From the Guidelines
Fluocinonide and hydroxyzine can be useful in treating pruritus, but their use should be guided by the specific context and cause of the itching, with hydroxyzine being considered for short-term use or in palliative settings due to its sedative properties 1. When considering the treatment of pruritus, it's essential to differentiate between localized and generalized itching, as well as the underlying cause. Fluocinonide, a high-potency topical corticosteroid, is effective for inflammatory skin conditions like eczema, psoriasis, or contact dermatitis that cause localized itching. For adults, fluocinonide 0.05% cream or ointment is typically applied thinly to affected areas 2-4 times daily for up to 2 weeks.
- Key considerations for fluocinonide use include:
- Potential for skin thinning with long-term use
- Limited to short-term application for inflammatory conditions
- Hydroxyzine, an oral antihistamine, is useful for generalized itching or when the cause is allergic in nature, with a typical adult dose of 25-50 mg 3-4 times daily.
- However, hydroxyzine's use should be limited to short-term or palliative settings due to its sedative properties, as recommended by recent guidelines 1.
- For generalized pruritus of unknown origin (GPUO), considerations include:
- Topical doxepin for limited use
- Topical clobetasone butyrate or menthol
- Nonsedative antihistamines like fexofenadine or loratadine
- Combination therapy with H1 and H2 antagonists
- Other systemic treatments like paroxetine, fluvoxamine, or gabapentin in specific cases 1.
From the FDA Drug Label
Fluocinonide Cream USP, 0.05%, Fluocinonide Cream USP, 0.05% (Emulsified Base), Fluocinonide Gel USP, 0.05% and Fluocinonide Ointment USP, 0.05% are indicated for the relief of the inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses. For use in the management of pruritus due to allergic conditions such as chronic urticaria and atopic and contact dermatoses and in histamine-mediated pruritus: adults, 25 mg t.i.d. or q.i.d.
- Fluocinonide is useful in pruritus, specifically for the relief of pruritic manifestations of corticosteroid-responsive dermatoses 2.
- Hydroxyzine is useful in pruritus, specifically for the management of pruritus due to allergic conditions and histamine-mediated pruritus 3.
From the Research
Efficacy of Fluocinnonid and Hydroxyzine in Pruritus
- Hydroxyzine has been found to be effective in managing pruritus, with a study showing significant improvement in symptoms and quality of life in patients with chronic pruritus due to dermatological causes 4.
- The study demonstrated that hydroxyzine significantly improved symptoms of pruritus and quality of life in patients over 12 weeks, with 48.34% of patients experiencing symptom relief leading to early termination.
- Another study found that selective serotonin re-uptake inhibitors, such as paroxetine and fluvoxamine, were effective in treating chronic pruritus, with 68.0% of patients experiencing a weak, good, or very good antipruritic effect 5.
- However, there is no direct evidence on the efficacy of fluocinnonid in pruritus, but hydroxyzine has been shown to be effective in combination with topical corticosteroids for pruritus in atopic dermatitis, with a synergistic effect observed when combined with topical steroids 6.
- Hydroxyzine is also used to treat pruritus associated with kidney failure, and its mechanisms of action and efficacy in advanced chronic disease have been reviewed 7.
Safety and Tolerability
- Hydroxyzine was found to be well tolerated in a real-world setting, with only 11 mild-to-moderate adverse events reported, including dizziness, constipation, drowsiness, dry mouth, and sedation 4.
- The adverse events resolved without any intervention, and there were no serious adverse events reported.
- Other studies have also reported adverse events associated with hydroxyzine, including sedation, dry mouth, and drowsiness, but these were generally mild and well tolerated 8.