Topical Calcineurin Inhibitors in the Management of Chronic Pruritus in Older Adults: A Research Letter

February 2024 | Volume 23 | Issue 2 | e70 | Copyright © February 2024


Published online January 24, 2024

Janell Tully BSa,b, Daniel C. Butler MDb

aCollege of Medicine, Phoenix, University of Arizona, Phoenix, AZ
bDepartment of Dermatology, University of California, San Francisco, CA

RESULTS

Among the 16 studies included in final analysis (Table 1), TCIs were used to treat various pruritic conditions, including chronic generalized pruritus. Only one study included exclusively patients over the age of 65 (n=2). Most studies (15/16) found that TCIs significantly improved pruritus. The most common adverse effect reported was transient application site burning, reported in 10/16 studies. There was a single report of a mild erythematous rash and one report of a contact allergy to TCIs, but there were no reports of serious infection or malignancy.

DISCUSSION

TCIs are generally well-tolerated and adverse effects are typically mild without increased concern of known side effects for older adults as compared younger populations. While a limited number of cases of lymphoma or skin cancer have been reported in patients receiving TCI therapy,2 there is sparse evidence associating TCI use with malignancy.20 When comparing this information to current treatment options for pruritus, TCIs avoid systemic immunosuppression, do not result in sedation, a potentially debilitating side effect for older adults, and are not associated with skin thinning.21

Still, data evaluating the efficacy of TCIs for pruritus in geriatric patients remains limited. This is unsurprising given the general underrepresentation of older adults in clinical trials.22,23 Despite the paucity of primary literature, multiple articles highlight the use of TCIs as a plausible therapeutic option for pruritus in geriatric patients.1,3,24 To our knowledge, this is the largest evaluation to date of its use in this neglected and underrepresented population. In conclusion, the summation of these studies helps providers and payers identify TCIs as a safe therapeutic option for age-associated itch.

DISCLOSURES

The authors have no conflict of interest to declare.

REFERENCES

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AUTHOR CORRESPONDENCE

Daniel C. Butler MD Daniel.Butler@ucsf.edu
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