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Antihistamines in dermatology.

Malcolm W Greaves1

  • 1National Skin Centre, Singapore, Singapore. mwatsong@hotmail.com

Skin Pharmacology and Physiology
|July 15, 2005
PubMed
Summary

Antihistamines are crucial in dermatology for conditions like urticaria and eczema. While first-generation drugs have significant side effects, newer second-generation antihistamines are generally safer and well-tolerated.

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Area of Science:

  • Dermatology
  • Pharmacology

Background:

  • Antihistamines are widely used systemic drugs in dermatology, alongside antibiotics.
  • Histamine plays a key role in common skin conditions like urticaria and atopic eczema.
  • H1 and H2 histamine receptor subtypes are identified in human skin.

Purpose of the Study:

  • To review the role and classification of antihistamines in dermatology.
  • To discuss the mechanisms, indications, and side effects of H1 antihistamines.
  • To compare first-generation and second-generation antihistamines regarding efficacy and safety.

Main Methods:

  • Literature review of antihistamine use in dermatological conditions.
  • Analysis of histamine receptor subtypes and their antagonists.
  • Evaluation of clinical evidence for antihistamine efficacy and safety profiles.

Main Results:

  • H1 and H2 antihistamines act as inverse agonists, not just competitive antagonists.
  • First-generation H1 antihistamines are associated with significant side effects (somnolence, anti-adrenergic, atropine-like actions).
  • Second-generation H1 antihistamines show reduced or absent side effects and are generally well-tolerated, though some early compounds were withdrawn due to cardiac issues.

Conclusions:

  • H1 antihistamines are primarily used to suppress pruritus in urticaria and atopic eczema.
  • The evidence for antihistamine use in atopic eczema is controversial despite widespread practice.
  • Second-generation antihistamines offer a safer alternative, particularly for the elderly, minimizing psychomotor impairment and other adverse effects.

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