Notalgia Paresthetica Medication
- Author: Ally N Alai, MD, FAAD; Chief Editor: Dirk M Elston, MD more...
While no uniformly effective topical treatment has been reported for the cutaneous symptoms of notalgia paresthetica (NP), common first-line dermatologic medications have typically included potent topical steroid creams and topical antipruritics like capsaicin. Currently available therapeutic options for the localized itch syndromes include capsaicin cream, eutectic mixture of local anesthetic (EMLA) cream, topical steroids, pramoxine cream, topical cooling or ice pack applications, oral steroids, Tiger balm, camphor and menthol creams, flurandrenolide tape (Cordran Tape), intralesional corticosteroid injections, botulinum toxin injections, oral antihistamines, hydroxyzine, doxepin, topiramate (Topamax), anticonvulsant medications, carbamazepine (Tegretol), antidepressant medications, gabapentin (Neurontin), oxcarbazepine, and thalidomide.
Some of the current systemic therapies may exert their effect through the spinal nerves and central nervous system, thereby supporting the neuropathic etiology of notalgia paresthetica.[4, 11]
Second-line therapy for notalgia paresthetica includes medications such as oral nonsteroidal anti-inflammatory medications (eg, ibuprofen, celecoxib, ketorolac) and oral muscle relaxants (eg, carisoprodol, cyclobenzaprine, methocarbamol, metaxalone).
Topical corticosteroid (very high potency)
Clobetasol propionate is a class I superpotent topical steroid; it suppresses mitosis and increases the synthesis of proteins that decrease inflammation and cause vasoconstriction. Clobetasol propionate decreases inflammation by stabilizing lysosomal membranes, inhibiting PMN and mast cell degranulation.
Topical corticosteroid (high potency)
Fluocinonide is a high-potency steroid that inhibits cell proliferation. It is immunosuppressive, antiproliferative, and anti-inflammatory. Fluocinonide also has antipruritic and vasoconstrictive properties.
Topical corticosteroid (medium potency)
Triamcinolone topical is used for inflammatory dermatosis responsive to steroids; it decreases inflammation by suppressing the migration of PMNs and reversing capillary permeability. It is available in ointment (0.1%) and cream (0.025%, 0.1%, 0.5%).
Hydroxyzine hydrochloride antagonizes H1 receptors in the periphery. It may suppress histamine activity in the subcortical region of CNS.
Capsaicin is a natural chemical derived from plants of the Solanaceae family. It penetrates deep for temporary relief of minor aches and pains of muscles and joints associated inflammatory reactions. Capsaicin may render skin and joints insensitive to pain by depleting substance P in peripheral sensory neurons. It has demonstrated effectiveness in several studies of diabetic neuropathic pain and in other types of neuropathic pain.
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