Journal of Drugs in Dermatology - Efficacy of gabapentin in the management of pruritus of unknown origin
Efficacy of Gabapentin in the Management of Pruritus of Unknown Origin
Yesudian PD, et al. Archives of Dermatology. 2005;141:1507-1509.
Summary
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The authors present 2 cases of generalized pruritus of unknown origin treated with gabapentin. Patient one was an 80-year-old man with generalized pruritus of unknown origin for greater than 12 months. Patient 2 was a 72-year-old man with a 2-year history of the same condition. For both patients, prior treatments included topical emollients, topical corticosteroids, oral antihistamines, oral prednisolone, and broadband UV-B therapy. For patient one, medications taken for other medical problems were stopped for at least 3 months with no effect on the pruritus and treatment of low serum iron levels resulted in no improvement. Patient 2 was also treated with topical cooling agents, oral dothiepin hydrochloride, and ketotifen fumarate without improvement. The patients had normal complete blood cell counts, electrolyte profiles, and liver function tests. Patient one had an increased serum creatinine level of 1.8 mg/dL and an increased total IgE level of 3019 IU/L. Patient 2 had a normal serum creatinine and an increased total IgE level of 169 IU/L. Treatment of both patients began with 300 mg of gabapentin, increasing to 600 mg the second day, and 900 mg the third day. Over the next 3 to 4 weeks, the gabapentin dose was titrated to symptoms of pruritus reaching 1800 mg daily. Complete control of pruritus was reported within the first month of treatment. The patients were continued on maintenance doses of gabapentin and had no recurrence of pruritus for greater than 9 months. No adverse effects related to gabapentin were reported.
Comment
Generalized pruritus of unknown origin encompasses itching without a rash in the absence of any underlying systemic or dermatologic disease. Despite multiple attempts at treatment, therapy is often unsuccessful and frustrating to the patient. The authors present case reports of 2 patients with this condition who were recalcitrant to many therapeutic modalities. The authors cite reports of gabapentin used for the treatment of brachioradial pruritus and instituted treatment with this drug for their patients. Both patients had control of their pruritus within the first month of treatment and maintained this response for greater than 9 months. These results are encouraging; however, it is unclear from this article if gabapentin is truly effective or purely placebo. If control of pruritus was secondary to the gabapentin, the exact mechanism of action is, as of yet, unknown. As gabapentin is a well-tolerated medication with few side effects, its use in generalized pruritus of unknown origin would be desirable. Placebo-controlled, randomized trials are needed to further evaluate its true efficacy in the management of this condition.
Compiled by Frank Victor MD
New York University, Department of Dermatology
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