pregabalin and Prurigo

Prurigo nodularis (PN) is a chronic, highly pruritic condition characterized by the presence of hyperkeratotic, excoriated, pruritic papules and nodules, with a tendency to symmetrical distribution. No reliable data exist about incidence and prevalence of PN in the general population, but it seems to be more frequent and more intense in females. PN may be associated with many dermatological and non-dermatological comorbidities, including psychiatric disease. Recent findings suggest a neuropathic origin of PN, with alterations in the dermal and epidermal small diameter nerve fibers. PN may have a tremendous impact on the quality of life, and few effective treatment options are available. Few randomized controlled trials (RCT) on the therapy of PN are available, demonstrating the efficacy of phototherapy alone or with psoralen, and of topical calcipotriol and topical steroids in occlusive medications. Thalidomide may be effective, but no RCT are available and its use is impractical due to the unfavorable safety profile. Gabapentin, pregabalin and the neurokinin receptor 1 antagonist, aprepitant, seem also to be effective in the therapy of PN, but RCTs are still lacking.

Topics: Amines; Chronic Disease; Cyclohexanecarboxylic Acids; Dermatologic Agents; Epidermis; Female; Gabapentin; gamma-Aminobutyric Acid; Glucocorticoids; Humans; Immunosuppressive Agents; Male; Physical Therapy Modalities; Pregabalin; Prurigo; Sex Factors; Skin

Prurigo nodularis (PN) is a chronic skin condition that is difficult to treat. Pregabalin is one of the possible treatments for PN but its safety and efficacy are not well defined. We aimed to assess the efficacy of pregabalin in patients with PN.. Thirty patients (10 men, 20 women; mean age 51.6 ± 9.39 years) were treated with pregabalin (75 mg/day) for 3 months. Efficacy was classified as (i) successful (disappearance of the pruritus and reduction of nodules); (ii) slight improvement/reduction of the nodules, that is, number and/or flattening, no disappearance of itching; or (iii) unsuccessful.. Twenty-three patients (76%) responded successfully after 3 months of treatment. There was a statistically significant difference between visual analogue scale scores before and after 1 month treatment period (8·15 ± 2·04 and 1·5 ± 1·12, respectively; P < 0·0001). Pregabalin was generally well tolerated with only six (20%) patients reporting side effects. No patient showed any renal insufficiency.. In our study, pregabalin was effective for the treatment of PN. However, given the open and non-controlled study design used, a properly powered randomized controlled validation study is called for.

Topics: Adult; Aged; Analgesics; Female; Follow-Up Studies; gamma-Aminobutyric Acid; Humans; Male; Middle Aged; Pregabalin; Prurigo; Treatment Outcome

Prurigo nodularis is a pruritic condition characterized by skin noduli. Different treatment options have been used with limited success. Pregabalin is a drug licensed for treatment of neuropathic pain in adults. As prurigo nodularis involves suffering for the patients and is difficult to treat, the aim of this case report is to report the effect of pregabalin treatment in seven patients with prurigo nodularis, treated in the dermatology clinic in Malmö, Sweden. Four patients experienced good effect of pregabalin, though two patients had a transient effect. Side effects of pregabalin have been reported. This case report indicates that pregabalin is a treatment option for therapy-resistant prurigo nodularis; even though one must be aware of that the effect may not be permanent and that there are side effects. The aim must be to use the drug for a limited time, taking the patient to a remission state, where the vicious itch-scratch cycle can be inhibited.

Topics: Adult; Aged; Calcium Channel Blockers; Female; Humans; Male; Middle Aged; Pregabalin; Prurigo

A 73-year-old Japanese man developed chronic intractable itching due to prurigo nodularis. High-dose glucocorticoid ointment failed, and the treatment resulted in poor glycemic control. Repeated scratching caused hematogenous bacterial dissemination via cutaneous injuries, resulting in the formation of iliopsoas and spinal epidural abscesses that required long-term antibiotic treatment. Pregabalin was administered to treat the pruritus, and a considerable improvement was observed. A reduction in the dose and intensity of the topical corticosteroids improved the patient's glycemic control, resulting in the complete resolution of the abscesses. Pregabalin significantly improved the patient's pruritus and decreased the risk of infection.

Topics: Administration, Oral; Administration, Topical; Adrenal Cortex Hormones; Aged; Antipruritics; Diabetes Complications; gamma-Aminobutyric Acid; Humans; Magnetic Resonance Imaging; Male; Pregabalin; Prurigo; Pruritus; Psoas Abscess

Focal pruritus may have a neurological cause. According to the underlying mechanism, two categories of central itch have been distinguished, neuropathic and neurogenic pruritus. We here describe a patient with Brown-Séquard syndrome related to unilateral damage of the spinal cord. The patient progressively developed neuropathic pruritus with chronic prurigo lesions showing strictly hemicorporal distribution. The patient was given pregabalin, an analogue of the neurotransmitter gamma-aminobutyric acid,with significant improvement. Our observation of chronic prurigo with hemicorporal involvement is unique. It underscores the importance of a detailed neurological examination in case of persistent localized itch and further supports the idea that chronic prurigo reflects a neurological problem in a subset of affected patients. Antiepileptic drugs should be considered not only for neuropathic pain, but also for neuropathic itch.

Topics: Adult; Anticonvulsants; Antipruritics; Brown-Sequard Syndrome; gamma-Aminobutyric Acid; Humans; Male; Neurologic Examination; Pregabalin; Prurigo; Pruritus; Skin; Spinal Cord Injuries