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Pruritus pp 229-233 | Cite as

Other Forms of Neuropathic Pruritus

  • Astrid Stumpf
  • Claudia Zeidler
  • Sonja StänderEmail author
Chapter

Abstract

Scars and keloids can provoke enormous itch often associated with stinging and burning probably due to abnormal nerve fiber function of small fibers (C-fibers, Ad-fibers). People of African descent, Latin Americans and Asians have an up to 15-fold higher risk of developing keloids. Keloids can result from surgery, injuries, and inflammatory dermatoses or arise spontaneously. There are several ways to treat keloids and hypertrophic scars: intradermal glucocorticoid therapy, 5-fluorouracil, cryotherapy, pulsed-dye laser, irradiation or surgery (for disabling scar contractures). A good result might be achieved by a combination of therapies. Post-herpetic neuralgia (PHN) or itch is the most common localized pruritus syndrome. It results from damage to or dysfunction of peripheral and skin nerve fibers due to herpes zoster infection. Often patients describe burning and stinging, paraesthesias, spontaneous (not stimulus-induced) pain, electric shock-like sensations and mechanically-inducible pain (allodynia). These sensations can be mixed with itch sensations. The pathomechanism of post- herpetic itch is not completely understood. It is likely due to spontaneous firing of central and peripheral nerve fibers mediating itch. PHN can be managed using a stepwise approach. Antidepressants represent first-line drugs. As second-line treatment, topical capsaicin applied several times daily or a capsaicin dermal patch (capsaicin, 8 %) or alternatively topical anesthetics like lidocaine in combination with anticonvulsants can be tried. Finally, a combination of low-dose opioids and transdermal electric nerve stimulation (TENS) is recommended as third-line therapy.

Keywords

Scar Keloid Burn Neuropathic sensory dysfunction Intralesional glucocorticoid therapy Paraesthesias Pain Herpes zoster infection Antidepressants Capsaicin dermal patch 

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Copyright information

© Springer-Verlag London 2016

Authors and Affiliations

  • Astrid Stumpf
    • 1
    • 2
  • Claudia Zeidler
    • 3
  • Sonja Ständer
    • 3
    Email author
  1. 1.Department of Psychosomatics and PsychotherapyUniversity Hospital of MünsterMünsterGermany
  2. 2.Center for Chronic Pruritus (KCP)University Hospital of MünsterMünsterGermany
  3. 3.Center for Chronic Pruritus (KCP), Department of DermatologyUniversity Hospital of MünsterMünsterGermany

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