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CME ARTICLE
Year : 2014  |  Volume : 22  |  Issue : 1  |  Page : 13-21

Postburn pruritus: A practical review


1 Department of Burns, Plastic, Maxillofacial and Microvascular Surgery, Lok Nayak Hospital and associated Maulana Azad Medical College, New Delhi, India
2 Now Wing Commander and Classified Specialist (Surgery) and Plastic Surgeon at Command Hospital Air Force, Bengaluru, Karnataka, India

Correspondence Address:
Rajeev B Ahuja
Head, Department of Burns & Plastic Surgery, Lok Nayak Hospital and associated Maulana Azad Medical College, New Delhi 110 002
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-653X.146996

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The incidence of postburn pruritus is reported to vary between 80% and 100% and the persistence of itching leads to disabling symptoms such as sleep disturbance, anxiety, and disruption of daily activities. Recently, a few small randomized controlled trials by investigators have focused our attention to the neurobiology and molecular mechanisms of the postburn pruritus and the role of centrally acting agents in its treatment. It is now recognized that the central nervous system develops aberrant autonomous activity that causes maintenance of pruritic symptoms into a chronic state. This practical review on the topic aims to rationalize and simplify the current treatment options, through emerging and available evidence, to enable the physician to make an even better informed choice. While antihistamines and massage therapy will continue to be effective first-line strategy for most clinicians, the promising results in controlled studies obtained with gabapentin/pregabalin to ameliorate pruritic symptoms in a predictable fashion in burns patients have caused a paradigm shift in the therapeutic approach. Tailoring the drug therapy to the severity of symptoms leads to more successful therapy of this vexing malady and current evidence supports the use of gabapentin/pregabalin in patients with moderate to severe postburn pruritus (visual analog scale score >5) as the first line, even if as an "off label" indication. Other treatment modalities like doxepin, ondansetron, or transcutaneous electrical nerve stimulation may have applications on a case to case basis. However, massage therapy should continue to be an adjunct with all other modalities.


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