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The Cutting Edge: Challenges in Medical and Surgical Therapies
February 2013

Topical Amitriptyline-Ketamine for the Treatment of Brachioradial Pruritus

Author Affiliations
 

SECTION EDITOR: EDWARD W. COWEN, MD, MHSc; ASSISTANT SECTION EDITORS: MURAD ALAM, MD; RUTH ANN VLEUGELS, MD

JAMA Dermatol. 2013;149(2):148-150. doi:10.1001/2013.jamadermatol.646

Brachioradial pruritus is a neuropathic itching condition that is characterized by unilateral or bilateral upper extremity itching. Herein, we report a case of brachioradial pruritus that was refractory to multiple other treatments but was completely relieved with the use of topical amitriptyline-ketamine.

In the winter of 2005, a 41-year-old male custodian with no notable medical history presented to the dermatology clinic with a chief complaint of intense itching of his right upper extremity with a 5-year history. This caused him significant discomfort and woke him at night, and he felt that “the itching was driving me crazy.” This began as a prickling sensation that he first noticed in the summer months, which he believed to be related to heat or light exposure. He could obtain some level of relief by using a cold ice cube or cold soda can applied to the skin, and initially it would resolve in the winter and fall months. Within the 2 years prior to his presentation, however, he began to feel discomfort almost continuously. This was described as an itching and “sharp pricking” sensation. The patient was seen by his local primary care physician, a neurologist, and an allergist, and multiple trials of medications including halobetasol propionate, pimecrolimus, capsaicin, doxepin hydrochloride creams, and oral hydroxyzine hydrochloride and desloratadine had failed. None of these treatments provided any symptom relief.

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