Successful Treatment of Chronic Intractable Itching Using Oral Pregabalin in a Patient with Diabetes and Systemic Prurigo Nodularis: A Case Report of an Iliopsoas Muscle Abscess

Abstract

A 73-year-old Japanese man developed chronic intractable itching due to prurigo nodularis. High-dose glucocorticoid ointment failed, and the treatment resulted in poor glycemic control. Repeated scratching caused hematogenous bacterial dissemination via cutaneous injuries, resulting in the formation of iliopsoas and spinal epidural abscesses that required long-term antibiotic treatment. Pregabalin was administered to treat the pruritus, and a considerable improvement was observed. A reduction in the dose and intensity of the topical corticosteroids improved the patient's glycemic control, resulting in the complete resolution of the abscesses. Pregabalin significantly improved the patient's pruritus and decreased the risk of infection.

2020 guidelines for the diagnosis and treatment of prurigo

“…Efficacy was further reported at the case report level. 111 There are no reports supporting that pregabalin is effective against prurigo chronica multiformis.…”

Comparison of pregabalin with doxepin in the management of uremic pruritus: a randomized single blind clinical trial

“…As a scale for the assessment of itch severity, the VAS is a horizontal line which is divided into 10 equal parts. Based on the score of the VAS the severity of pruritus is divided into five levels: no itch (0 points), mild (0.1–3.9 points), moderate (4–6.9 points), severe (7–8.9 points), and very severe (9–10 points) itch …”

“…It has ten questions and predominantly focuses on the symptoms of disease and related feelings such as embarrassment, daily activities, social or leisure activities, work and school activities, personal relationships, and problems related to the treatment of disease. The scores of all questions are summed to calculate the total score of the DLQI which can be between zero “no effect at all on the quality of life of patient” and thirty “extremely large effect on the quality of life of patient.”…”

Chronic Nodular Prurigo: An Update on the Pathogenesis and Treatment

“…For CNPG, twenty-three out of thirty patients responded with a significant improvement in VAS scores with good tolerance after one-month treatment of pregabalin at a dose of 75 mg/day [ 104 ]. A case report showed a rapid reduction in VAS scores from 10 to 0 within one day at an initial dose of 150 mg/day of pregabalin and a maintenance dose of 225 mg/day [ 105 ].…”