Can we use psychoactive drugs to treat pruritus?

Abstract

Pruritus is a frequent complaint both in dermatology and general medicine. This burdensome symptom has a complex and multifactorial pathogenesis, with the key involvement of central nervous system in its development. Psychoactive drugs (psychopharmaceuticals) encompass several therapeutic groups utilized mainly in psychiatry. However, these drugs are occasionally used in dermatological practice and may contribute to alleviation of pruritus in a variety of cutaneous and extracutaneous disorders. This review article summarizes the role of H1‐antihistamines, antidepressants, antipsychotics and antiepileptics in managing pruritus.

A protracted, postherpetic neuralgic ulcer treated with risperidone and intranasal butorphanol

“…Risperidone, a second-generation antipsychotic medication that blocks dopamine in the mesolimbic neural circuit, has been reported to successfully reduce pruritus and scratching behavior in delusional parasitosis, a psychiatric cause of chronic pruritus, yet there are no reports of its successful use in neuropathic pruritus. 6 We decided to use risperidone to improve our patient's longstanding scratching behavior and nocturnal pruritus. Risperidone may be started at a dose of 0.5 mg before bedtime and increased weekly until reaches a maximum dose of 4 mg/d.…”

The Mind Body Connection in Dermatologic Conditions: A Literature Review

“…84 Tetracyclic antidepressants, such as mirtazapine, are not only reported to reduce psychological symptoms at low to moderate doses (15 to 45mg), but also to improve sleep and pruritus at low doses (7.5 to 30mg). 58,[85][86][87][88] In AD, dupilumab, has been shown to reduce symptoms of anxiety and depression as early as 2 weeks through inhibition of pro-inflammatory cytokines (IL-4, IL-12) and IgE. 89 Tralokinumab (anti IL-13) has been linked to overall QoL improvement in AD patients due to its proposed anti-pruritic, anti-depressant, anti-anxiety, and sedative effects.…”

Neuropathischer Pruritus – evidenzbasierte Behandlungsempfehlungen

“…Eine Besserung des Juckens und des Kratzverhaltens ist bei einer Patientin mit postherpetischem Pruritus durch die intranasale Gabe von Butorphanol und Risperidon [ 80 ] dokumentiert. Butorphanol ist ein Opioid, das als Agonist auf die κ‑ und δ‑Opioidrezeptoren und als Antagonist auf die μ‑Opioidrezeptoren wirkt [ 81 ], und Risperidon, ein Neuroleptikum, wurde erfolgreich zur Behandlung von Patienten mit einer wahnhaften Parasitose eingesetzt [ 82 , 83 ]. Bei einem Patienten mit Post-Zoster-Pruritus im Bereich des N. trigeminus führte die hochthorakale epidurale Infusion von Bupivacain und Clonidin zu einer Linderung der Symptomatik [ 84 ].…”