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Anti Pruritus, counter iritan dan
Anti Histamin
• Pruritus is the most common symptom of skin disease and can best
be defined as an unpleasant sensation that leads to a desire to
• It can also be a lead symptom in systemic and psychiatric disorders.
All human beings experience pruritus in the course oftheir lifetime;
• therefore, it is important to make a distinction between acute itch,
which is of a limited period of time ranging from seconds to a week
such as the itch related to acute insect bite reaction,
• and chronic itch, which lasts for greater than 6 weeks and the
treatment of which will be the focus of this review. Pruritus has a
profound impact on quality of life through disturbances related to
sleep, attention, and sexual function
• Beberapa
penyakit yang
• Terapi anti pruritus
– Anti histamin (sistemik dan topikal)
– Corticosteroid (sistemik dan topikal)
– Counter iritan topical
Anti Histamin
H1 receptor antagonists
• A histamine antagonist (commonly called an
antihistamine) is a pharmaceutical drug that
•  inhibits the action of histamine by either blocking
its attachment to histamine receptors, or
•  inhibiting the enzymatic activity of histidine
decarboxylase which catalyzes the transformation of
histidine into histamine
H1 receptor antagonists
1st Generation:
– Highly Sedative
• dimenhydrinate, Diphenhydramine, Doxylamine, Hydroxyzine,
– Moderately Sedative
• clemastine, Pyrilamine, Cyproheptadine, Pheniramine,
– Mild Sedative
• chlorpheniramine, Triprolidine, Cyclizine, Betahistine
2nd Generation:
– Terfenadine, Astemizole, Cetirizine, Loratadine, Mizolastine,
Fexofenadine, Levocetrizine, Ebastine
3rd Generation:
• Desloratadin, Levocetrizine,
H1 receptor antagonists
2nd generation
-absence of sedation
- antichollinergic property
-devoid of
H1 receptor antagonists
Adverse effects
Sedation ,↓alertness
Motor incoordination
Tendency to fall sleep
Blurred vision
Urinary retention
Dry mouth
H1 receptor antagonists
Allergic disorders
Urticaria , Angioedema , Conjunctivitis , Rhinitis
Itching (Pruritus)
Common Cold
H1 receptor antagonists
Motion sickness
Promethazine , Diphenhydramine , Meclizine
Morning sickness (vomiting of early pregnancy)
Doxylamine , Meclizine
H1 receptor antagonists
Cinnarizine – Dimenhydrinate , Promethazine
Topical Antihistamines
• Doxepin, a tricyclic antidepressant, is a potent
H1 antagonist.
• Doxepin 5% cream has been shown to
significantly reduce pruritus in patients with
atopic dermatitis, limiting its use especially in
• Other common side effects of this treatment
include localized cutaneous burning and
allergic contact dermatitis.
Topical corticosteroid
• Topical corticosteroids should only be used to provide relief
of itching associated with inflammatory skin diseases such
as atopic dermatitis.
• However, they should not be used to treat generalized
chronic itch or for prolonged periods. Corticosteroids are
not directly antipruritic and it is believed they exert a
beneficial effect on pruritus through their reduction in skin
• It has been shown that 2.5 % hydrocortisone significantly
decreases experimentally induced pruritus when compared
to placebo. Although higher strengths of corticosteroid
have greater efficacies, there is also an increased risk of
Klasifikasi Kortikosteroid topical berdasarkan potensinya
Klasifikasi Kortikosteroid topical berdasarkan potensinya
• Hal yang harus diperhatikan dari steroid per
oral topikal??
• Side effect of corticosteroid ??
Counter irritant
• Topical salicylic acid
• Topical acetylsalicylic acid, a cyclooxygenase
inhibitor, has been shown to significantly
reduce pruritus in a double-blind, crossover
placebo trial in patients with lichen simplex
• Menthol has been used alone or in combination as a topical
antipruritic for centuries.
• Menthol elicits the same cool sensation as low temperature
through the TRPM8 receptor, a member of the transient receptor
potential (TRP) family of excitatory ion channels. Cooling the skin
and menthol both result in the relief of experimentally induced itch,
although the latter is not associated with a decrease in skin
• This has lead to menthol at concentrations of 1 – 3 % being
commonly used to relieve pruritus while higher doses can induce
• Of note, patients who report a reduction in pruritus with cold
sensation may especially benefit from topical therapies containing
Topical capsaicin
• Topical capsaicin acts through TRPV1 (transient-receptor potential
vanilloid receptor-1 ) expressed on sensory skin nerves to release
neuropeptides such as substance P.
• TRPV1 recently has been implicated in the pathogenesis of pruritus and
thus may be the target through which capsaicin exerts its antipruritic
• Beneficial effects of capsaicin have been reported in chronic, localized
pruritic disorders, particularly those of neuropathic origin,
• Initial application causes an intense transient burning sensation at the
application site which may lead to poor compliance or premature
cessation of treatment; however, this side effect usually resolves after
using the medication for a few days
• A recent study suggests that African Americans display a notably limited
hyperalgesia and neurogenic inflammation in response to topical capsaicin
suggesting that response to certain anti-pruritic agents may differ
between ethnic populations
• Hal yang harus diperhatikan dari penggunaan
counter irritant?
• Side effect??
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