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Topical ketamine-amitriptyline-lidocaine for chronic pruritus: A retrospective study assessing efficacy and tolerability

      To the Editor: Topical analgesics have been well studied in the management of neuropathic pain,
      • Lynch M.E.
      • Clark A.J.
      • Sawynok J.
      • et al.
      Topical amitriptyline and ketamine in neuropathic pain syndromes: an open-label study.
      however, limited data are present on their role in treating pruritus. Although noted improvement was seen with low concentrations of topical ketamine-amitriptyline in the therapy of localized itch,
      • Poterucha T.J.
      • Murphy S.L.
      • Sandroni P.
      • et al.
      Topical amitriptyline combined with topical ketamine for the management of recalcitrant localized pruritus: a retrospective pilot study.
      there are no studies to our knowledge examining the combination of topical ketamine-amitriptyline-lidocaine (TKAL) on chronic itch with validated tools. Its proposed mechanism of action is aimed at reducing hypersensitivity of peripheral nerve fibers through blockade of N-methyl-D-aspartate receptor and sodium channels.
      • Pancrazio J.
      • Kamatchi G.L.
      • Roscoe A.K.
      • et al.
      Inhibition of neuronal Na+ channels by antidepressant drugs.
      • Sawynok J.
      Topical and peripherally acting analgesics.
      Our study was intended to retrospectively examine the clinical response and tolerability of TKAL in the setting of chronic itch.
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      References

        • Lynch M.E.
        • Clark A.J.
        • Sawynok J.
        • et al.
        Topical amitriptyline and ketamine in neuropathic pain syndromes: an open-label study.
        J Pain. 2005; 6: 644-649
        • Poterucha T.J.
        • Murphy S.L.
        • Sandroni P.
        • et al.
        Topical amitriptyline combined with topical ketamine for the management of recalcitrant localized pruritus: a retrospective pilot study.
        J Am Acad Dermatol. 2013; 69: 320-321
        • Pancrazio J.
        • Kamatchi G.L.
        • Roscoe A.K.
        • et al.
        Inhibition of neuronal Na+ channels by antidepressant drugs.
        J Pharmacol Exp Ther. 1998; 284: 208-214
        • Sawynok J.
        Topical and peripherally acting analgesics.
        Pharmacol Rev. 2003; 55: 1-20
        • Cardis M.A.
        • Pasieka H.B.
        Safety of topical neuromodulators for the treatment of pruritus.
        JAMA Dermatol. September 14, 2016; https://doi.org/10.1001/jamadermatol.2016.3118