Local pruritus

The further allergologic workup is recommended should be performed within 6 months after the reaction [13]. Both delayed IDTs and patch tests are frequently positive, when read after 48 and 72 h (in case of local pruritus or erythematous plaques optionally at other time points, e.g. 24 h, 96 h). Since some patients tested positive with only one of these tests, it is recommended to use both tests in parallel to enhance test sensitivity (table 3). Patch tests should be conducted with undiluted RCM, whereas 10-fold diluted products in physiologic saline had been recommended when performing delayed IDTs. IDTs and late readings with undiluted RCM may be discussed in non-severe reactions to increase sensitivity, however this has not been evaluated in a sufficient number of controls. A panel of several different RCM should be tested to identify skin test-negative substances. 

Ciclopirox olamine is a hydroxypyridone antifungal that is structurally unrelated to other antifungal agents. It is a broad-spectrum antimycotic agent with inhibitory activity against dermatophytes and yeasts such as Candida species and Pityrosporum orbicu-lare. Although some absorption may occur adverse reactions are rare. Local pruritus may occur. 

A 43-year-old man with type 1 diabetes developed local pruritus, redness, and swelling 4—5 times a week, 15-20 minutes after an injection, subsiding within 1-2 hours (163). Later he had a generalized urticarial reaction 5 minutes after an injection. Insulin lispro did not help. When checked for allergens, he was positive for all types of insulin and negative for additives. With oral mizolastine the local reactions abated for a week, but then reappeared with every injection. Generalized urticaria recurred later. With continuous subcutaneous insulin infusion... 

In 31 patients with Rhus allergy over a 10-year period the clinical manifestations included maculopapular eruptions (65%), erythema multiforme (32%), erythroderma (19%) pustules, purpura, wheals, and blisters (5). All the patients had generalized or localized pruritus, and other symptoms included gastrointestinal problems (32%), fever (26%), chills, and headache. Many developed a leukocytosis (70%) with neutrophilia (88%), and some had toxic effects on the liver or kidneys. All responded to glucocorticoids or antihistamines. 

A single-centre study monitored the efficacy and safety of intralesional cidofovir administered for recalcitrant cutaneous viral warts [7 ]. Two hxmdred and eighty patients were treated with intralesional cidofovir (15mg/mL once per month). Local adverse reactions were frequent all patients reported pain and burning sensations during the injection. In 51/280 patients, local pruritus and erythema occxured after treatment. Post-inflammatory hyperpigmentation of the hands occurred in 20/280 patients. Renal function was monitored, and there were no alterations at the end of treatment, nor any systemic side effects reported. In this small, uncontrolled study, all local side effects resolved spontaneously and did not require medical intervention. 

Placebo-controlled studies A placebo-controlled study evaluated the safety and efficacy of topical cidofovir in preventing beard hair growth in healthy men (n = 20) [ll ]. Participants received cidofovir (randomised to either 1% or 3%) and placebo, each applied to one side of the face after shaving (the side allocation was randomised), for either 6 or 8 weeks. There were adverse events reported in 12 subjects the most frequent was upper respiratory tract infection (n=4), and erythema or hyperpigmentation (n = 3), or local pruritus (n = 2). The local skin reactions were all mild and most resolved spontaneously within 8 weeks of the end of treatment. There were no significant changes in blood urea nitrogen or creatinine levels in this small study. 

Rare drying effect, local irritation, including erythema, pruritus, burning sensation Burning, stinging, itching, worsening of the condition, contact dermatis, erythema, irritation... 

The most frequent adverse effects are local reactions at the injection site (pain, tenderness, erythema, swelling, and pruritus), fevers (greater than 37.5°C or 99.5°F), headaches, dizziness, and irritability. Anaphylaxis and hypersensitivity reactions have been reported rarely and occur within a few hours after vaccine administration. In rare instances, a serum sickness-like apparent hypersensitivity syndrome (arthralgia, urticaria, ecchymoses, erythema multiforme, and erythema nodosum) has been... 

Epidural analgesia is frequently used for lower extremity procedures and pain (e.g., knee surgery, labor pain, and some abdominal procedures). Intermittent bolus or continuous infusion of preservative-free opioids (morphine, hydromorphone, or fentanyl) and local anesthetics (bupivacaine) may be used for epidural analgesia. Opiates given by this route may cause pruritus that is relieved by naloxone. Adverse effects including respiratory depression, hypotension, and urinary retention may occur. When epidural routes are used in narcotic-dependent patients, systemic analgesics must also be used to prevent withdrawal since the opioid is not absorbed and remains in the epidural space. Doses of opioids used in epidural analgesia are 10 times less than intravenous doses, and intrathecal doses are 10 times less than epidural doses (i.e., 10 mg of IV morphine is equivalent to 1 mg epidural morphine and 0.1 mg of intrathecally administered morphine).45... 

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... 

Pruritus Localized or generalized itching due to irritation of sensory nerve endings. 

Injections are well tolerated, but acute joint swelling and local skin reactions (e.g., rash, ecchymoses, or pruritus) have been reported. 

Topical corticosteroids (Table 16-1) may halt synthesis and mitosis of DNA in epidermal cells and appear to inhibit phospholipase A, lowering the amounts of arachidonic acid, prostaglandins, and leukotrienes in the skin. These effects, coupled with local vasoconstriction, reduce erythema, pruritus, and scaling. As antipsoriatic agents, they are best used adjunc-tively with a product that specifically functions to normalize epidermal hyperproliferation. 

Tazarotene (Tazorac) is a synthetic retinoid that is hydrolyzed to its active metabolite, tazarotenic acid, which modulates keratinocyte proliferation and differentiation. It is available as a 0.05% or 0.1% gel and cream and is applied once daily (usually in the evening) for mild to moderate plaque psoriasis. Adverse effects are dose- and frequency related and include mild to moderate pruritus, burning, stinging, and erythema. Application of the gel to eczematous skin or to more than 20% of body surface area is not recommended because this may lead to extensive systemic absorption. Tazarotene is often used with topical corticosteroids to decrease local adverse effects and increase efficacy. 

Chilblains are areas of the skin that are locally inflamed and bluish-red in colour. They occur as a reaction to cold, damp weather. The lesions are very often accompanied by tenderness and intense pruritus. 

Local Mild local irritation (eg, injection-site bleeding, rash, pruritus) may occur following subcutaneous injection. 

Local injection site reactions The most common adverse events associated with enfuvirtide use are local injection site reactions. Manifestations may include pain and discomfort, induration, erythema, nodules and cysts, pruritus, and ecchymosis. Pneumonia An increased rate of bacterial pneumonia was observed in subjects treated with enfuvirtide in the phase 3 clinical trials compared with the control arm. Hypersensitivity reactions Hypersensitivity reactions have been associated with enfuvirtide therapy and may recur on rechallenge. Hypersensitivity reactions have included individually and in combination Rash, fever, nausea and vomiting, chills. 

Local injection site reactions including pain/discomfort, induration, erythema, nodules and cysts, pruritus, and ecchymosis were the most frequent adverse events associated with the use of enfuvirtide. 

Pruritus Relief of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses Contact dermatitis, atopic dermatitis, nummular eczema, stasis eczema, asteatotic eczema, lichen planus, lichen simplex chronicus, insect and arthropod bite reactions, first- and second-degree localized burns, and sunburns. 

Irritation Tretinoin may induce severe local erythema, pruritus, burning, stinging, and peeling at the application site. If the degree of local irritation warrants, use medication less frequently or discontinue use temporarily or completely. Tretinoin may cause severe irritation to eczematous skin use with caution in patients with this condition. 

Almost all patients reported 1 or more local reactions such as peeling, dry skin, burning, stinging, erythema, and pruritus during therapy with tretinoin. 

Topical azole derivatives include the imidazoles bifonazole, clotrimazole, econazole, ketoconazole, miconazole, oxiconazole, lanoconazole, flutrima-zole and sertaconazole. These drugs show activity against the dermatophytes Epidermophyton, Mi-crosporum and Trichophyton. They are also effective against the yeasts Candida albicans and Pityrospo-rum orbiculare. Local side effects include pruritus, erythema and local irritation. Allergic dermatitis is rare. 

The treatment should be causal, but symptomatic treatment is also important. Heat and dehydration should be counteracted as far as possible. Skin softeners without perfume and irritant ingredients should be used frequently to treat dry skin. A sedating antihistamine often alleviates the pruritus, especially at night. Local steroids have no place in treatment unless there are inflammatory skin changes. 

Hypersensitivity reaction (chills, fever, pruritus, urticaria, asthma, rhinitis, lacrima-tion, headache) mild, local skin irritation... 

Local skin disorders (minor Burns, insect Bites, prickly heat, skin manifestations ofchick-enpox, aBrasions), and mucous memBrane disorders (local anesthesia of oral, nasal, and laryngeal mucous memBranes local anesthesia of respiratory, urinary tract relief of discomfort of pruritus ani, hemorrhoids, pruritus vulvae) Topical Apply to affected areas as needed. 

Change in sense of taste decreased sensitivity of skin, particularly to touch redness of the skin skin rash (maculopapular, erythematous), local edema, skin discoloration pruritus hypoesthesia paresthesias parosmia urticaria oral/pharyngeal edema Rare... 

Mechanism of Action A surface or local anesthetic which is not chemically related to the "caine" types of local anesthetics. Decreases the neuronal membrane permeability to sodium ions, blocking both initiation and conduction of nerve impulses, therefore inhibiting depolarization of the neuron. Therapeutic Effect Temporarily relieves pain and itching associated with anogenital pruritus or irritation. 

Discontinue the drug and notifythe physician if a local reaction (such as blistering, burning, irritation, pruritus, oozing, erythema, or edema) occurs... 

Topical Temporary change in pigmentation, photosensitivity, Local inflammatory reactions (peeling, dry skin, stinging, erythema, pruritus) are to be expected and are reversible with discontinuation of tretinoin... 

It is antihistaminic agent having antiemetic, sedative, anticholinergic and local anaesthetic property. Used in anxiety, pruritus and dermatoses as an adjunct therapy in acute/ chronic alcoholism. 

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