Use of Systemic Treatment in Patients with Chronic Pruritus: A Survey of Dermatologists in the Netherlands
Tessa A. Kouwenhoven, Peter C.M. van de Kerkhof, Marijke Kamsteeg
Treatment of chronic pruritus can be a challenge for clinicians. Several systemic treatments have been suggested to reduce itch, such as gabapentinoids and antidepressants. The aim of this study was to assess the current practice of dermatologists regarding systemic treatment in patients with chronic pruritus, and to identify possible barriers in the prescription of these treatments. An online survey was sent to all dermatologists and dermatology residents in the Netherlands between July 2017 and April 2018. A total of 193 physicians completed the questionnaire (response rate 27.0%). Overall, 61.7% prescribed gabapentinoids or antidepressants in patients with chronic pruritus. Amitriptyline was prescribed most frequently, followed by gabapentin, doxepin and mirtazapine. Reasons not to prescribe systemic treatment included lack of knowledge or experience, risk of side-effects, and lack of available evidence. As only a minority of respondents felt comfortable prescribing these drugs, more education on effective and safe dosing is needed.
This study analysed the prescription of systemic treatment by dermatologists in patients with chronic itch. Overall, 6 out of 10 dermatologists prescribed antidepressants or gabapentinoids, of which, antidepressants were prescribed most frequently. Reasons not to prescribe systemic treatment included lack of knowledge or experience, risk of side- effects, and lack of available evidence. Only a minority of the clinicians surveyed felt comfortable prescribing these drugs; therefore, we recommend more education on effective and safe dosing.