Oral antidepressants may be an effective treatment option for patients with chronic pruritus that is refractory to topical treatment and oral antihistamines, according to a recent systematic review.
Chronic pruritus is common and can significantly impact quality of life. However, determining adequate treatment options for this condition can be challenging for clinicians.
To investigate whether oral antidepressants could treat chronic pruritus, the researchers identified and evaluated 35 studies that had examined the oral use of fluoxetine, fluvoxamine, paroxetine, sertraline, amitriptyline, nortriptyline, doxepin, and mirtazapine to treat the skin condition. Study data were obtained from PubMed, EMBASE, Cochrane, and Web of Science databases.
The Cochrane Risk of Bias tool was used to assess the risk for bias in randomized controlled trials, and the Newcastle-Ottawa Scale was used to determine this risk in observational studies.
Findings from most of the 35 studies showed that treatment with oral antidepressants had resulted in a marked improvement of pruritus.
“Oral antidepressants should be considered in patients with chronic pruritus that is unresponsive to topical treatment and oral antihistamines, particularly in patients with uremic pruritus, cholestatic pruritus, or paraneoplastic pruritus,” the researchers concluded. “More evidence based on randomized-controlled trials is required.”
—Christina Vogt
Reference:
Kouwenhoven TA, van de Kerkhof PCM, Kamsteeg M. Use of oral antidepressants in patients with chronic pruritus: a systematic review. J Am Acad Dermatol. 2017;77(6):1068-1073.e7. https://dx.doi.org/10.1016/j.jaad.2017.08.025.
