of pain and itch neural signals. Topical capsaicin cream (0.025-0.05%) is a natural plant product that depletes substance P from cutaneous nerve endings. [47]  It has been reported by a number of authors to provide relief of brachioradial pruritus within weeks. [16, 22, 48, 49, 50]  Capsaicin patches have also been used. [51, 52]

Numerous oral medications have been tried with varying success. Case reports describe sustained symptomatic relief with gabapentin (1800 mg/d), [33] lamotrigine (200 mg/d), [9] amitriptyline (25-150 mg qhs), [22] and pimozide (1-2 mg/d). Oxcarbemazepine has proven effective in several patients reported by Savk and Savk. [31] Risperidone has been used with some success in certain patients. No medication works predictably. When using psychotropic medications, obtaining a psychiatric opinion is advisable unless the treating physician commonly prescribes these agents.

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