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Botulinum toxin type A treatment for depression, Raynaud's phenomenon, and other novel dermatologic therapeutic applications
Published in Anthony V. Benedetto, Botulinum Toxins in Clinical Aesthetic Practice, 2017
Irèn Kossintseva, Benjamin Barankin, Kevin Smith
BoNT-A's antinociceptive properties have been used in the treatment of multiple cutaneous piloleiomyomas, with effective rapid and sustained resolution of pain.44 It has also shown substantial benefit in the treatment of notalgia paresthetica.45
Histopathology
Published in Dimitris Rigopoulos, Alexander C. Katoulis, Hyperpigmentation, 2017
Notalgia paraesthetica results from damage of thoracic nerves that is followed by localized itch, usually on the upper back.34 The clinically pigmented patches show only mild changes on microscopy. There are melanophages in the upper dermis and maybe some hyperpigmentation of the basal layer. In addition, some compact orthokeratosis and individual dyskeratoitic keratinocytes in the mid- and upper spinous layer may be encountered.
The Gallbladder (GB)
Published in Narda G. Robinson, Interactive Medical Acupuncture Anatomy, 2016
Long thoracic nerve (C5-C7): Innervates the anterior serratus muscle. Neuropathy of the long thoracic nerve can lead to notalgia paresthetica, a poorly understood condition characterized by pruritus and/or pain. Proposed etiologies of notalgia paresthetica include degenerative changes of the T2-T6 vertebrae, nerve entrapment of the posterior rami of the T2-T6 spinal nerves, or genetic predisposition. Serratus anterior dysfunction may also result from irritability of the long thoracic nerve.1 The long thoracic nerve emerges through the middle scalene muscle; myofascial dysfunction in the middle scalene may irritate the long thoracic nerve and lead to serratus anterior dysfunction and trigger points.
Current and emerging systemic treatments targeting the neural system for chronic pruritus
Published in Expert Opinion on Pharmacotherapy, 2020
Rachel Shireen Golpanian, Gil Yosipovitch
Gabapentin and pregabalin are agonists of GABA which are effective in reducing itch, likely through their role in reducing central neural hypersensitization [15]. These drugs are classically used for the treatment of neuropathic pain syndromes such as diabetic neuropathy and post-herpetic neuralgia, but have demonstrated success in treating several types of itch. Gabapentin has been demonstrated to significantly improved itch of varying etiologies, including neuropathic forms of itch (i.e. brachioradial pruritus [16–19], notalgia paresthetica [20,21]), uremic itch [22–25], prurigo nodularis [26,27], post-burn pruritus [28,29], and chronic pruritus of unknown origin [30]. Similarly, pregabalin, an analogue of gabapentin, has demonstrated success in the treatment of brachioradial pruritus [31,32], notalgia paresthetica [33], uremic itch [34–36], prurigo nodularis [37], chronic pruritus of unknown origin [38]. Although these drugs belong to the same class of medication, patients may only respond to one or the other. Thus, non-responders of gabapentin should be tried on pregabalin, and vice versa. The most common side effect of these drugs is drowsiness or somnolence, and others include dizziness, weight gain, lower-extremity swelling, and gastrointestinal symptoms [6].
Emerging drugs for the treatment of chronic pruritic diseases
Published in Expert Opinion on Emerging Drugs, 2020
Kayla Fourzali, Rachel Shireen Golpanian, Gil Yosipovitch
Chronic pruritus (CP), defined as itch lasting more than six weeks, is a hallmark feature of some chronic dermatologic conditions, such as atopic dermatitis (AD) psoriasis and chronic idiopathic urticaria. Beyond the dermatologic sphere, CP may also be secondary to systemic disorders such as malignancy, chronic kidney disease (CKD), and cholestatic liver disease [1]. Neuropathic itch may be a result of diabetic neuropathy, post-herpetic neuralgia, trauma, or conditions such as brachioradial pruritus and notalgia paresthetica. In approximately 11% of chronic itch patients, there is no determined cause despite thorough medical workup and these cases are referred to as chronic pruritus of unknown origin (CPUO) [2].
Therapy for pruritus in the elderly: a review of treatment developments
Published in Expert Opinion on Pharmacotherapy, 2018
Manuel P. Pereira, Sonja Ständer
For localized neuropathic forms of CP, e.g. brachioradial pruritus, notalgia paresthetica, or postherpetic neuralgia, the topical application of capsaicin may be preferred over systemic drugs due to the better side effect profile [20]. Capsaicin may be applied to circumscribed areas of the skin as a highly concentrated 8% patch for 30–60 min depending on the location (treatment may be repeated every 3 months), or as a cream applied 4–6× daily in concentrations varying from 0.025% to 0.1%. The capsaicin found in chili peppers destroys cutaneous nerve endings and depletes their neurotransmitters [20,21]. It produces an intense redness and burning sensation and should not be administered on excoriated skin.