What is the treatment for severe pruritus (itching) induced by sunburn?

From the Guidelines

To treat severe itching induced by sunburn, apply cool compresses, take cool baths or showers, and use over-the-counter hydrocortisone cream (1%) to reduce inflammation and itching, as recommended by the most recent guidelines 1. When treating severe itching from sunburn, it's essential to prioritize methods that reduce inflammation and alleviate itching sensations.

• Cool baths or showers can help reduce the temperature of the skin, providing relief from itching and inflammation.
• Applying aloe vera gel or calamine lotion to the affected areas several times daily can also help soothe the skin and reduce itching.
• Over-the-counter hydrocortisone cream (1%) can be applied thinly 2-3 times per day for up to a week to reduce inflammation and itching, as supported by the 2024 American Heart Association and American Red Cross guidelines for first aid 1.
• Oral antihistamines like diphenhydramine (Benadryl) 25-50mg every 4-6 hours or non-drowsy options like cetirizine (Zyrtec) 10mg once daily can also help control itching, although their efficacy is still debated 1. It's crucial to stay hydrated by drinking plenty of water and avoid further sun exposure until healed, as well as wear loose, soft clothing to minimize irritation. If the sunburn is accompanied by severe blistering, fever, or signs of infection, or if symptoms don't improve within a few days, seek medical attention as prescription-strength treatments may be necessary.

From the FDA Drug Label

Uses temporarily relieves itching associated with minor skin irritations, inflammation, and rashes Directions for itching of skin irritation, inflammation, and rashes: adults and children 2 years of age and older: apply to affected area not more than 3 to 4 times daily Purpose Anti-itch

The treatment for severe itching induced by sunburn is not explicitly stated in the provided drug labels. However, based on the information available, hydrocortisone (TOP) can be used to temporarily relieve itching associated with minor skin irritations and inflammation.

• For adults and children 2 years of age and older, apply hydrocortisone (TOP) to the affected area not more than 3 to 4 times daily 2, 3. It is essential to note that sunburn is not explicitly mentioned in the drug labels, and therefore, the use of hydrocortisone (TOP) for this specific condition is not directly supported. Severe itching may require medical attention, and it is recommended to consult a doctor for proper evaluation and treatment 3.

From the Research

Treatment Options for Severe Itching Induced by Sunburn

• Topical corticosteroids, such as 0.1% methylprednisolone aceponate milk (MPA) and 0.1% hydrocortisone 17-butyrate emulsion (HCB), have been shown to be safe and effective in reducing sunburn reaction, including itching, in healthy volunteers 4.
• However, another study found that topical corticosteroid treatment did not provide a clinically useful decrease in acute sunburn reaction when applied 6 or 23 hours after UV exposure 5.
• A review of the literature on the management of acute sunburn suggests that symptomatic treatment of UV light-induced symptoms, including erythema, pain, and pruritus, is the most effective and practical approach, as there is no consensus on an algorithm for treatment 6.
• The use of oral nonsteroidal anti-inflammatory drugs (NSAIDs) and topical corticosteroids in combination has been shown to have a synergistic effect in reducing UVB-induced erythema and skin blood flow 7.
• Conservative local symptomatic treatment with adequate pain control is currently suggested, as there is a lack of demonstrated clinical efficacy of pharmacologic agents to eliminate sunburn or decrease healing time 8.

Key Findings

• Topical corticosteroids can reduce sunburn reaction, including itching, when applied promptly after UV exposure 4.
• The combination of oral NSAIDs and topical corticosteroids may be more effective than either treatment alone in reducing UVB-induced erythema and skin blood flow 7.
• Symptomatic treatment of UV light-induced symptoms is the most effective and practical approach to managing acute sunburn 6.