From the Guidelines
Oral medications such as antihistamines, corticosteroids, and other systemic agents like doxepin and aprepitant are used to treat pruritus associated with skin rashes, with the choice of medication depending on the severity and underlying cause of the rash. When considering treatment options, it's essential to weigh the potential benefits and risks of each medication.
- Antihistamines, such as diphenhydramine (Benadryl) 25-50mg every 4-6 hours or hydroxyzine (Atarax) 25-50mg every 6-8 hours, are effective for mild to moderate pruritus due to their sedating properties 1.
- Second-generation antihistamines like cetirizine (Zyrtec) 10mg daily, loratadine (Claritin) 10mg daily, or fexofenadine (Allegra) 180mg daily may be preferred for daytime use as they cause less drowsiness 1.
- For severe or widespread rashes, oral corticosteroids like prednisone (typically 20-60mg daily for 5-14 days with a tapering schedule) may be necessary, as they reduce inflammation and suppress the immune response that triggers itching 1.
- In chronic cases, other medications such as gabapentin (starting at 300mg daily and gradually increasing) or doxepin (10-25mg at bedtime) might be considered, as they have been shown to be effective in managing pruritus in various studies 1.
- Aprepitant, a neurokinin-1 (NK-1) receptor antagonist, has also been reported to reduce pruritus related to certain medications, and may be considered as an alternative treatment option 1. It's crucial to identify and treat the underlying cause of the rash while managing symptoms, and patients should be aware of potential side effects associated with these medications, such as drowsiness, dry mouth, and blurred vision with antihistamines, and side effects with prolonged use of corticosteroids 1.
From the FDA Drug Label
DESCRIPTION PredniSONE Tablets contain prednisone which is a glucocorticoid. The oral medication used to treat pruritus (itching) associated with a skin rash is prednisone (PO), a glucocorticoid 2.
- Key points:
- Prednisone is a glucocorticoid that can be used to treat itching associated with skin rashes.
- It is available in various strengths, including 1 mg, 2.5 mg, 5 mg, 10 mg, and 20 mg tablets. Note that loratadine (PO) 3 is an antihistamine, but there is no information in the provided drug label that directly supports its use for treating pruritus associated with a skin rash.
From the Research
Oral Medications for Pruritus with Skin Rash
- Antihistamines, such as H1 antihistamines, are commonly used to treat pruritus, although they are not licensed for this purpose and have limited efficacy in many cases 4.
- Oral antihistamines are not recommended for treating pruritus in atopic dermatitis as they do not reduce pruritus 5.
- However, some studies suggest that H1-antihistamines may have a synergistic effect when combined with topical steroids in treating pruritus in atopic dermatitis 6.
- Loratadine, a type of antihistamine, has been shown to have a therapeutic effect on pruritus in patients with atopic dermatitis 7.
- Other oral medications, such as azathioprine, may be used as steroid-sparing agents in the treatment of chronic pruritus, particularly in cases of urticarial dermatitis 8.
Specific Oral Medications
- Loratadine: may be effective in reducing pruritus in patients with atopic dermatitis 7.
- Azathioprine: may be used as a steroid-sparing agent in the treatment of chronic pruritus, particularly in cases of urticarial dermatitis 8.
- Non-sedating antihistamines: may be effective in treating chronic pruritus, particularly when used in high doses 4.