The itch is neuropathic; antihistamines, steroids won’t help
It is difficult to treat NP without treating the underlying disease, which is usually spinal damage.4 Little has been published on the treatment of NP, and most of the literature on the subject involves case reports. Because the pruritus in NP is neuropathic, antihistamines and topical steroids are ineffective.4
The most commonly used treatment for NP among dermatologists is capsaicin as a 0.025% cream or 8% patch. One study with 20 patients reported improvement of pruritus in 70% of patients at 2 weeks, with some relapsing in about a month.6
Another treatment that has been used is cutaneous botulinum toxin type A injections, but its use is controversial. This strategy was proposed by Weinfeld7 after successful treatment of 2 patients. However, other studies have had variable outcomes with no resolution of pruritus.8
Other treatments include gabapentin,9 transcutaneous electrical nerve stimulation,10 and narrow-band ultraviolet-B.11 It is appropriate to consider surgical decompression or neurolysis of the nerve when other forms of treatment fail.12
Our patient was treated with topical capsaicin cream 0.25 mg/g, which lessened the intensity of her itching. After 2 months, the patient reported improvement of her symptoms.
CORRESPONDENCE
Joana Sequeira, MD, Estrada da Mata nº56, Leiria, Portugal; joanaseq@gmail.com.