Q: 44 years old male with a history of cirrhosis is now recovering from esophageal variceal bleeding. Patient complains of generalized pruritus. Antidepressants and anticonvulsants can be used as adjuvant treatment for generalized pruritus?
A) True
B) False
Answer: A
Generalized pruritus is an umbrella term for any pruritus not limited to a specific body area and can be due to any underlying pathology such as skin disorders, renal or hepatic dysfunction, malignancy, systemic rheumatic disease, infections, drug reactions, or simple idiopathic. In severe form, it can be life-limiting.
Antidepressants such as mirtazapine and selective serotonin reuptake inhibitors (SSRIs) work well due to their effect on serotonin and histamine levels. Anticonvulsants such as gabapentin and pregabalin may be helpful due to their effect on nerves and can be very beneficial in neuropathic pruritus or where nerves get affected due to inflammation and edema caused by skin injury/itching.
#neurology
#dermatology
References:
1. Kouwenhoven TA, van de Kerkhof PCM, Kamsteeg M. Use of oral antidepressants in patients with chronic pruritus: A systematic review. J Am Acad Dermatol 2017; 77:1068.
2. Ständer S, Böckenholt B, Schürmeyer-Horst F, et al. Treatment of chronic pruritus with the selective serotonin re-uptake inhibitors paroxetine and fluvoxamine: results of an open-labelled, two-arm proof-of-concept study. Acta Derm Venereol 2009; 89:45.
3. Pour-Reza-Gholi F, Nasrollahi A, Firouzan A, et al. Low-dose doxepin for treatment of pruritus in patients on hemodialysis. Iran J Kidney Dis 2007; 1:34.
4. Matsuda KM, Sharma D, Schonfeld AR, Kwatra SG. Gabapentin and pregabalin for the treatment of chronic pruritus. J Am Acad Dermatol 2016; 75:619.
5. Yesudian PD, Wilson NJ. Efficacy of gabapentin in the management of pruritus of unknown origin. Arch Dermatol 2005; 141:1507.
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