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Effective use of mirtazapine for refractory pruritus associated with carcinoma en cuirasse
  1. Jonathan J Lee1,2,
  2. Sasha D Girouard1,
  3. Valerie M Carlberg1 and
  4. Arash Mostaghimi1
  1. 1Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
  2. 2Program in Dermatopathology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Arash Mostaghimi, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA; amostaghimi{at}partners.org

Abstract

Pruritus is a debilitating symptom that can be associated with cutaneous involvement by an underlying malignancy. We report the case of a 68-year-old woman with a history of triple-negative breast cancer who presented with extensive, localised cutaneous metastasis complicated by incapacitating, treatment-refractory pruritus localised to the anatomic regions involved by her metastatic disease. Physical examination revealed an indurated, ecchymotic, ulcerated plaque circumferentially encasing her thorax. Histopathological examination revealed substantial dermal lymphatic involvement and dilation as well as dermal collagen infiltration by tumour cells and nodules. The clinical and pathological findings were consistent with a diagnosis of carcinoma en cuirasse. Mirtazapine, a noradrenergic antidepressant with antiserotonin and antihistamine activity, was started and led to rapid, sustained relief of the patient's pruritus. Mirtazapine may be a useful systemic agent for the palliative relief of pruritus associated with cutaneous infiltration by an underlying malignancy.

  • Skin care
  • Received 14 September 2014.
  • Revision received 3 November 2014.
  • Accepted 29 November 2014.

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  • Received 14 September 2014.
  • Revision received 3 November 2014.
  • Accepted 29 November 2014.
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