Journal
JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY
Volume 63, Issue 4, Pages 680-688Publisher
MOSBY-ELSEVIER
DOI: 10.1016/j.jaad.2009.08.052
Keywords
atopic dermatitis; itch; opioid receptor antagonist; pruritus; sensory nerve fibers; therapy
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During the past two decades, systemic mu-opioid receptor antagonists (MORA) have been used in the treatment of various forms of chronic pruritus. In a number of case reports, case series, and controlled trials; treatment with MORA has demonstrated considerable antipruritic effects. In double-blind controlled studies, significant antipruritic relief has been achieved by MORA in cholestatic pruritus, chronic urticaria, and atopic dermatitis. In case reports and case series; antipruritic efficacy of MORA has been reported in prurigo nodularis, mycosis fungoides, postburn pruritus, aquagenic pruritus, hydroxyethyl starch-induced pruritus, and pruritus of unknown origin. However, most of the evidence remains anecdotal, the design of these trials varies; and comparison of results is difficult. In this review we aim to present an overview of these reports and to assess the evidence for the antipruritic action of the drugs naloxone, nalmefene, and naltrexone, which are currently in use for the treatment of chronic pruritus of different origins. We will also evaluate recommendations for the use of MORA in daily medical practice. (J Am Acad Dermatol 2010;63:680-8.)
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