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Antihistamines are commonly used to treat itching associated with allergies.

Abirritants, also known as anti-itch drugs are medications used for relieving or preventing itching (pruritus) around the body.[1]

Common indications for abirritants include dermatitis, eczema, psoriasis, allergic reactions, itch caused by chronic kidney disease and related conditions.[2]

Abirritants consist of a large group of drugs belonging to different classes with varying mechanisms to treat itch. They may work either directly or indirectly to relieve itch, and evidence on their effectiveness varies from one class to another.[3] Some alternative medicines are also used to treat itch.[4][5] Side effects of abirritants also vary depending on the class of the drug. Even before the emergence of modern evidence-based medicine, abirritants have already been used in many civilizations, but practices and choice of drugs may differ by culture.[6]

Types

[edit]

A number of drug classes are available as abirritants for itching relief, but there is no one single specific abirritant to treat all forms of itch.[7] Treatments may vary depending on the cause. Commonly prescribed abirritants can be broadly divided into topical and systemic drugs, and may include a combination of one or more drugs, described as below:

Topical drugs

[edit]
Corticosteroid creams can be applied directly on the skin to treat itch.

Topical formulations are preferred for treating localized itch caused by skin damage, inflammation or dryness.[8]

Medication Mechanism of Action Examples
Corticosteroids Suppresses itch originating from immune response and inflammation[9]
Antihistamines Antihistamines have anti-inflammatory properties that can relieve itching by suppressing the underlying inflammation[10]
Anesthetics Prevents the propagation of nerve signals that would otherwise cause an itching sensation[11]
Phosphodiesterase-4 inhibitors Suppresses inflammation to relieve itch[11]
Capsaicin Desensitizes nerves that cause itch[8]

Systemic drugs

[edit]

Generalized itch, or itching across the whole body, can be a symptom of a dermatological disorder or an underlying systemic problem.[12] Some systemic diseases can that cause generalized itch include diabetes, hypothyroidism, kidney diseases and liver diseases.[13][12] It is usually treated with systemic agents instead of topical agents.[14] Corticosteroids and antihistamines mentioned above can also be used to treat generalized itch.[15] Common systemic abirritants are listed below:

Gabapentin is an anticonvulsant which can also be used to treat itch.
Medication Mechanism of Action Examples
Corticosteroids Suppresses itch originating from immune response and inflammation[9]
Antihistamines Antihistamines have anti-inflammatory properties that can relieve itching by suppressing the underlying inflammation[10]
μ-opioid receptor antagonists Blocks the μ-opioid receptor, the stimulation of which causes itch in clinical settings such as itch due to liver diseases[16]
Antidepressants Reduces itch by mediating serotonin and histamine levels in the body.[17] Two main classes of antidepressants are utilized to relieve itch:
Immunosuppressants Suppresses the immune system to reduce inflammation and hence reduce itch[18]
Anticonvulsants Mechanism of action is unclear, but is thought to prevent itching by desensitizing calcium channels in nerves[19]
Thalidomide Thalidomide suppresses itching through a number of ways:
  • Acts as a central depressant;
  • Reduces inflammation;
  • Modulates immune response; and
  • Modulates nerve signal transmission[20]
Butorphanol Butorphanol activates the κ-opioid receptor and blocks the μ-opioid receptor, inhibiting generalized pruritus due to an imbalance between the μ- and κ-opioid systems

Alternative treatments

[edit]

A number of herbs have been used to treat itching such as cannabis, pigweed (portulaca oleracaea), Ashoka (sarco asoca), and fig (fificus carica).[5]

Other unconventional forms of treatment with potential efficacy for treating systemic itch include topical cannabinoids[21] and H4 antihistamines.[22]

Effectiveness

[edit]

Despite the availability of many forms of treatment, there is only a limited number of case series or small-scale studies examining the efficacy of abirritants.[17] There is a lack of evidence on treatment for chronic pruritus of unknown origin.[23][24]There is also little to no evidence on the efficacy and safety of using abirritants during pregnancy.[25]

Treating itch associated with disease

[edit]

Some abirritants work by indirectly treating itch through treating the causative medical conditions, which means that the itching associated with the condition will often subside when it is properly treated. This includes antihistamines and corticosteroids, which are effective in treating inflammatory disorders of the skin, in particular atopic dermatitis.[26] Successful treatment of atopic dermatitis with either corticosteroids or antihistamines would resolve the associated itching.[27]

Treating itch directly

[edit]

Some abirritants treat pruritus directly without necessarily treating the causative medical condition. Abirritants that directly treat itching and are established to be effective are reported here in the table below:

Medication Effectiveness
Gabapentin Gabapentin was found to be effective in decreasing the severity of uremic pruritus compared to placebo.[28]
Butorphanol Continuous intravenous butorphanol reduced the incidence of morphine-induced pruritus significantly.[29]
Thalidomide Thalidomide is effective in treating chronic refractory pruritus among patients who had failed conventional therapy (corticosteroids or antihistamines), with a 50% or greater reduction in symptoms and a shorter time to improvement.[20]
μ-opioid receptor antagonists μ-opioid receptor antagonists such as naltrexone and nalmefene demonstrated significant improvement in treating patients with cholestatic pruritus, or itch arising from urticaria and atopic dermatitis.[16]

Traditional Chinese Medicine

[edit]
Dictamnus is one of the many herbs used to treat itch in Traditional Chinese Medicine.

Traditional Chinese medicine is extensively used in Asia for relief of itch. It is believed that itching is caused by irritations from wind, dampness or blood stasis, and can be relieved by the use of herbs such as chrysanthemum, gardenia fruit or mung bean.[30] Sometimes these herbal remedies are used in combination with acupuncture and moxibustion,[4] but their efficacy is still unclear.[31] Sericin cream and oral omega-3 fatty acid supplements may show benefit in reducing itch.[24]

Adverse effects

[edit]

Each class of abirritants has its own set of potential adverse effects.

Systemic Corticosteroids

[edit]
Fat tissue deposits on the sides of the face causes the patient's face to have a rounded appearance.
Systemic corticosteroid treatment can cause redistribution of fat tissue, leading to moon face.[32]

Systemic corticosteroid use has been associated with a wide range of potential adverse effects. In a review article, the following common complications were noted for prolonged use: redistribution of fat tissues (moon face), high blood sugar, infections, delayed wound healing, and HPA axis suppression, where the body's natural production of hormones like corticotropin-releasing hormone and adrenocorticotropic hormone is suppressed as a response to the increased level of corticosteroids in the blood.[32]

There is a lack of data on adverse effects associated with corticosteroid use of a shorter period and lower dose.[32]

Topical Corticosteroids

[edit]

Both local and systemic side effects can result from topical corticosteroid use, especially in prolonged treatment.[27]

Local side effects can occur regularly from prolonged use,[33] which include skin atrophy (thinning), stretch marks, infections, lighter skin color, and sudden decrease in efficacy of the drug.[27][33]

Systemic side effects are far less prevalent than local ones.[33] Prolonged high potency corticosteroids use on thin skin, especially in children, increases the risk of systemic side effects since thin skin allows for greater absorption.[34] One commonly cited systemic side effect from topical use is HPA axis suppression.[34] A meta-analysis of topical corticosteroid use in children concluded that low-potency corticosteroid at recommended dosages and duration do not cause clinically significant HPA suppression.[35]

Antihistamines

[edit]

Antihistamines target the molecule histamine by blocking the histamine H1 receptor.[36] First-generation antihistamines like diphenhydramine and chlorpheniramine are able to move from the blood into the brain across the blood–brain barrier, where they block the H1 receptor, reducing the neurotransmitter effect of histamine, leading to central nervous system side effects such as drowsiness and confusion.[36] Second generation antihistamines, such as fexofenadine and cetirizine are less able to move from blood circulation into the brain and are therefore associated with fewer side effects in usual doses.[36]

μ-Opioid receptor antagonists

[edit]

μ-opioid receptor antagonists are usually well-tolerated and have no abuse potential since they do not cause physical dependence.[16] Side effects are dose-dependent and generally limited to the first two weeks of treatment.[37][38][39] Opioid withdrawal symptoms are rare and may include severe lightheadedness, depersonalization and anxiety.[16]

Antidepressants

[edit]

Serotonin reuptake inhibitors, including both serotonin-norepinephrine reuptake inhibitors (SNRIs) and selective serotonin reuptake inhibitors (SSRIs), are generally well tolerated.[40] Common side effects include:

  • Sexual dysfunction, which is the most common side effect of all serotonin reuptake inhibitors, manifesting as delayed ejaculation, inability to achieve orgasm and decreased libido.[40]
  • Gastrointestinal effects such as nausea and vomiting, which depend on the dose and usually resolve within the first two weeks of treatment.[40]
  • Central nervous system disturbances such as anxiety, insomnia and sedation.[40]
  • Suicide risk: a combined analysis of placebo-controlled trials of various antidepressants including SSRIs in children and adolescents showed a doubled risk of suicide in those taking antidepressants.[41] In response, the United States Food and Drug Administration issued a warning in 2004 regarding the elevated risk of suicidal thoughts and behavior in children and adolescents.[41]

Immunosuppressants

[edit]

Immunosuppressants may cause immunodeficiency, resulting in an increased susceptibility to infection. Other side effects include bone marrow suppression, increased risk of cardiovascular disease and increased risk of cancer.[42]

Capsaicin

[edit]

Being the main chemical that causes heat in chili pepper, the main side effect of capsaicin is a burning sensation that usually persists for several days. A topical anesthetic can be used to reduce the sensation. In addition, the topical anesthetic can also provide anti-itch effect on its own.[43]

History

[edit]
Squill was used to treat itch and is commonly listed in ancient pharmacopeia.

Abirritants have an extensive history in treating itch. The history of abirritants dates back to the Byzantine period, when Alexander of Tralleis, a famous physician, recommended crushed rue and alum mixed in honey for topical application to the scalp for itching caused by scabby conditions of the head.[6]

During the 7th century, Paul of Aegina, a famous Greek physician, described a list of drugs for treatment of itch including plants such as the squill, metallic components, and goat droppings which were applied externally. These drugs are common in ancient pharmacopeia.[44]

The Lorscher Azneibuch written in the monastery of Lorsch in the 7th century described many preparations of abirritants for both systemic and topical use, such as an ointment prepared from stinging nettle seeds.[45]

Mercury-coated girdles were used in the 17th century as an expensive treatment to alleviate symptoms of itch caused by scabies, but mercury toxins in the blood often caused other troubling symptoms in patients.[46]

In the 20th century, many new abirritants for external use emerged, including salicylic acids, naphthol, tar, carbolic acid, thymol, and menthol, which were mostly available in the form of ointments. Alcohol and opium were also commonly prescribed.[6]

See also

[edit]

References

[edit]
  1. ^ "Antipruritic definition and meaning | Collins English Dictionary". www.collinsdictionary.com. Retrieved 2021-03-25.
  2. ^ "Pruritus and Systemic Disease: Background, Pathophysiology, Etiology". 2020-12-11. {{cite journal}}: Cite journal requires |journal= (help)
  3. ^ Simonsen, Elizabeth; Komenda, Paul; Lerner, Blake; Askin, Nicole; Bohm, Clara; Shaw, James; Tangri, Navdeep; Rigatto, Claudio (November 2017). "Treatment of Uremic Pruritus: A Systematic Review". American Journal of Kidney Diseases. 70 (5): 638–655. doi:10.1053/j.ajkd.2017.05.018.
  4. ^ a b Shi, Zhao-feng; Song, Tie-bing; Xie, Juan; Yan, Yi-quan; Du, Yong-ping (2017). "The Traditional Chinese Medicine and Relevant Treatment for the Efficacy and Safety of Atopic Dermatitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials". Evidence-Based Complementary and Alternative Medicine. 2017: 1–20. doi:10.1155/2017/6026434. ISSN 1741-427X.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  5. ^ a b Tabassum, Nahida; Hamdani, Mariya (2014). "Plants used to treat skin diseases". Pharmacognosy Reviews. 8 (15): 52. doi:10.4103/0973-7847.125531. ISSN 0973-7847. PMC 3931201. PMID 24600196.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
  6. ^ a b c Weisshaar, Elke; Grüll, Verena; König, Agathe; Schweinfurth, Dagmar; Diepgen, Thomas L.; Eckart, Wolfgang U. (17 November 2009). "The symptom of itch in medical history: highlights through the centuries". International Journal of Dermatology. 48 (12): 1385–1394. doi:10.1111/j.1365-4632.2009.04117.x. ISSN 1365-4632.
  7. ^ Yosipovitch, Gil (2009), "Pruritus", Dermatological Signs of Internal Disease, Elsevier, pp. 75–79, doi:10.1016/b978-1-4160-6111-3.00015-x, ISBN 978-1-4160-6111-3, retrieved 14 March 2021
  8. ^ a b Yosipovitch, Gil (December 2003). "Assessment of Itch: More to be Learned and Improvements to be Made". Journal of Investigative Dermatology. 121 (6): xiv–xv. doi:10.1111/j.1523-1747.2003.12650.x.
  9. ^ a b Norris, David A. (July 2005). "Mechanisms of action of topical therapies and the rationale for combination therapy". Journal of the American Academy of Dermatology. 53 (1): S17–S25. doi:10.1016/j.jaad.2005.04.027.
  10. ^ a b Buddenkotte, Jörg; Maurer, Marcus; Steinhoff, Martin (2010), Thurmond, Robin L. (ed.), "Histamine and Antihistamines in Atopic Dermatitis", Histamine in Inflammation, vol. 709, Boston, MA: Springer US, pp. 73–80, doi:10.1007/978-1-4419-8056-4_8, ISBN 978-1-4419-8055-7, retrieved 2021-03-28
  11. ^ a b Rinaldi, Giulia (2019-04-30). "The Itch-Scratch Cycle: A Review of the Mechanisms". Dermatology Practical & Conceptual: 90–97. doi:10.5826/dpc.0902a03. ISSN 2160-9381. PMC 6502296. PMID 31106010.{{cite journal}}: CS1 maint: PMC format (link)
  12. ^ a b Reamy, Brian V.; Bunt, Christopher W.; Fletcher, Stacy (2011-07-15). "A Diagnostic Approach to Pruritus". American Family Physician. 84 (2): 195–202. ISSN 0002-838X.
  13. ^ Kantor, Gary R.; Lookingbill, Donald P. (1983-09-01). "Generalized pruritus and systemic disease". Journal of the American Academy of Dermatology. 9 (3): 375–382. doi:10.1016/S0190-9622(83)70144-1. ISSN 0190-9622.
  14. ^ R., Freedberg, Irwin M. Sanchez, Miguel (2001). Current dermatologic diagnosis & treatment. Current Medicine. ISBN 1-57340-172-2. OCLC 45129566.{{cite book}}: CS1 maint: multiple names: authors list (link)
  15. ^ Yosipovitch, Gil; Bernhard, Jeffrey D. (2013-04-25). "Chronic Pruritus". New England Journal of Medicine. 368 (17): 1625–1634. doi:10.1056/NEJMcp1208814. ISSN 0028-4793.
  16. ^ a b c d Phan, Ngoc Quan; Bernhard, Jeffrey D.; Luger, Thomas A.; Ständer, Sonja (October 2010). "Antipruritic treatment with systemic μ-opioid receptor antagonists: A review". Journal of the American Academy of Dermatology. 63 (4): 680–688. doi:10.1016/j.jaad.2009.08.052.
  17. ^ a b c d Patel, Tejesh; Yosipovitch, Gil (2010-04-29). "Therapy of pruritus". Expert Opinion on Pharmacotherapy. 11 (10): 1673–1682. doi:10.1517/14656566.2010.484420. ISSN 1465-6566.
  18. ^ Schmitt, J; Schmitt, N; Meurer, M (2007-02-06). "Cyclosporin in the treatment of patients with atopic eczema ? a systematic review and meta-analysis". Journal of the European Academy of Dermatology and Venereology. 0 (0): 070206173308005–???. doi:10.1111/j.1468-3083.2006.02023.x. ISSN 0926-9959.
  19. ^ Matsuda, Kazuki M.; Sharma, Divya; Schonfeld, Ariel R.; Kwatra, Shawn G. (September 2016). "Gabapentin and pregabalin for the treatment of chronic pruritus". Journal of the American Academy of Dermatology. 75 (3): 619–625.e6. doi:10.1016/j.jaad.2016.02.1237.
  20. ^ a b Sharma, Divya; Kwatra, Shawn G. (February 2016). "Thalidomide for the treatment of chronic refractory pruritus". Journal of the American Academy of Dermatology. 74 (2): 363–369. doi:10.1016/j.jaad.2015.09.039.
  21. ^ Baswan, Sudhir M; Klosner, Allison E; Glynn, Kelly; Rajgopal, Arun; Malik, Kausar; Yim, Sunghan; Stern, Nathan (December 2020). "Therapeutic Potential of Cannabidiol (CBD) for Skin Health and Disorders". Clinical, Cosmetic and Investigational Dermatology. Volume 13: 927–942. doi:10.2147/CCID.S286411. ISSN 1178-7015. PMC 7736837. PMID 33335413. {{cite journal}}: |volume= has extra text (help)CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
  22. ^ "NEW HISTAMINE H2-RECEPTOR ANTAGONISTS ARE ON THE WAY". InPharma. 251 (1): 3–4. August 1980. doi:10.1007/bf03317207. ISSN 0156-2703.
  23. ^ Andrade, Andrea; Kuah, Chii Yang; Martin-Lopez, Juliana Esther; Chua, Shunjie; Shpadaruk, Volha; Sanclemente, Gloria; Franco, Juan VA (2020-01-25). Cochrane Skin Group (ed.). "Interventions for chronic pruritus of unknown origin". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD013128.pub2. PMC 6984650. PMID 31981369.{{cite journal}}: CS1 maint: PMC format (link)
  24. ^ a b Millington, G.W.M.; Collins, A.; Lovell, C.R.; Leslie, T.A.; Yong, A.S.W.; Morgan, J.D.; Ajithkumar, T.; Andrews, M.J.; Rushbook, S.M.; Coelho, R.R.; Catten, S.J. (January 2018). "British Association of Dermatologists' guidelines for the investigation and management of generalized pruritus in adults without an underlying dermatosis, 2018". British Journal of Dermatology. 178 (1): 34–60. doi:10.1111/bjd.16117. ISSN 0007-0963.
  25. ^ Rungsiprakarn, Phassawan; Laopaiboon, Malinee; Sangkomkamhang, Ussanee S; Lumbiganon, Pisake (2016-02-19). Cochrane Pregnancy and Childbirth Group (ed.). "Pharmacological interventions for generalised itching (not caused by systemic disease or skin lesions) in pregnancy". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD011351.pub2.
  26. ^ Wahlgren, Carl-Fredrik (November 1999). "Itch and Atopic Dermatitis: An Overview". The Journal of Dermatology. 26 (11): 770–779. doi:10.1111/j.1346-8138.1999.tb02090.x.
  27. ^ a b c Coondoo, Arijit; Phiske, Meghana; Verma, Shyam; Lahiri, Koushik (2014). "Side-effects of topical steroids: A long overdue revisit". Indian Dermatology Online Journal. 5 (4): 416. doi:10.4103/2229-5178.142483. ISSN 2229-5178. PMC 4228634. PMID 25396122.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
  28. ^ Eusebio‐Alpapara, Kathleen May V.; Castillo, Rochelle L.; Dofitas, Belen L. (April 2020). "Gabapentin for uremic pruritus: a systematic review of randomized controlled trials". International Journal of Dermatology. 59 (4): 412–422. doi:10.1111/ijd.14708. ISSN 0011-9059.
  29. ^ Du, Bo-Xiang; Song, Zhe-Ming; Wang, Kai; Zhang, Hao; Xu, Feng-Ying; Zou, Zui; Shi, Xue-Yin (September 2013). "Butorphanol prevents morphine-induced pruritus without increasing pain and other side effects: a systematic review of randomized controlled trials". Canadian Journal of Anesthesia/Journal canadien d'anesthésie. 60 (9): 907–917. doi:10.1007/s12630-013-9989-4. ISSN 0832-610X.
  30. ^ "Chinese Herbal Selections for Itchy Conditions". www.shen-nong.com. Retrieved 2021-03-25.
  31. ^ Zhang, W; Leonard, T; Bath-Hextall, F; Chambers, Ca; Lee, C; Humphreys, R; Williams, Hc (2004-04-19), The Cochrane Collaboration (ed.), "Chinese herbal medicine for atopic eczema", Cochrane Database of Systematic Reviews, Chichester, UK: John Wiley & Sons, Ltd, pp. CD002291.pub2, doi:10.1002/14651858.cd002291.pub3, retrieved 2021-03-13
  32. ^ a b c Poetker, David M.; Reh, Douglas D. (August 2010). "A Comprehensive Review of the Adverse Effects of Systemic Corticosteroids". Otolaryngologic Clinics of North America. 43 (4): 753–768. doi:10.1016/j.otc.2010.04.003.
  33. ^ a b c Hengge, Ulrich R.; Ruzicka, Thomas; Schwartz, Robert A.; Cork, Michael J. (2006-01-01). "Adverse effects of topical glucocorticosteroids". Journal of the American Academy of Dermatology. 54 (1): 1–15. doi:10.1016/j.jaad.2005.01.010. ISSN 0190-9622.
  34. ^ a b Dhar, Sandipan; Seth, Joly; Parikh, Deepak (2014). "Systemic side-effects of topical corticosteroids". Indian Journal of Dermatology. 59 (5): 460. doi:10.4103/0019-5154.139874. ISSN 0019-5154. PMC 4171913. PMID 25284850.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
  35. ^ Wood Heickman, Lauren K.; Davallow Ghajar, Ladan; Conaway, Mark; Rogol, Alan D. (2018). "Evaluation of Hypothalamic-Pituitary-Adrenal Axis Suppression following Cutaneous Use of Topical Corticosteroids in Children: A Meta-Analysis". Hormone Research in Paediatrics. 89 (6): 389–396. doi:10.1159/000489125. ISSN 1663-2818.
  36. ^ a b c Simons, F. Estelle R. (2004-11-18). "Advances in H 1 -Antihistamines". New England Journal of Medicine. 351 (21): 2203–2217. doi:10.1056/NEJMra033121. ISSN 0028-4793.
  37. ^ Dixon, Ross; Gentile, Joseph; Hsu, Hon-Bin; Hsiao, Jane; Howes, John; Garg, Dyal; Weidler, Donald (1987). "Nalmefene: Safety and Kinetics After Single and Multiple Oral Doses of a New Opioid Antagonist". The Journal of Clinical Pharmacology. 27 (3): 233–239. doi:10.1002/j.1552-4604.1987.tb02191.x. ISSN 1552-4604.
  38. ^ Metze, Dieter; Reimann, Sonja; Beissert, Stefan; Luger, Thomas (1999-10-01). "Efficacy and safety of naltrexone, an oral opiate receptor antagonist, in the treatment of pruritus in internal and dermatological diseases". Journal of the American Academy of Dermatology. 41 (4): 533–539. doi:10.1016/S0190-9622(99)80048-6. ISSN 0190-9622.
  39. ^ Bergasa, Nora Valeria; Alling, David W.; Talbot, Thomas L.; Swain, Mark G.; Yurdaydin, Cihan; Turner, Maria L.; Schmitt, Joseph M.; Walker, Elijah C.; Jones, E. Anthony (1995-08-01). "Effects of Naloxone Infusions in Patients with the Pruritus of Cholestasis: A Double-Blind, Randomized, Controlled Trial". Annals of Internal Medicine. 123 (3): 161–167. doi:10.7326/0003-4819-123-3-199508010-00001. ISSN 0003-4819.
  40. ^ a b c d Khawam, E. A; Laurencic, G.; Malone, D. A (2006-04-01). "Side effects of antidepressants: an overview". Cleveland Clinic Journal of Medicine. 73 (4): 351–353. doi:10.3949/ccjm.73.4.351. ISSN 0891-1150.
  41. ^ a b Research, Center for Drug Evaluation and (2018-11-03). "Suicidality in Children and Adolescents Being Treated With Antidepressant Medications". FDA.
  42. ^ Hsu, Denise; Katelaris, Constance (2009-06-01). "Long-term management of patients taking immunosuppressive drugs". Australian Prescriber. 32 (3): 68–71. doi:10.18773/austprescr.2009.035. ISSN 0312-8008.
  43. ^ Leslie, Tabi Anika; Greaves, Malcolm W.; Yosipovitch, Gil (2015), Cowan, Alan; Yosipovitch, Gil (eds.), "Current Topical and Systemic Therapies for Itch", Pharmacology of Itch, vol. 226, Berlin, Heidelberg: Springer Berlin Heidelberg, pp. 337–356, doi:10.1007/978-3-662-44605-8_18, ISBN 978-3-662-44604-1, retrieved 2021-03-14
  44. ^ Er, Uygur; Naderi, Sait (April 2013). "Paulus Aegineta". Spine. 38 (8): 692–695. doi:10.1097/brs.0b013e3182760fa0. ISSN 0362-2436.
  45. ^ Brevart, Francis B. (June 1994). "Das "Lorscher Arzneibuch": Ein medizinisches Kompendium des 8. Jahrhunderts (Codex Bambergensis medicinalis 1): Text, Ubersetzung und Fachglossar. Ulrich Stoll". Isis. 85 (2): 314–315. doi:10.1086/356835. ISSN 0021-1753.
  46. ^ Puza, Charles J.; Suresh, Visakha (2018-05-01). "Scabies and Pruritus—A Historical Review". JAMA Dermatology. 154 (5): 536. doi:10.1001/jamadermatol.2018.0147. ISSN 2168-6068.

Category:Antipruritics

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