The efficacy of emollient creams with endocannabinoids in the treatment of uremic pruritus

Uremic pruritus is still a common and distressing symptom in patients with chronic renal failure undergoing dialysis treatment, despite advances made in its treatment. Cannabinoids, obtained from marijuana plants, seem to be a rational therapeutic option for pruritic diseases via their antiinflammatory effects. There has been only one study in literature regarding the antipruritic effects of cannabinoids in uremic pruritus. The aim of this retrospective study was to evaluate the efficacy and safety of emollients with endocannabinoids in the treatment of uremic pruritus. All 40 uremic pruritus patients (24 male and 16 female) included in this retrospective study applied a cream with structured natural lipids (derma membrane structure) and endocannabinoids (N-acetylethanolamine and N-palmitoylethanolamide) twice daily for 4 weeks and were followed up for 3 months. İntensity of pruritus was evaluated using two scoring methods: the "Visual analogue scale" and the "Modified itch severity scale". Xerosis was also assessed using the "El Gammal xerosis scale". Pruritus was evaluated before treatment, at weekly intervals during treatment and at biweekly intervals over a 3-month follow-up period. Xerosis was assessed before and after the treatment period. After a 4-week treatment period, pruritus was completely eliminated in 8 patients (20%) and a significant reduction of pruritus was noted in 26 patients (65%) using both scales for itching intensity assessment (p=0.000). Xerosis scores were also significantly reduced in 29 patients (72.5%) (p=0.000). Three months after discontinuation of the treatment, pruritus remained significantly less intensive compared to the beginning of the study (p=0.000). The cream was well tolerated by all patients. The results of our study revealed that emollient creams containing endocannabinoids are an effective and safe option for the treatment of uremic pruritus. In addition, the antipruritic effect of the cream is sustained for a long period after discontinuation of treatment. These emollients could also be of help in controlling xerosis in the patients. Keywords: Cannabinoids, chronic renal failure, hemodialysis, peritoneal dialysis, uremic pruritus.