Abstract: We studied the effect of a potent topical histamine H1 and H2 receptor blocker, doxepin, on sev ere burn wound pruritus. We compared the response of doxepin cream in 20 patients with healed itching burn wounds, using the standard of care, which included oral antihistamines, skin moisturizers, and sedatives. The patients (all outpatients) were first assessed as to the degree of itching using the 0 to 10 pain scale with an initial assessment and a take-home chart for a seven-day period after which all patients were placed on the topical doxepin alone, and a daily pruritus assessment was made for seven days. At the end of the doxepin-treatment period, wounds were assessed, after which the previous standard of care was resumed. The degree of pruritus decreased significantly with the use of doxepin cream, decreasing from a value of 7±2 on standard care to a value of 3±1 with the doxepin cream. The response was noted within 15 minutes, and no tachyphylaxis was noted. We also noted a significant decrease in wound erythema. Some somnolence was noted in 20 percent of patients, which decreased with two to three days of doxepin use. The degree of itching and degree of wound erythema returned to pre-doxepin levels with a return to standard care therapy. We concluded that a topical doxepin cream is effective in decreasing wound pruritus in burn patients with results superior to oral antihistamines, skin moisturizers, and sedatives.

Wounds 2001:13(6); 210-215.

Abstract:  Severe itching, accompanied by erythema, is a common and incapacitating problem in the healed burn wound. Itching is most common in a partial thickness wound requiring about 3 weeks to heal. Increased release of histamine from local wound mast cells and/or increased sensitivity of sensory nerves to local histamine release, is considered a major causative factor. The current standard approach for itch, which consists of oral antihistamines, skin moisturizers and sedatives, is often ineffective. Doxepin is a trycyclic compound found to have extremely potent antihistamine properties. A 5% doxepin cream is used to control the histamine induced itch of atopic dermatitis, urticaria and other pruritic skin disorders.

Our purpose was to test the efficacy of doxepin cream in controlling post burn itch compared to a more standard care, in outpatients with healed itching burn wounds. The study was continued over a 3 month period or until the itch ceased. A (0-10) itch scale, 10 being the worst and a (0 to 3) erythema scale, 3 being the worst, were used in this randomized prospective trial.

We found that itch and erythema, which were 5±2 and 2±1 with standard care decreased significantly to 2±1 and 1±.5 respectively, for the length of the study period with the Doxepin cream. Also, itching ceased in 50% of patients, using doxepin cream before the 3 month period compared to only 10% using the oral antihistamines. Mild and transient somnolence was seen in 15% of patients using the doxepin cream, compared to 100% of patients using standard care.

We can conclude that the 5% doxepin cream significantly decreases itching and erythema, in the healed burn wound, compared to oral antihistamines.