aprepitant and Paraneoplastic-Syndromes

Itch is a global clinical problem and finding effective treatment remains a therapeutic challenge because of the complex pathophysiology of itch. The key component of treating itch should be directed at the underlying etiologies when possible. However, without eradication of the underlying diseases, treatment is often palliative at best. Treatment with systemic therapies can vary according to the etiology of the chronic itch. The aim of this article is to review the major systemic anti-itch agents and give a summary on the possible systemic treatments for different types of itch.

Topics: Amines; Analgesics; Analgesics, Opioid; Anion Exchange Resins; Antidepressive Agents; Aprepitant; Cholagogues and Choleretics; Cholestasis; Cholestyramine Resin; Cyclohexanecarboxylic Acids; Gabapentin; gamma-Aminobutyric Acid; Histamine Antagonists; Humans; Morpholines; Narcotic Antagonists; Neurokinin-1 Receptor Antagonists; Paraneoplastic Syndromes; Peripheral Nervous System Diseases; Pregabalin; Pruritus; Receptors, Opioid, kappa; Receptors, Opioid, mu; Rifampin; Thalidomide; Uremia; Ursodeoxycholic Acid

Paraneoplastic itch occurs as the result of a systemic reaction to an underlying malignancy. Paraneoplastic itch is most commonly associated with lymphoproliferative malignancies and solid tumors that result in cholestasis. Paraneoplastic itch may occur in the absence of a primary rash or in association with dermatologic conditions such as erythroderma, acanthosis nigricans, dermatomyositis, Grover's disease, and eruptive seborrheic keratosis. Treatment of paraneoplastic itch is centered on targeting the underlying malignancy responsible for the systemic reaction. In cases of malignancy that are refractive to treatment, other therapies have been found to be effective for paraneoplastic itch, including selective serotonin reuptake inhibitors, mirtazapine, gabapentin, thalidomide, opioids, aprepitant, and histone deacetylase inhibitors.

Topics: Acantholysis; Acanthosis Nigricans; Analgesics, Opioid; Anticonvulsants; Antidepressive Agents; Aprepitant; Dermatitis, Exfoliative; Dermatomyositis; Histone Deacetylase Inhibitors; Humans; Ichthyosis; Immunosuppressive Agents; Keratosis, Seborrheic; Mianserin; Mirtazapine; Morpholines; Neoplasms; Neurokinin-1 Receptor Antagonists; Paraneoplastic Syndromes; Pruritus; Selective Serotonin Reuptake Inhibitors; Thalidomide