RESUMO
Botulinum toxin type A (Botox) is thought to have antipruritic effects through inhibition of pruritic factors, including acetylcholine, substance P, and glutamate. The aim of this randomized, single-blind, placebo-controlled trial was to test the effect of botulinum toxin type A on cowhage, a non-histaminergic model for chronic itch. Botulinum toxin type A was injected into the arm of 35 healthy subjects, with a saline control injected into the contralateral arm. Thermal sensory parameters (warmth and heat thresholds and heat pain intensity) and itch intensity after cowhage application were examined on test areas. Botulinum toxin type A reduced itch intensity, overall perceived itch (area under the curve (AUC); percentage change from baseline), and peak itch intensity compared with the control at 1 week, 1 month, and 3 months. Botulinum toxin type A had no effect on thermal thresholds or heat pain intensity. In conclusion, botulinum toxin type A reduced cowhage itch for at least 3 months, which suggests that botulinum toxin type A is a potential long-lasting treatment for localized, non-histaminergic itch.
Assuntos
Toxinas Botulínicas Tipo A , Humanos , Toxinas Botulínicas Tipo A/efeitos adversos , Antipruriginosos/efeitos adversos , Método Simples-Cego , Prurido/tratamento farmacológico , Prurido/induzido quimicamente , Medição da Dor , Método Duplo-CegoAssuntos
Fibroma , Fibroma/diagnóstico , Fibroma/patologia , Dedos/patologia , Humanos , Extremidade Superior/patologiaAssuntos
Exantema/parasitologia , Inseticidas/uso terapêutico , Permetrina/uso terapêutico , Escabiose/diagnóstico , Administração Tópica , Animais , Exantema/tratamento farmacológico , Exantema/patologia , Família , Humanos , Lactente , Masculino , Escabiose/tratamento farmacológico , Resultado do TratamentoAssuntos
Prurido/epidemiologia , Escleroderma Sistêmico/epidemiologia , Adulto , Idoso , Doença Crônica , Efeitos Psicossociais da Doença , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Philadelphia/epidemiologia , Prevalência , Prurido/diagnóstico , Prurido/fisiopatologia , Prurido/psicologia , Qualidade de Vida , Fatores de Risco , Escleroderma Sistêmico/diagnóstico , Escleroderma Sistêmico/fisiopatologia , Escleroderma Sistêmico/psicologia , Estações do Ano , Fatores de TempoAssuntos
Dermatologistas/história , Dermatologia/história , Pessoas Famosas , Dermatopatias/história , História do Século XV , História do Século XVI , História do Século XVII , História do Século XVIII , História do Século XIX , História do Século XX , História do Século XXI , História Antiga , História Medieval , HumanosRESUMO
INTRODUCTION: Chronic pruritus is a common symptom that arises from both dermatologic and non-dermatologic conditions including chronic kidney disease, cholestasis, lymphoma and neuropathy. Over the past decade, research has elucidated many of the receptors, neuropeptides and cytokines involved in itch sensation and transmission. In addition, the first biomarker for cholestatic itch has been discovered. These findings have led to the development of a host of novel antipruritic medications, both on the market and in the pipeline. AREAS COVERED: A summary of new and emerging treatments for pruritus, as well as possible targets for future therapeutic development is provided. EXPERT OPINION: At present, there is no universally effective treatment available for all types of chronic pruritus. A combination of topical and systemic therapies addressing peripheral mediators, and a top-down approach targeting the brain and spinal cord, seems preferable to a single agent approach. Neural hypersensitization plays a significant role in many forms of chronic pruritus and may be downregulated by new treatments. In addition, specific neuropeptides are now targeted by novel antipruritic therapies. Furthermore, targeted biologic agents are anticipated to play a significant role in treating pruritus of inflammatory origin.
