Pruritus, treatment

Azelastine is an ophthalmic antihistaminic preparation. It is indicated in the treatment of symptoms of seasonal allergic rhinitis, such as rhinorrhea, sneezing, and nasal pruritus treatment of symptoms of vasomotor rhinitis, such as rhin-orrhea, nasal congestion, and postnasal drip (nasal inhalation) treatment of itching of eye associated with allergic conjunctivitis (ophthalmic). 

Systemic treatment of 13-cis retinoic acid frequently leads to cheilitis and eye irritations (e.g., unspecific cornea inflammation). Also other symptoms such as headache, pruritus, alopecia, pains of joints and bone, and exostosis formation have been reported. Notably, an increase of very low density lipoproteins and triglycerides accompanied by a decrease of the high density lipoproteins has been reported in 10-20% of treated patients. Transiently, liver function markers can increase during oral retinoid therapy. Etretinate causes the side effects of 13-cis retinoid acid at lower doses. In addition to this, generalized edema and centrilobulary toxic liver cell necrosis have been observed. 

Optic neuritis (a decrease in visual acuity and changes in color perception), which appears to be related to the dose given and die duration of treatment, has occurred in some patients receiving ethambutol. Usually, tiiis adverse reaction disappears when the drug is discontinued. Other adverse reactions are dermatitis, pruritus, anaphylactoid reactions (unusual or exaggerated allergic reactions), joint pain, anorexia, nausea, and vomiting. 

MTX is a potentially toxic dmg that is also used in the treatment of malignancies and psoriasis. Nausea, vomiting, a decreased platelet count, leukopenia (decreased white blood cell count), stomatitis (inflammation of the oral cavity), rash, pruritus, dermatitis, diarrhea, alopecia (loss of hair), and diarrhea may be seen with the administration of this dmg. 

Antiflatulents are used for die relief of painful symptoms of excess gas in the digestive tract. These drugs are useful as adjunctive treatment of any condition in which gas retention may be a problem (ie, postoperative gaseous distention, air swallowing, dyspepsia, peptic ulcer, irritable colon, or diverticulosis). In addition to its use for tiie relief of intestinal gas, charcoal may be used in the prevention of nonspecific pruritus associated with kidney dialysis treatment and as an antidote in poisoning. Simethicone is in some antacid products, such as Mylanta liquid and Di-Gel liquid. 

Although side effects are usually mild, treatment with brimonidine tartrate includes oral dryness, ocular hyperemia, burning and stinging, headache, visual blurring, foreign body sensation, fatigue drowsiness, ovular allergic reactions, and ocular pruritus. 

Nonpharmacologic Therapy Pruritus associated with CKD is difficult to alleviate. It is important to evaluate other potential dermatologic causes of pruritus to maximize the potential for relief. Adequate dialysis is generally the first line of treatment in patients with pruritus. However, this has not been shown to decrease the incidence of pruritus significantly. Maintaining proper nutritional intake, especially with regard to dietary phosphorus and protein intake, may lessen the degree or occurrence of pruritus. Patients who do not attain relief from other measures may benefit from ultraviolet B phototherapy. 

Pharmacologic Therapy Topical emollients have been used as treatment for pruritus in patients with dry skin, but are often not effective in relieving pruritus associated with CKD. Antihistamines, such as hydroxyzine 25 to 50 mg or diphenhydramine 25 to 50 mg orally or intravenously, are used as... 

Allergic reactions to insulin include erythema, pruritus, and indurations,22 which usually are transient. For the more troublesome reactions, treatment options include dexamethasone, desensitization, or change in delivery system (i.e., insulin pump or inhaled insulin). 

Treatment goals for patients with psoriasis are to minimize signs such as plaques and scales, alleviate symptoms such as pruritus, reduce the frequency of flare-ups, and ensure appropriate treatment of associated conditions such as psoriatic arthritis or clinical depression, and minimize treatment-related morbidity. 

Because of the increased permeability of their skin, infants are at risk for excessive absorption and toxicity from the use of topical steroids. Although these agents are effective in decreasing inflammation and relieving pruritus, steroid use in infants for the treatment of diaper dermatitis should be limited to only the low-potency preparations.38... 

The agent of choice for scabies is permerthrin 5% (Elimite) cream. Alternative agents in subjects who cannot use permethrin are crotamiton 10% (Eurax) and oral ivermectin (Stromectal) 200 mcg/kg as a single dose. To initiate the treatment with permerthrin, the skin should be scrubbed in a warm soapy bath to remove the scabs. The permerthrin lotion should then be applied to the whole body, avoiding the face, mucous membranes, and eyes, and left on for 8 to 14 hours. A single application eradicates 97% of scabies. All close contacts should be treated appropriately. The pruritus associated with scabies may persist for 2 to 4 weeks because of the remnants of mite parts in the skin. 

Sorafenib is a multikinase inhibitor that inhibits both intracellular and extracellular kinases to decrease renal cell cancer proliferation. The half-life of sorafenib is 25 to 48 hours, with a bioavailability of 38% to 49% and a time to peak concentration of 3 hours. Sorafenib is metabolized primarily by the liver by CYP450 3A4. Sorafenib is used for the treatment of renal cell cancer. The primary side effects of sorafenib include rash, hand-foot skin reaction, diarrhea, pruritus, and elevations in serum lipase. 

Select azole antifungals (e.g., itraconazole, voriconazole, and posaconazole) and the echinocandins are available for IA treatment. For initial therapy of IA, voriconazole had higher response and survival rates than c-AMB.102 An advantage of voriconazole is its 96% oral bioavailability, making use of this oral drug an attractive and less expensive alternative. The dose of voriconazole was 6 mg/kg IV every 12 hours for two doses, followed by 4 mg/kg IV every 12 hours for at least 7 days, at which time oral voriconazole 200 mg every 12 hours could be administered. Common toxicities reported with voriconazole include infusion-related, transient visual disturbances (i.e., blurred vision, altered color perception, photophobia, and visual hallucinations), skin reactions (i.e., rash, pruritus, and photosensitivity), elevations in hepatic transaminases and alkaline phosphatase, nausea, and headache.102 In addition, voriconazole increases the serum concentrations of medications cleared by cytochrome P-450 2C9, 2C19, and 3A4 (e.g., cyclophosphamide and calcineurin inhibitors) concomitant voriconazole-sirolimus should be avoided.103... 

Elidel cream consists of pimecrolimus, which is a calcineurin inhibitor that is used for eczema or psoriasis. Patients should be advised to avoid alcoholic drink during the treatment period as consumption of alcohol may lead to facial flushing and skin irritation. Side-effects associated with the topical administration of pimecrolimus include a burning sensation, pruritus, erythema and skin infections, including folliculitis and, less commonly, impetigo. 

Hj antihistamines are clinically used in the treatment of histamine-mediated allergic conditions. Specifically, these indications may include allergic rhinitis, allergic conjunctivitis, allergic dermatological conditions (contact dermatitis), pruritus (atopic dermatitis, insect... 

Hypersensitivity reactions Allergic reactions occur in approximately 33% of patients. They are more common at the start of treatment, and occur as generalized rashes or drug fever. Discontinue treatment and reinstitute at a low dosage such as 250 mg/day, with gradual increases. Administering prednisolone 20 mg/day for the first few weeks of penicillamine therapy reduces the severity of these reactions. Antihistamines may control pruritus. 

A iate rash A late rash is less commonly seen, usually after 6 months or more of treatment, and requires drug discontinuation. It usually appears on the trunk, is accompanied by intense pruritus, and is usually unresponsive to topical corticosteroids. 

Primary axillary hyperhidrosis Adverse events (in at least 3% of patients) included injection site pain and hemorrhage, nonaxillary sweating, infection, pharyngitis, flu syndrome, headache, fever, neck or back pain, pruritus, and anxiety. Blepharospasm The most frequently reported treatment-related adverse reactions were ptosis (20.8%), superficial punctate keratitis (6.3%), and eye dryness (6.3%). Strabismus Extraocular muscles adjacent to the injection site can be affected, causing ptosis, vertical deviation, spatial disorientation, double vision, or past-pointing, especially with higher doses of botulinum toxin type A. 

Nitisinone is a reversibile inhibitor of 4-hydroxy-phenylpyruvate oxidase, an enzyme that plays a crucial role in the tyrosine catabolic pathway. Nitisinone prevents the accumulation of the toxic metabolites fumaryl acetoacetate, succinyl acetoacetate and succinyl acetone. Nitisinone is used for the treatment of hereditary tyrosinemia type 1. After oral administration bioavailability is 90% and peak levels are reached at 2.5 hours after dosing. The drug is eliminated mainly in the urine but some CYP3A4-mediated metabolism seems to occur. The elimination half-life is 45 hours. Blood dyscrasias are frequently occurring side effects as are eye problems like conjunctivitis, corneal opacity and keratitis. Exfoliative dermatitis, erythematous rash and pruritus... 

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. 

Fenoprofen (Nalfon) is chemically and pharmacologically similar to ibuprofen and is used in the treatment of rheumatoid arthritis, osteoarthritis, and mild to moderate pain. GI effects such as dyspepsia and pain are most common, although dizziness, pruritus, and palpitations may occur. GI bleeding, sometimes severe, has been reported, and interstitial nephritis has been rarely associated with this drug. Concomitant administration of aspirin decreases the biological half-Ufe of fenoprofen by increasing the metabolic clearance of hydroxy-lated fenoprofen. Chronic administration of pheno-barbital also decreases the drug s half-life. 

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