Cutaneous pruritus

In a study of the effects of Cremophor after 74 cycles of doxorubicin in Cremophor in 39 patients, there were no major hypersensitivity reactions to Cremophor, and no patients had their infusion discontinued or modified (11). Adverse effects that were considered to be potentially related to Cremophor were cutaneous (pruritus, flushing, or rashes), hypotension or dizziness, and headache. Because of the subjective nature of some of these symptoms, they were classified as grade 1 (mild and not requiring treatment or interfering with function), grade... 

Case 1. A 56-year-old woman, suffering from asthma with permanent dyspnea and undergoing long-term steroid therapy received a monthly injection of 1 mg depot tetracosapeptide. On 8 November 1968, she had her ninth injection without incident. On 8 December 1968,15 min after the tenth injection, cutaneous pruritus, generalized eruption, and dyspnea developed. The patient did not inform us of the incident and on 8 January 1969, she had the eleventh injection, resulting in eruption and immediate acute dyspnea. In 48 h, she improved and was cured within 12 days. On 13 March 1969, skin tests were positive (Fig. 1) with 1 100 and 1 1,000 dilutions of tetracosapeptide. She was hospitalized again on 10 December 1969 for an acute attack of asthma. For 14 days she received DW 75 pentacosapep-tide, first at very small doses (25 lU) then for the last six injections 200 lU daily, without any incident. 

Medicinal use Used for the treatment of external skin dermatomycoses and cutaneous pruritus. It is also used as remedy of diabetes mellitus and rheumatoidal arthritis and as diuretic agent. 

They differ to some extent from signs and symptoms that occur during anaphylaxis not associated with anesthesia. Early subjective symptoms such as malaise, pruritus, sensation of heat, and dizziness are absent in the anesthetized patient. Cutaneous signs in a completely wrapped patient may escape the attention of the anesthetist. The increase in heart rate, a decrease in blood pressure and an increase in airway resistance may be initially misinterpreted as a result of a pharmacological dose-related effect of the drugs, or of excessively light anesthesia. Many differential diagnoses have to be considered (table 1). 

Theoretically, the risk of serious GI adverse events should be less than with oral NSAIDs, but long-term studies evaluating these events are lacking.38 Studies comparing topical NSAIDs with other topical products, including counterirritants, are also needed.35 Local cutaneous adverse reactions (e.g., erythema, pruritus, and irritation) occur in 1% to 2% of patients and may be due in part to the vehicle used.38... 

Rashes are usually mild to moderate, maculopapular, erythematous cutaneous eruptions with or without pruritus, located on the trunk, face, and extremities. Closely monitor patients if isolated rash of any severity occurs. 

Hypersensitivity reactions, such as pruritus, cutaneous vasculitis, and thrombocytopenia, are seen in some patients, and an immune-mediated systemic flulike syndrome with thrombocytopenia also has been described. Rifampin imparts a harmless red-orange color to urine, feces, saliva, sweat, tears, and contact lenses. Patients should be advised of such discoloration of body fluids. 

Pruritus is a warning sign for development of cutaneous reactions... 

Tinea pedis, tinea cruris, tinea corporis, cutaneous candidiasis, tinea versicolor, tinea rubrum Action Antifungal antibiotic cellular depletion of essential substrates /or ions Dose Adults Peds >10 y. Massage into affected area bid Onychomycosis Apply to nails daily, w/ removal q7d Caution [B, ] Contra Component sensitivity Disp Cream, gel, topical susp, shampoo, nail lacquer SE Pruritus, local irritation, burning Interactions None noted EMS None OD Not likely, no info available if large amt ingested... 

Miyamoto, T., Nojima, H., Nakahashi, T., and Kuraishi, Y. Involvement of cutaneous ACh and M3 muscarinic ACH receptors in dry skin-associated pruritus in mice, in Proceedings of the Second International Workshop for the Study of Itch, Toyoma, Japan, (2003), p. 61. 

Skin and subcutaneous tissue disorders Reversible cutaneous reactions have been observed and are generally mild to moderate. Reactions are characterised by a rash including localised eruptions mainly on the feet and hands (including severe hand and foot syndrome), but also on the arms, face or thorax, and frequently associated with pruritus. Eruptions generally occur within one week after the docetaxel infusion. Severe nail disorders are characterised by hypo- or hyperpigmentation and sometimes pain and onycholysis. 

Shohrati, M., Davoudi, M., Almasi, M., Sadr, B., Peyman, M. (2007a). Comparative study of Unna s Boot and betamethasone cream in the treatment of sulfur mustard-related pruritus. Cutan. Ocul. Toxicol. 26 303-9. 

Cutaneous reactions to aldesleukin generally comprise pruritus, flushing, mild to moderate erythematous macular and desquamative eruptions, while generalized erythroderma or photosensitivity have occasionally been observed (95). The severity was not dose-dependent and... 

Other cutaneous sjmptoms, such as burning, pruritus, dermatitis, and skin redness, have also been reported (1). In trials in the USA, 14% of 1500 patients had shght transient rises in liver function tests, the significance of which is unclear (SEDA-13, 79). Headache, dizziness, gastrointestinal discomfort, and dysuria have also been described (1). Asthma can be precipitated in aspirin-sensitive patients. 

A 48-year-old woman with a long history of insulin-dependent diabetes meUitus developed a severe cutaneous reaction to icodextrin (3). This happened 10 days after changing over to 7.5% icodextrin in order to improve ultrafiltration. The rash was maculo-papular and it affected most parts of her body. It was associated with severe pruritus. By the 13th day after it first appeared the rash had become exfohative and erythrodermic. There was rapid improvement in the first few days after the icodextrin dialysate had been withdrawn and she reverted to conventional glucose peritoneal dialysate. 

In 120 patients who had received plasma substitutes (including 93 who had received etherified starch) skin biopsies showed lysosomal deposits in the histiocytes, some of them also in the cutaneous epithelium and endothehum (47). The extent of lysosomal storage correlated with the amount of etherified starch infused. Consecutive biopsies in some cases showed a slow reduction (over years) of etherified starch deposits in vacuoles. The authors suggested that pruritus after high cumulative doses of etherified starches was closely related to deposition of etherified starch in cutaneous nerves. 

Metze D, Reimann S, Szepfalusi Z, Bohle B, Kraft D, Luger TA. Persistent pruritus after hydroxyethyl starch infusion therapy a result of long-term storage in cutaneous nerves. Br J Dermatol 1997 136(4) 553-9. 

Skin reactions to mefloquine have been reviewed, in relation to 74 case reports published between 1983 and 1997 (39). Pruritus and maculopapular rash were the most common skin reactions in some studies, their approximate frequency was 4—10% for pruritus and up to 30% for non-specific maculopapular rashes. Adverse effects less commonly associated with mefloquine included urticaria, facial lesions, and cutaneous vasculitis. There was one case of Stevens-Johnson syndrome and one fatal case of toxic epidermal necrolysis. 

Allergic skin reactions occur in 1-2% of patients who take nitrofurantoin and comprise about 21% of all adverse reactions to nitrofurantoin (5,71). They often occur with other reactions, such as drug fever, lung, or hver reactions. The lesions can present as pruritus, as macular, maculopapular, or vesicular rashes, urticaria, angioedema, or erjdhema multiforme (72). The frequency of serious cutaneous reactions (erythema multiforme, Stevens-Johnson syndrome, or toxic epidermal necrolysis) after nitrofurantoin has been estimated to be 7 cases per 100 000 exposed individuals (71). 

Short-term reactions are not uncommon. They include erythema, burns, nausea, pruritus, headache, and dizziness. Hypersensitivity reactions, which are uncommon, include drug fever, skin rashes, and bronchial asthma. Long-term treatment increases the risk of non-melanoma skin cancers and possibly of cutaneous melanoma. 

Bork K, Cutaneous Side Effects of Drugs WB Saunders, 169 Pruritus Psoriasis Purpura... 

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