RESUMEN
Brachioradial pruritus (BRP) and notalgia paraesthetica (NP) represent 2 of the most common neuropathic itch syndromes. A total of 58 consecutive patients presenting at the Center for Chronic Pruritus, University Hospital Münster, were analysed with regard to clinical presentation, anatomical and morphological pathologies, impairment in quality of life, and response to treatment with topical capsaicin. Patients with BRP reported stinging and burning more often than those with NP. In the BRP group structural magnetic resonance imaging abnormalities more frequently correlated with localization of the symptoms compared with in patients with NP. In addition, intraepidermal nerve fibre density was decreased in lesional skin in patients with BRP, but not in those with NP, confirming the neuropathic origin in BRP. Topical capsaicin resulted in a significantly higher alleviation of itch and pain intensity and improvement in quality of life in patients with BRP compared with those with NP, which may reflect clinical and aetiological differences between the conditions.
Asunto(s)
Síndromes de Compresión Nerviosa/complicaciones , Parestesia/etiología , Prurito/etiología , Anciano , Antipruriginosos/administración & dosificación , Dorso , Capsaicina/administración & dosificación , Vértebras Cervicales , Femenino , Antebrazo , Ganglios Espinales , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Síndromes de Compresión Nerviosa/diagnóstico por imagen , Parestesia/tratamiento farmacológico , Prurito/tratamiento farmacológico , Calidad de Vida , Estudios Retrospectivos , Piel/inervación , Compresión de la Médula Espinal/complicaciones , Compresión de la Médula Espinal/diagnóstico por imagen , Nervios Espinales , Vértebras Torácicas , Parche TransdérmicoRESUMEN
In brachioradial pruritus and notalgia paraesthetica, the 8% capsaicin patch is a novel and effective, but cost-intense, therapy. Routine data for 44 patients were collected 6 months retrospectively and prospectively to first patch application. The cost to health insurance and the patient, and patient-reported outcomes were analysed (visual analogue scale, numerical rating scale, verbal rating scale for pruritus symptoms, Dermatological Life Quality Index, and Patient Benefit Index). Mean inpatient treatment costs were reduced by 212.31, and mean outpatient treatment and medication costs by 100.74 per patient (p.p.). However, these reductions did not offset the high cost of the patch itself (767.02 p.p.); thus the total cost to health insurance increased by 453.97 p.p. (p ≤ 0.01). The additional costs of therapy to the patient decreased by 441.06, thus the overall cost p.p. remained approximately the same (3,306.03 vs. 3,318.94). Capsaicin patch therapy resulted in reduced pruritus, improved quality of life and greater patient benefit, thus long-term cost-efficiency analyses are necessary.