What is the treatment for pruritic rash?

From the Guidelines

The treatment for pruritic rash depends on the underlying cause, but nonsedative antihistamines such as fexofenadine 180 mg or loratadine 10 mg are often considered as a first-line treatment 1.

Treatment Options

• Topical doxepin may be prescribed for a limited period of 8 days, with a maximum of 12 g daily 1.
• Emollients and self-care advice are recommended for patients with generalized pruritus of unknown origin (GPUO) 1.
• Menthol and clobetasone butyrate may be beneficial in some cases of GPUO 1.
• Sedative antihistamines such as hydroxyzine may be used in the short-term or palliative setting, but are not recommended for long-term use due to the risk of dementia 1.
• Acupuncture and acupressure may be considered as alternative therapies, although the evidence is limited 1.
• UVB phototherapy and PUVA may be effective in managing pruritus associated with certain conditions, such as cholestatic pruritus and aquagenic pruritus 1.

Specific Conditions

• Uraemic pruritus: BB-UVB is an effective treatment, and capsaicin cream may be considered 1.
• Hepatic pruritus: Rifampicin is recommended as a first-line treatment, and cholestyramine may be used as a second-line treatment 1.
• Neuropathic pruritus: Patients should be referred to a specialist for treatment 1.
• Psychogenic pruritus: Psychosocial and behavioural interventions may be beneficial, and NB-UVB may be considered 1.

From the Research

Treatment Options for Pruritic Rash

• The treatment for pruritic rash often depends on the underlying cause of the condition 2.
• For urticaria, which is primarily mediated by histamine, treatment with H1 antihistamines is effective, with second-generation, nonsedating antihistamines appearing to be more effective than sedating antihistamines 2.
• Other systemic pharmacologic options may be useful in nonhistamine-mediated disorders, such as immunomodulators for inflammation-induced pruritus or opiate antagonists for atopic dermatitis 2.
• Nonpharmacologic measures, such as proper skin care, and physical modalities, such as phototherapy or acupuncture, may also be helpful 2.

Specific Treatments for Different Conditions

• For atopic dermatitis, treatment options include topical anti-inflammatory therapies such as hydrocortisone (2.5%), triamcinolone (0.1%), or tacrolimus ointment, as well as systemic oral or injectable treatments such as dupilumab or methotrexate 3.
• For neuropathic chronic pruritus, treatment options include neuropathic topical treatments such as menthol, pramoxine, or lidocaine, as well as gabapentin, antidepressants such as sertraline or doxepin, or opioid receptor agonist/antagonists such as naltrexone or butorphanol 3.
• For pruritic papular eruption in HIV patients, narrow-band ultraviolet B phototherapy has been shown to be effective 4.

General Approach to Treatment

• A thorough history, review of symptoms, and laboratory evaluation should be performed to determine the underlying cause of the pruritic rash 3.
• Treatment should be tailored to the specific cause of the condition, with a focus on addressing the underlying pathophysiologic mechanisms 5.
• A variety of treatment approaches are available, including device-based physical therapies and medications that act on the itch-perception processing pathway from the skin, peripheral sensory nerves, the spinal cord, to the brain 5.