Acta Dermato-Venereologica 99-3CompleteContent | Page 14

304 INVESTIGATIVE REPORT 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 and Marijke KAMSTEEG Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands 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 sys- temic treatment in patients with chronic pruritus, and to identify possible barriers in the prescription of these treatments. An online survey was sent to all derma- tologists and dermatology residents in the Nether- lands 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. Ami- triptyline was prescribed most frequently, followed by gabapentin, doxepin and mirtazapine. Reasons not to prescribe systemic treatment included lack of know- ledge or experience, risk of side-effects, and lack of available evidence. As only a minority of respondents felt comfortable prescribing these drugs, more educa- tion on effective and safe dosing is needed. Key words: pruritus; therapeutics; gabapentin; antidepressive agents; survey. Accepted Dec 6, 2018; E-published Dec 6, 2018 Acta Derm Venereol 2019; 99: 304–308. Corr: Tessa Kouwenhoven, Radboud University Medical Center, Depart- ment of Dermatology, PO Box 9101, NL-6500 HB Nijmegen, The Nether- lands. E-mail: [email protected] I tch is one of the most common symptoms presented in daily dermatological practice, with an estimated point prevalence of 36.2% (1–3). Chronic pruritus (CP) (itch present for a minimum of 6 weeks) can be caused by several dermatological, systemic, neurological and psychiatric disorders (2, 4). CP is associated with a reduced quality of life, including impact on mood, con- centration and sleep, and a higher risk of anxiety and depression (5–8). Several systemic treatment options have been sug- gested for patients with CP (2, 9–11). For example ga- bapentinoids, such as gabapentin and pregabalin, were used in patients with uremic pruritus and neurogenic itch (12–20). In addition, treatment with oral antidepressants, such as mirtazapine, paroxetine and sertraline, have been recommended in patients with pruritus unresponsive to conventional treatment options, and particularly in patients with uraemic pruritus, cholestatic pruritus or paraneoplastic pruritus (21–28). Other systemic treat- doi: 10.2340/00015555-3101 Acta Derm Venereol 2019; 99: 304–308 SIGNIFICANCE 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 treat­ ment 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 ef- fective and safe dosing. ment options include opioid receptor agonists and anta- gonists, thalidomide and neurokinin 1 receptor (NKR1) antagonists (29–36). Due to its heterogeneity and difficult to establish underlying origin, treatment of CP remains a challenge for clinicians (37, 38). If systemic treatment is initiated, side-effects can complicate therapeutic attempts, especi- ally in elderly patients. In addition, dermatologists might not feel comfortable prescribing psychotropic medication (39). Data on the use of systemic treatments for CP by clinicians in daily practice is currently scarce. The aim of this study was to provide more insight into the current practice of dermatologists regarding systemic treatment in patients with CP, including identification of the treatments used, clinicians’ experiences on reducing itch after initiation of systemic treatment, and possible barriers to prescription of systemic treatment. METHODS An anonymous web-based questionnaire was sent by e-mail to all members of the Dutch Society of Dermatology and Venereology (NVDV) between July 2017 and April 2018. It was first piloted to dermatologists (n = 3) and dermatology residents (n = 6) in June 2017 at the Radboud University Medical Center, Nijmegen, the Netherlands, resulting in the adaptation of a few questions and instructions to avoid ambiguity. The final questionnaire consisted of 19 questions, including multiple-choice questions, 5-point Likert scale questions and open-ended questions. Participants were asked about demographic and professional data, prevalence of CP in their clinical practice, use of antiepileptics and antide- pressants in treatment of CP, their level of comfort in prescribing these pharmaceuticals and other systemic treatment options used in treatment of CP. In this survey, CP was defined as itch present for a minimum of 6 weeks due to both dermatological and non- dermatological conditions. Study data were collected and managed This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica.