title: Effective use of mirtazapine for refractory pruritus associated with carcinoma en cuirasse.
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.
authors.affiliation: Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA Program in Dermatopathology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Lee
authors.affiliation: Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Sasha D
authors.initials: SD
authors.lastname: Girouard
authors.affiliation: Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Valerie M
authors.initials: VM
authors.lastname: Carlberg
authors.affiliation: Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Arash
authors.initials: A
authors.lastname: Mostaghimi
mesh_terms: D000368:Aged; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D000982:Antipruritics / Q000627:therapeutic use*; D018270:Carcinoma, Ductal, Breast / Q000150:complications*; D005260:Female; D006633:Histamine Antagonists / Q000627:therapeutic use; D006801:Humans; D008803:Mianserin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000078785:Mirtazapine; D011537:Pruritus / Q000188:drug therapy* / Q000209:etiology* / Q000473:pathology; D012702:Serotonin Antagonists / Q000627:therapeutic use; D012878:Skin Neoplasms / Q000556:secondary*; D016896:Treatment Outcome; D064726:Triple Negative Breast Neoplasms / Q000150:complications*
chemical_list: D000929:Antidepressive Agents, Tricyclic; D000982:Antipruritics; D006633:Histamine Antagonists; D012702:Serotonin Antagonists; D008803:Mianserin; D000078785:Mirtazapine
keywords: Skin care