Treatment for Refractory Pruritus Using Oral Aprepitant
Abstract
Dear Editor:
Chronic pruritus is difficult to treat and severely affects patient's quality of life and psychological well-being. Substance P (SP) is an important mediator in the induction and maintenance of pruritus, and therefore represents a promising target for antipruritic treatment. Aprepitant is an oral neurokinin-1 receptor (NK-1R) antagonist, which acts by inhibiting the binding of the NK-1R with the SP ligand in the skin and central nervous system1,2.
A 79-year-old man presented with refractory pruritus that had been resistant to local application of corticosteroid, standard systemic therapies such as antihistamine, cyclosporine, gabapentin and tricyclic antidepressant, and phototherapy. The origin of pruritus was unclear despite extensive laboratory and radiological investigation. Histopathological examination of a biopsy taken from the lower back showed superficial psoriasiform dermatitis with spongiosis and parakeratosis. He complained that he could not sleep for more than 1 hour because of the pruritus. After stopping antipruritic treatment for 3 weeks, we administered 125 mg of aprepitant on day 1 and 80 mg on day 2, 3 and 4 at the same time of day. Before treatment, visual analogue scale (VAS) score was 8/10 and Dermatologic Life Quality Index (DLQI) score was 24/30. After 24 hours from first administration, these values reduced to 4 and 16, respectively. He mentioned that pruritus was reduced significantly and he could consistently sleep for more than 4…
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