Antipruritic effect of oral cyclosporin A in essential senile pruritus.

Sir, RESULTS Ten patients, aged between 59 and 72 years (6 women and 4 men), affected with essential pruritus were enrolled in the All 10 subjects completed the study. The status of pruritus study after verbal informed consent was obtained. At clinical was assessed and compared with the baseline using the VAS investigation all patients presented with discomforting diffuse forms filled in by patients at each visit. CyA treatment pruritus of 6 to 11 months’ duration and which frequently significantly reduced the itch intensity in all 10 patients. Four disturbed sleep at night. None of the subjects presented any patients experienced an improvement of pruritus within a few specific skin alterations and all were resistant to oral antidays. Six others showed a decrease in itch on days 10–12. A histamines, topical and systemic corticosteroids and topical total of eight subjects were free of pruritus within the 4th emollients. week of treatment, but two subjects who had experienced consistent itch relief by the 14th day of CyA treatment had no further improvement. At the clinical follow-up no relapse MATERIAL AND METHODS were reported until 3 months after discontinuation of therapy. Study design One subject referred a mild localized pruritus 1 month after This open uncontrolled study was designed for subjects with persistent discontinuation of therapy. pruritus for a minimum of 6 months before entry into the study. None of the patients enrolled had significant adverse reacRoutine laboratory tests, IgE level, serum complement, thyroid hortions to CyA treatment. Two patients had an increase in mone levels, chest X-ray, were all within normal limits and stool diastolic blood pressure (100 mmHg) reversible on dose adjustexamination for parasites was negative in all subjects. Excluding ment. No laboratory test modifications occurred in any of criteria to enter the study were hepatic or renal affections, pre-existing the subjects. hypertension or history of malignancies, acute infection, pathological routine laboratory tests, drug or alcohol abuse. Any topical and The antipruritic effect of CyA needs to be clarified, including systemic medications previously prescribed for the treatment of pruthe possible hypothesized role of CyA in inhibiting certain ritus were stopped 4 weeks before the start of the study. All subjects ‘‘pruritogenic cytokines’’ or counteracting certain neuropepwere treated with Cyclosporin A (CyA) oral solution (Sandimmun tides released in situ in the skin (1, 2). Neoral, Sandoz) 5 mg/kg/day in two administrations for 8 weeks. The initial dose was maintained for 4 weeks and then gradually reduced by 0.5 mg/kg/day every week until discontinuation of the therapy. REFERENCES Patients were monitored at each visit for CyA side effects, in particular renal or liver dysfunction and changes in blood pressure. Patients 1. Wahlgren CF, Scheynius A, Hägermark Ö. Antipruritic effect of were followed-up for 3 months after the end of treatment to evaluate oral cyclosporin A in atopic dermatitis. Acta Derm Venereol relapse of symptoms. (Stockh) 1990; 70: 323–329. Recording of itching intensity 2. Teofoli P, Guarcello V, Lotti T, Panconesi E. Detection of mRNA encoding proopiomelanocortin (POMC) in the epidermoid cell line The effects were evaluated by measuring itch intensity using a visual A431. Int J Immunopathol Pharmacol 1997; 10: 1, 69–71. analogue scale (VAS) in which the subjects indicate the intensity of itch on a scale ranging from no itch to maximal itch. The assessment of the itch score on the first 2 days constituted a patient’s baseline value; the itch score was recorded on days 0, 7, 14 and 28 and then Accepted November 21, 1997 every 2 weeks until discontinuation of therapy (8 weeks).