Topical ketamine-amitriptyline-lidocaine for chronic pruritus: A retrospective study assessing efficacy and tolerability

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

“…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.…”

“…Previous treatment included oral mycophenolic acid, intralesional muscle triamcinolone acetonide and multiple topical corticosteroids, but none of them had brought satisfactory results. After her visit to our clinic, clobetasol lotion was continued and TALK (originally described as “TKAL”; topical 5% amitriptyline, 5% lidocaine and 10% ketamine in Lipobase® [Leo Laboratories, Hurley, UK]) was initiated and the patient achieved 75% improvement of pruritus and 30% improvement of burning sensation.…”

Skin Barrier Damage and Itch: Review of Mechanisms, Topical Management and Future Directions

“…TRPM8 agonists are promising novel compounds, especially for patients who report that cooling reduces their itch, that could be added to existing topical therapies and therefore warrant further investigation. A combined topical application of ketamine-amitriptyline-lidocaine has demonstrated antipruritic properties effective in the treatment of chronic itch (111,112). Ketamine, a N-methyl-D-aspartate antagonist, has a role in the treatment of pain in subanaesthetic doses (113).…”

“…Ketamine, a N-methyl-D-aspartate antagonist, has a role in the treatment of pain in subanaesthetic doses (113). However, the mechanism of action of this topical combination is unknown and likely acts peripherally through blockade of sodium channels (111).…”

A prospective case of postherpetic itch monitored by quantitative sensory testing for 1 year while undergoing 8% topical capsaicin treatments

“…On the basis of evidence from cases studies, PHI can be as disabling as pain, and is often intractable [2,4] . Although no controlled trials have been conducted specifically for PHI, case studies report partial efficacy of gabapentinoids, topical amitriptyline/ketamine, 8% topical capsaicin, pulsed radiofrequency treatment, and topical lidocaine [1,[6][7][8][9] , which is largely in line with treatment for postherpetic neuralgia and brachio-radial pruritus. Topically applied capsaicin causes strong depolarization of intraepidermal transient receptor potential vanilloid 1 (TRPV1)-positive pruritic and nociceptive C-fibers of the skin, which results in prolonged, reversible defunctionalization and deafferentation [10] .…”