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Safety of Topical Neuromodulators for the Treatment of Pruritus ONLINE FIRST

Michael A. Cardis, MD1,2; Helena B. Pasieka, MD, MS1,2
[+] Author Affiliations
1Department of Dermatology, MedStar Washington Hospital Center, Washington, DC
2Department of Dermatology, MedStar Georgetown University Hospital, Washington, DC
JAMA Dermatol. Published online September 14, 2016. doi:10.1001/jamadermatol.2016.3118
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This case report describes the occurrence of adverse effects after application of topical neuromodulators for the treatment of pruritus.

The use of ketamine and amitriptyline compounded topically for the management of chronic neuropathic pain and itch is increasing. Topically administered ketamine can provide local analgesia, but systemic absorption, even at relatively low doses, may be associated with adverse psychotropic effects including alteration of both internal and external perceptions of reality.1 We present a case of systemic absorption and subsequent toxic encephalopathy following application of topical amitriptyline, ketamine, and lidocaine for recalcitrant pruritus.

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