Successful Treatment of Epidermal Nevus-associated Pruritus with Topical Ketamine–Amitriptyline–Lidocaine

Jaller, Jose A.; Yosipovitch, Gil

doi:10.2340/00015555-2811

Cited by 4 publications

(4 citation statements)

References 6 publications

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“…Combination of topical amitriptyline and ketamine was originally reported as a treatment for neuropathic pain syndromes and its efficacy in pruritus has been reported . TALK, which is produced by adding lidocaine to it, has been more recently applied with successful outcomes and high tolerance . The efficacy for dysesthesias other than pruritus has not yet been reported, but our experience supports its therapeutic value to burning and pain as well.…”

Section: Discussionsupporting

confidence: 53%

“…10,11 TALK, which is produced by adding lidocaine to it, has been more recently applied with successful outcomes and high tolerance. 2,12 The efficacy for dysesthesias other than pruritus has not yet been reported, but our experience supports its therapeutic value to burning and pain as well. Treatments detected in our published work review include other systemic antidepressants and anticonvulsants.…”

Section: Discussionsupporting

confidence: 51%

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Diagnostic and therapeutic approach to scalp dysesthesia: A case series and published work review

Kinoshita‐Ise

Shear

2019

The Journal of Dermatology

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Scalp dysesthesia may be underrecognized but is an important condition which requires special management strategies. Through our case series of four patients, we have noted that patients were frequently misdiagnosed with seborrheic dermatitis and failed standard treatment. However, patients did benefit from low doses of oral pregabalin and a topical compound of amitriptyline, lidocaine and ketamine. Oral antihistamines and topical corticosteroids did not work sufficiently on their own but added value when used in conjunction with analgesic agents. Our experience and published work also suggest the association of cervical spinal changes, psychiatric disorders, and other environmental and habitual factors.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionsupporting

confidence: 51%

Diagnostic and therapeutic approach to scalp dysesthesia: A case series and published work review

Kinoshita‐Ise

Shear

2019

The Journal of Dermatology

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“…Musculoskeletal pain, neuropathy, pruritus, and nausea are just a few conditions that have been assessed to show possible benefit following the application of topically applied medications and where systemic absorption to the extent of oral dosage forms may not be required. 9 –11 Thus, topical preparations of medications offer clinicians an alternative method of drug delivery when conventional methods are unavailable, impractical, or unsafe. It must be noted, however, that the pharmacokinetic behaviors of many topical products are either poorly characterized or not studied at all.…”

Section: Discussionmentioning

confidence: 99%

A Lack of Systemic Absorption Following the Repeated Application of Topical Quetiapine in Healthy Adults

Kayhart

Lapid

Nelson

et al. 2018

Am J Hosp Palliat Care

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In the absence of suitable oral or intravenous access for medication administration and when the intramuscular medications are undesirable, alternative routes for drug delivery may be considered. Antipsychotics administered via an inhaled, intranasal, rectal, or topical route have been described in the literature. Topically administered antipsychotics have been previously reported to produce negligible systemic absorption despite being used in clinical practice for nausea and behavioral symptoms associated with dementia. Additionally, the American Academy of Hospice and Palliative Medicine recommends against the use of topical medications that lack supporting literature. Three studies have assessed the systemic absorption of different antipsychotics after administration of only a single, topically applied dose. To evaluate whether the repeated administration of a topically applied antipsychotic may result in detectable serum levels in an accumulating fashion, a pharmacokinetic study was conducted. Five healthy, adult participants consented to receive extemporaneously prepared topical quetiapine in Lipoderm every 4 hours for a total of 5 doses. Blood samples were drawn at baseline and hours 2, 4, 8, 12, 16, and 24, and serum quetiapine concentrations were measured using high-performance liquid chromatography. Quetiapine was undetectable in every sample from 3 participants. Two participants had minimally detectable serum quetiapine levels no sooner than hour 12 of the study period. Extemporaneously prepared quetiapine in Lipoderm resulted in nonexistent or minimal serum level following repeated topical administration. The use of topically applied quetiapine should still be questioned.

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“…In our clinic, we have successfully treated pruritic scars with this formulation (unpublished data). We have published data on the efficacy of this topical formulation for a scarring congenital naevi and neuropathic itch ( 67 , 68 )…”

Section: Treatment Of Itch In Keloids and Their Putative Mechanismsmentioning

confidence: 99%

Pruritus in Keloid Scars: Mechanisms and Treatments

Hawash¹,

Ingrasci²,

Nouri³

et al. 2021

Acta Derm Venereol

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Keloids are scars that extend beyond the margins of an insulting cutaneous injury. Keloids are often thought to be primarily a cosmetic issue, as they are typically quite raised and pigmented. However, these scars also present with functional symptoms of pruritus and pain that significantly impact quality of life. The symptom of pruritus is frequently overlooked by dermatologists, and treatments are often primarily focused on the gross appearance of the scar. This review describes the prevalence and importance of pruritus in keloids. In addition, the putative mechanisms underlying the development of keloid pruritus, which include neuronal and immunological mechanisms, are discussed. Furthermore, this review describes keloid treatments that have been shown to reduce pruritus, treatments that specifically target the itch, and emerging therapies.

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Successful Treatment of Epidermal Nevus-associated Pruritus with Topical Ketamine–Amitriptyline–Lidocaine

Abstract: Fig. 1. Well-demarcated, linear, red, scaly plaque on the right forehead consistent with ILVEN (post-treatment).

Cited by 4 publications

References 6 publications

Diagnostic and therapeutic approach to scalp dysesthesia: A case series and published work review

Diagnostic and therapeutic approach to scalp dysesthesia: A case series and published work review

A Lack of Systemic Absorption Following the Repeated Application of Topical Quetiapine in Healthy Adults

Pruritus in Keloid Scars: Mechanisms and Treatments

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