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Therapeutic Approach

Neuropathic itch, medically termed pruritus, arises from damage to or dysfunction of nerves within the central and/or peripheral nervous systems. Commonly prescribed anti-itch therapies, such as antihistamines and corticosteroids, are largely ineffective in the management of neuropathic pruritus. Treatment strategies for neuropathic pruritus vary according to etiology and clinical severity. Often, a combination of treatments is required to achieve complete symptomatic control. In the authors’ experience, topical therapies are best utilized in the management of localized pruritus that is physically accessible to the individual, while systemic therapy is required for more generalized or less accessible anatomic regions. First-line systemic therapy includes gabapentin or pregabalin, which may require several weeks to months of single-agent therapy before consideration of the addition of or change to tricyclic antidepressants or mirtazapine. Caution must be used to titrate all systemic medications slowly and to taper upon decision to discontinue. See Table 17-1.

Table 17-1Neuropathic Pruritus Treatment Table

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