Parenteral Lignocaine for pruritus in mycosis fungoides

Pruritus can be a very distressing symptom in mycosis fungoides (MF) and often proves resistant to therapy. Several authors have described the use of parenteral lignocaine for intractable itch. (1, 2) We have incorporated this into our management of intractable pruritus of diverse aetiologies since 1998 and report a retrospective audit of 7 MF patients who received a continuous infusion of subcutaneous (sc) lignocaine. Therapy periods ranged from 5-107 days and dose from 600mg to 1500mg/24hour, via a Graseby syringe driver. We defined response as follows: complete response (CR) - no itch; partial response (PR) - itch tolerable, able to sleep; no response (NR) - itch still distressing and unable to sleep. Given the multiple confounders determining pruritus (eg concurrent chemotherapy, skin care, ultraviolet light therapy) response was calculated according to the percent of time each criterion was present per patient. Cumulative mean response was CR 28%, PR 50% and NR 22%. All patients had at least a partial response during treatment. Further study is required to determine optimum dosing and method of administration. References:
 1. Watson WC. Lancet 1973; 1(7796):211
 2. Fishman et al. Am J Med 1997; 102(6):584-5