What are the treatment options for itching?

From the Guidelines

For itching treatment, the most effective approach is to start with simple self-care advice, such as keeping nails short, using emollients, and avoiding irritants, followed by a short trial of a nonsedating antihistamine if warranted, as recommended by the British Association of Dermatologists' guidelines 1. When considering treatment options for itching, it's essential to differentiate between mild and persistent itching. For mild itching, non-medication approaches can be effective, including:

• Avoiding irritants
• Using fragrance-free moisturizers
• Taking cool baths with colloidal oatmeal
• Wearing loose cotton clothing Over-the-counter options can also be considered, such as:
• Antihistamines like diphenhydramine (Benadryl) 25-50mg every 4-6 hours or cetirizine (Zyrtec) 10mg daily
• Topical treatments like calamine lotion, 1% hydrocortisone cream applied thinly 2-3 times daily for up to two weeks, or menthol/pramoxine creams For persistent itching, prescription options may be necessary, including:
• Stronger corticosteroid creams
• Immunomodulators like tacrolimus ointment
• Oral medications such as higher-dose antihistamines or gabapentin for neuropathic itch It's crucial to treat the underlying cause of itching, such as dry skin, allergies, or skin conditions, to achieve long-term relief, as scratching can damage the skin and create a cycle of more inflammation and itching 1. In specific cases, such as intrahepatic cholestasis of pregnancy, ursodeoxycholic acid (UDCA) is the recommended first-line treatment for maternal symptoms of pruritus, with a typical starting dose of 10-15 mg/kg per day, divided into 2 or 3 daily doses 1.

From the FDA Drug Label

Uses • Temporarily relieves these symptoms due to hay fever or other respiratory allergies: • runny nose • sneezing • itchy, watery eyes • itching of the nose or throat The treatment options for itching include diphenhydramine (PO), which can temporarily relieve itching of the nose or throat due to hay fever or other respiratory allergies 2.

• Key uses: temporarily relieves itching symptoms
• Specific areas: itching of the nose or throat

From the Research

Itching Treatment Options

• The treatment of itching can involve a combination of topical anti-inflammatory drugs and moisturizers, as seen in a study published in 2024 3, which found that the combined use of these treatments improved clinical findings and quality of life in patients with mild-to-moderate atopic dermatitis.
• Antihistamines are also commonly used to treat itching, although their efficacy is not universally supported by evidence, with some studies suggesting that they may not be effective in reducing itch in patients with atopic dermatitis 4, 5.
• Moisturizers containing specific ingredients, such as maltotetraose, have been shown to be effective in relieving itching and improving skin hydration in patients with dry, itchy, and sensitive skin 6.
• Topical antihistamines, such as doxepin, have been demonstrated to be effective in reducing pruritus in some studies, although the evidence for other topical antihistamines is mixed 7.

Treatment Considerations

• The choice of treatment for itching will depend on the underlying cause of the itch, as well as the individual patient's needs and medical history.
• A combination of treatments, such as topical anti-inflammatory drugs and moisturizers, may be more effective than a single treatment approach.
• Patients with atopic dermatitis or other skin conditions may require ongoing treatment and management to control their symptoms and prevent flare-ups.

Emerging Treatments

• Research into the mechanisms underlying itching is ongoing, and new treatments are being developed to target specific pathways and receptors involved in itch perception 5, 6.
• The use of substance P and neurokinin 1 receptor (NK1R) inhibitors is being explored as a potential treatment for chronic itching 6.