What is the treatment for pruritis (itching) in pregnancy?

From the Guidelines

The treatment for pruritus in pregnancy should begin with non-pharmacological approaches and may include ursodeoxycholic acid (10-15mg/kg/day) for severe cases or specific conditions like intrahepatic cholestasis of pregnancy, as recommended by the most recent guidelines 1.

Non-Pharmacological Approaches

• Wearing loose cotton clothing
• Using mild soaps
• Taking cool baths with colloidal oatmeal
• Applying moisturizers

Pharmacological Treatment

• Topical treatments like calamine lotion, menthol 1% in aqueous cream, or low-potency corticosteroids (hydrocortisone 1%) for mild to moderate itching
• Oral antihistamines, such as diphenhydramine (25-50mg every 4-6 hours) or chlorpheniramine (4mg every 4-6 hours), for mild to moderate itching
• Ursodeoxycholic acid (10-15mg/kg/day) for severe pruritus or specific conditions like intrahepatic cholestasis of pregnancy, as supported by recent studies 1

Important Considerations

• Identify and treat any underlying causes of the itching, such as cholestasis, pemphigoid gestationis, or other dermatological conditions
• Severe or persistent itching should prompt medical evaluation, as it may indicate liver dysfunction or other pregnancy complications that require specific management
• The diagnosis of intrahepatic cholestasis of pregnancy is based on a serum bile acid level >10 mmol/L in the setting of pruritus, typically during the second or third trimester, and treatment should be offered with oral ursodeoxycholic acid in a total daily dose of 10–15 mg/kg, as recommended by the American Journal of Obstetrics and Gynecology 1

From the Research

Treatment Options for Pruritis in Pregnancy

• Conventional treatment includes ursodeoxycholic acid and cholestyramine 2
• Ondansetron, a 5-hydroxytryptamine 3 receptor antagonist antiemetic, has been shown to reduce pruritus of different etiologies including cholestasis 2
• Antipruritic treatments may include topical and systemic treatments, depending on the underlying aetiology of the pruritus and the stage and status of the skin 3, 4
• Systemic treatments such as systemic glucocorticosteroids, a restricted number of antihistamines and ultraviolet phototherapy may be necessary in severe and generalized forms of pruritus in pregnancy 4

Recommendations for Treatment

• Begin with topical treatment; emollient bath additives, moisturizing cream, talc 5
• If insufficient, a systemic treatment should be added, with antihistamines prescribed first: hydroxyzine or dexchlorpheniramine is used during the first 2 months, and from the third month, the same agents can be used, as can mequitazine 5
• The duration of treatment can be up to 10 days, with benzodiazepine (oxazepam) as second-line treatment 5

Considerations for Treatment

• The treatment of pruritus in pregnancy requires prudent consideration of whether the severity of the underlying disease warrants treatment and selection of the safest treatments available 4
• The use of topical and systemic treatments depends on the underlying aetiology of the pruritus and the stage and status of the skin 4
• Potential effects on the fetus must be considered when selecting treatments 4