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Postburn itch is a common but poorly understood treatment challenge
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Postburn itch is a common but poorly understood treatment challenge
What are effective interventions for postburn pruritus (itch) in any care setting?
The neuromodulatory agents gabapentin, pregabalin and doxepin may be more effective in reducing postburn pruritus than oral antihistamines (low-certainty evidence), while ondansetron probably reduces postburn pruritus more effectively than oral antihistamines (moderate-certainty evidence). These results indicate that postburn pruritus may be partly neuropathic.
In terms of topical therapies, CQ-01 (hydrogel) may be more effective in reducing postburn itch compared with relevant controls, and enalapril ointment probably reduces postburn itch more effectively than placebo. On the other hand, silicone gel cream and Provase moisturiser likely have little to no effect on postburn itch, while the impact of beeswax and herbal oil cream could not be determined due to unavailable data.
Regarding physical modalities, enhanced education on silicone gel sheeting may be more effective in reducing postburn itch than conventional education. Massage therapy and extracorporeal shock wave therapy may also be more effective in reducing postburn itch compared with relevant controls.
The evidence is based on few trials with low sample numbers. These same trials had design issues such as lack of blinding and poor follow-up. Adverse event reporting was minimal, so it is unknown whether these treatments have any associated harms.
Practitioners should consider the applicability of the evidence for their patients and, given the wide range of surface areas affected by postburn pruritus, determine whether systemic or topical pharmacologic agents are most appropriate for each patient.
Postburn pruritus is a common and distressing symptom experienced on healing or healed burns or donor site wounds. Topical, systemic and physical treatments are available to control postburn pruritus; however, it remains unclear how effective these are.
Sinha S, et al. Interventions for postburn pruritus. Cochrane Database Syst Rev 2024;6:CD013468. This review contains 25 trials, which included 1166 people.