Amitriptyline as therapeutic and not symptomatic approach in the treatment of prurigo nodularis: A pilot study

Aim. Prurigo nodularis (PN) is a chronic skin disease of unknown etiology characterized by an intense pruritus, which affects the patients' life quality. The aim of this study was to investigate whether amitriptyline, a well investigated tricyclic antidepressant with a strong antipruritic effect based on a high binding affinity for the histamine H₁ receptor, could represent a novel therapeutic approach. Methods. In this open, uncontrolled pilot study, we investigated the efficacy and safety of amitriptyline, administered orally, in the treatment of PN. Patients were treated with an initial dosage of 60 mg for 3 weeks, followed by a dose reduction to 30 mg for 2 weeks and 10 mg for 1 week. Results. Of a total of 17 patients with PN, response was achieved in 82.4% of patients. Side effects were generally mild and included mostly reduced concentration during the day, but no patient discontinued the treatment Disease relapse occurred in 5 patients within 7 months, but reinitiation of amitriptyline lead again to immediate response. Conclusions. The significant remission achieved in our patients may designate amitriptyline as a novel therapeutic approach of PN.