Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0033774 (pruritus)
 14,546 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A eutectic mixture of local anesthetics (EMLA) contains 2.5% lidocaine and 2.5% prilocaine in an oil and water emulsion and has been found to give effective, safe analgesia on normal and diseased skin, making it useful for numerous medical and surgical procedures, such as anesthesia for superficial surgery, split-thickness skin grafts, venipuncture, argon laser treatment, epilation, and debridement of infected ulcers. Other indications have included use in postherpetic neuralgia, hyperhidrosis, painful ulcers, and inhibition of itching and burning. To be effective, EMLA should ideally be applied to the desired area for at least 1 hour under an occlusive dressing. The medication has been approved since May 1991 in Canada for use on intact skin and has been available in Europe for many years. This study discusses the background, efficacy, and current and potential uses of EMLA.
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PMID:EMLA. A new and effective topical anesthetic. 815 Oct 42

Topical capsaicin has been introduced in the U.S. and Canada as a cream indicated for temporary relief of neuralgia following episodes of herpes zoster infections and in the treatment of diabetic neuropathy. Although capsaicin is clinically used as an external analgesic for temporary relief of neuralgia, it has also been widely used as a research tool to study peripheral pain. Capsaicin apparently works to release substance P from sensory nerve fibers and after repeated applications, depletes neurons of substance P. Clinical investigations of topical capsaicin include trials in chronic pain syndromes such as postherpetic neuralgia, postmastectomy neuroma, reflex sympathetic dystrophy syndrome, diabetic neuropathy, rheumatoid arthritis, psoriasis, hemodialysis-associated itching, and vulvar vestibulitis. In addition, therapeutic benefits of capsaicin cream on apocrine chromhidrosis have been described. Further clinical studies are warranted in several of these conditions to establish the efficacy of topical capsaicin. Serious or unexpected adverse reactions from clinical use have not been reported to date. Considering the paucity of safe and effective treatments for the conditions mentioned above, capsaicin cream appears to warrant further clinical investigations to establish its efficacy in a variety of chronic pain syndromes.
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PMID:Topical capsaicin in dermatologic and peripheral pain disorders. 165 16

The use of transcutaneous electric nerve stimulation is new to dermatologists but has a long history. A list of published applications includes use in therapy for postherpetic neuralgia, increased peripheral circulation, itching, varicose ulcers, ischemic ulcers, diabetic neuropathy, leprous neuritis, would healing, increased survival of skin flaps, Raynaud's phenomenon, scleroderma, esophageal dysmotility, and glossodynia.
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PMID:Shocking therapy: uses of transcutaneous electric nerve stimulation in dermatology. 202 93

Recent studies indicate that antidepressant medications may be effective treatments for dermatologic disorders such as chronic urticaria and angioedema, nocturnal pruritus in atopic eczema, and postherpetic neuralgia, even in the absence of coexisting psychopathologic conditions. Their efficacy may be related to their antihistaminic, anticholinergic, and centrally mediated analgesic effects and appears to be independent of their antidepressant effect. It is likely, therefore, that more dermatologists will be prescribing these drugs without a psychiatric consultation.
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PMID:Antidepressant drugs in dermatology. An update. 357 46

Based on a study of 400 patients (272 patients with herpes zoster and 128 with postzoster neuralgia), the subcutaneous injection of triamcinolone in saline is concluded to be a safe and effective measure for reducing pain. The acute eruption and symptoms of herpes zoster cleared in an average of less than four days. Postzoster neuralgia developed in only 2.9% of the patients, although nearly 70% of these patients were more than 50 years of age. In cases of postzoster neuralgia, 35% cleared completely; 28.9% improved enough so that they could live with the occasional pain, itching, or numbness, and therapy was not beneficial for an additional 15.6%, and it failed in 18.7% of the cases. The results were satisfactory in 63.9% of the patients, and the side effects were minimal.
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PMID:Treatment of herpes zoster and postzoster neuralgia by subcutaneous injection of triamcinolone. 720 70

The effect of continuous subcutaneous (s.c.) infusion of ketamine on nerve injury pain was examined in patients with post-herpetic neuralgia. Five patients that reported pain relief after acute intravenous injection of ketamine were included in this open prospective study. Ketamine was administered continuously in increasing doses using a portable infusion pump (CADD-PLUS, Pharmacia), and the treatment period for each infusion rate (0.05, 0.075, 0.10, or 0.15 mg/kg/h) was 7 days and nights. Relief of continuous pain, as evaluated daily by visual analogue scales, was observed at the infusion rate of 0.05 mg/kg/h, but was most marked during infusion of 0.15 mg/kg/h. All the patients reported that ketamine reduced the severity of continuous pain as well as reduced the severity and number of attacks of spontaneous pain. Changes in evoked pain (allodynia and wind-up-like pain) were recorded before change of infusion rate. Allodynia was maximally reduced 59-100% after 1 week infusion of 0.05 mg/kg/h, and wind-up-like pain was maximally reduced 60-100% after 1 week infusion of 0.15 mg/kg/h. Itching and painful indurations at the injection site was the most bothersome side-effect and for this reason 1 patient discontinued treatment after 2 weeks. Other common side-effects were nausea, fatigue and dizziness. The present results show that continuous, spontaneous and evoked pain in patients with post-herpetic neuralgia is reduced by continuous s.c. infusion of ketamine, but is associated with intolerable side effects.
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PMID:Continuous subcutaneous administration of the N-methyl-D-aspartic acid (NMDA) receptor antagonist ketamine in the treatment of post-herpetic neuralgia. 765 32

Under normal conditions acute stimulation and sensitization of polymodal nociceptive C-fibres cause pain and, due to afferent axon reflex activation, a local skin vasodilatation, flare reaction and skin temperature increase. Two questions arise: (i) Do sensitized C-nociceptors signal allodynia in chronic postherpetic neuralgia? (ii) If not, does ongoing peripheral nociceptive C-fibre input maintain a central process that accounts for allodynia? Ten patients with postherpetic neuralgia and tactile allodynia and 10 control subjects were studied using a laser Doppler perfusion monitor. Peripheral nociceptive C-fibre function was assessed by quantitative measurement of the axon reflex vasodilatation and flare reaction induced by histamine iontophoresis and compared with non-neural vasodilatation induced by local skin heating. Resting skin temperature, skin resistance and resting skin blood flow were the same in the allodynic area and the contralateral homologous skin area. The histamine responses (vasodilatation and flare) were significantly reduced or nearly abolished in the allodynic area compared with the contralateral side, whereas the temperature-dependent vasodilatation in patients and the histamine responses in healthy controls showed no side differences. C-fibre mediated pain and itch sensations were also decreased in the allodynic area. These findings indicate a considerable impairment of cutaneous nociceptive C-fibre function in the allodynic area. Allodynic stimuli of 20 s did not cause any local blood flow change. Impairment of C-fibre function was positively correlated with intensity of neuropathic pain. We conclude that sensitized nociceptive C-fibres are not involved in signalling allodynia. Changes in CNS processing may occur after zoster infection that strengthen the synaptic ties between central pain signalling pathways and low-threshold mechanoreceptors with A beta-fibres. This altered central processing is not maintained by ongoing cutaneous nociceptive C-fibre input, at least in some patients with postherpetic neuralgia. On the contrary, an anatomical synaptic reorganization depending on afferent C-fibre degeneration seems to be more likely, particularly in advanced stages of postherpetic neuralgia.
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PMID:Postherpetic neuralgia. Are C-nociceptors involved in signalling and maintenance of tactile allodynia? 829 82

One hundred and ninety-one patients with postherpetic neuralgia (PHN) in whom treatment was begun 3 or more months after acute herpes zoster (HZ) were retrospectively considered. Relieved (> or = 75% fall in visual analogue score for worst pain within last 24 hr) and unrelieved groups were subdivided into those who had and those who had not received antiviral treatment for their acute shingles. More than 90% of all patients experienced allodynia with a clinically evident sensory deficit for temperature and/or pinprick sensation. The probability of relief is worst in patients with PHN of the isolated ophthalmic nerve and of the brachial plexus, and best when involving the jaw, neck, and trunk. The presence (90%) or absence of allodynia has no predictive significance; but the small number of patients without allodynia or sensory deficit (all of whom had had antiviral treatment for their acute shingles) all improved. The probability of pain relief was found to correlate very strongly with the brevity of the interval between rash onset and commencement of treatment with an adrenergically active antidepressant. Further, time to relief in patients treated with an antidepressant starting at the same interval after HZ is significantly shorter in patients who received acyclovir for their original HZ. With the possible exception of dextroamphetamine added to the antidepressant, other treatments (particularly analgesics, anticonvulsants, and sympathetic blockade) were found to be without value in most cases. Thirty percent of patients who recover from PHN and have had their original shingles treated with acyclovir subsequently suffer from severe itching. It is recommended that elderly patients be given low-dose antidepressant on diagnosis of shingles, and asked to report back in 6 weeks. If they are pain-free at this interval, low-dose antidepressant should be continued for another month or so and then stopped. If, however, pain is present at 6 weeks, the dose of antidepressant should be increased and the patient reviewed every 2 months.
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PMID:Postherpetic neuralgia and its treatment: a retrospective survey of 191 patients. 894 24

Topical anesthesia of the skin, nowadays performed for various indications from pruritus over postherpetic neuralgia to minor surgery, has been under investigation for more than 30 years. Due to low water solubility, the active base form of most of the local anesthetics on the market is poorly absorbed through the skin. Hence, the most challenging target was to develop galenic preparations which provide a good skin penetration in order to reach the dermal nerve endings and thereby lead to sufficient local anesthesia. On the other hand good skin penetration also results in a distribution of the drug in the circulation. Since local anesthetic agents are known to have an impact on the heart and central nervous system, unwanted side effects following topical application onto the skin are worth discussing. This article reviews the current topical local anesthetics with particular accent on their pharmacological and toxicological data.
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PMID:Toxicology of topical local anesthetics. 905 58

Neuropeptides are neurotransmitters and neurohormones that play a role in various cutaneous functions. Keratinocytes and dermal endothelial cells are able to synthesize neuropeptides which are transported by nerve fibers or immune cells. Specific receptors for neuropeptides are also present on cutaneous cells. Neuropeptides intervene as neurogenic modulators of inflammatory reactions and therefore participate in the pathogenesis of skin diseases. An increasing body of evidence supports the setting up of clinical trials using topically neuropeptide agonists and/or antagonists in the treatment of chronic inflammatory skin disorders such as post-herpetic neuralgia, prurigo nodularis, localized pruritus, psoriasis, atopic dermatitis, contact dermatitis, cold urticaria, nostalgia paresthetica, diabetic neuropathy, Raynaud's phenomenon. In the near future, neuropeptides will represent a new approach to skin therapy.
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PMID:[Neuromediators in dermatology. Therapeutic prospectives]. 915 69


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