Successful Treatment of Intractable Palmoplantar Pruritus With Ondansetron

Life-threatening blood loss from scratching provoked by pruritus in the bulky perineal nevocytoma variant of giant congenital melanocytic nevus in a child

“…It has been proposed that a local intermittent stimulation of afferent sensory nerve fibers produces itch, while a prolonged stimulation results in inhibition of pruritus by inhibitory neuronal pathways within the spinal cord. 15 In our case, local intermittent irritation from ingrown hairs within the nevus may have initiated the itch. It is also possible that dysregulation from the central inhibitory circuit resulted in persistent pruritus.…”

“…14,18,19 One case reported successful use of ondansetron in treating idiopathic intractable palmoplantar pruritus. 15 Commonly used for nausea and vomiting, ondansetron can be safely administered to children. It is generally well tolerated, the most common side effects being headache, constipation, drowsiness and elevated transaminases.…”

A randomized, placebo-controlled, double-blind trial of ondansetron in renal itch

“…The pruritus returned to pretreatment levels after 8 h. There was no reduction in itch with placebo. Ondansetron has also been reported to be effective in opioid‐induced pruritus, 8 cholestatic pruritus 9 and in intractable palmoplantar pruritus 10 …”

Severe pruritus in a haemodialysed patient: dramatic improvement with granisetron

“…Additionally, serotonin and histamine have been reported as possible mediators of uraemic pruritus. Ondansetron has been reported to improve pruritus in dialysis patients 2 and in palmoplantar pruritus resistant to other therapies 3 . These drugs have occasionally been used for cholestatic pruritus 4 …”