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Chronic pruritus is frequently refractory to currently available treatments. Studies suggest that pruritus may arise from an imbalance of the mu- and kappa-opioid receptor system activity in either the skin or the central nervous system. Stimulation of kappa-opioid receptors by their agonists inhibits pruritus in both animals and humans. The antipruritic effect of kappa-opioid receptors agonists can currently be assumed to be related to their binding to kappa-opioid receptors on keratinocytes and cutaneous and/or central itch neurones. To date, several case reports and 2 controlled trials have demonstrated a beneficial effect of systemic kappa-opioid receptor agonists in the treatment of uraemic pruritus, prurigo nodularis, paraneoplastic and cholestatic pruritus. Nalfurafine hydrochloride (Remitch®), a selective kappa-opioid receptor agonist, is approved for the treatment of chronic pruritus in Japan. The aim of this review is to provide an overview of the promising role of kappa-opioid receptors and their agonist in the pathophysiology and treatment of pruritus. [ABSTRACT FROM AUTHOR]

The article presents the case study of middle aged woman who was taken to the health care center because of itching, erythema, oedema of face and nasal congestion. It mentions that the patient denied the use of anticoagulants and hirudins . She was treated with systemic therapy with an oral antihistamines and was advised a steroid cream.