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Itch (Pruritus)

CAUSES

Illicit Substances

  • Opioids: morphine, heroin, oxycodone, oxycontin, codeine, buprenorphine

  • CNS stimulants: cocaine, amphetamine, dextroamphetamine (Adderall), lisdexamfetamine (Vyvanse), MDMA (ecstasy, E, Molly)

Lipman ZM, Yosipovitch G. Substance use disorders and chronic itch. J Am Acad Dermatol. 2021. PMID: 32891774.

MY SUMMARY: reviews the theoretic pathophysiologic dopaminergic and opioid mechanisms for itch and parallels to mechanisms for substance abuse.  Highlights CNS stimulants and opioids that could contribute to itch.

Dry Skin

  • Proposed mechanism is via IL-33 signaling in sensory neurons (34560104)

TREATMENT

 

Ketamine

  • Infusion of ketamine 100mg (along with lidocaine 100mg), and a nerve block of bupivacaine was effective at providing sustained itch relief for brachioradial pruritus after 2 infusions. 37531125

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