What treatments are used for itching?

From the Guidelines

For itching, the most effective treatment is often a combination of topical and oral medications, as well as non-medicinal approaches, with the goal of reducing symptoms and improving quality of life. The choice of treatment depends on the underlying cause and severity of the itching. For mild itching, over-the-counter antihistamines like diphenhydramine (Benadryl) 25-50mg every 6 hours, cetirizine (Zyrtec) 10mg daily, or loratadine (Claritin) 10mg daily can provide relief, as noted in various studies 1. Topical treatments such as calamine lotion, hydrocortisone cream (0.5-1%) applied 2-3 times daily, or moisturizers containing colloidal oatmeal can also soothe itchy skin.

For more severe itching, prescription medications may be necessary, including stronger corticosteroid creams, immunomodulators like tacrolimus ointment, or oral medications such as higher-dose antihistamines or corticosteroids. Non-medicinal approaches are also important: keeping fingernails short to prevent skin damage from scratching, wearing loose cotton clothing, using mild soaps, taking cool showers, and applying cold compresses. Itching occurs when nerve endings in the skin are stimulated by histamine and other inflammatory chemicals released during allergic reactions, skin conditions, or systemic diseases, which is why antihistamines and anti-inflammatory medications are effective, as discussed in 1.

Identifying and treating the underlying cause of itching, whether it's dry skin, allergies, eczema, psoriasis, or other conditions, is crucial for long-term relief. In some cases, such as cholestasis-associated pruritus, specific treatments like bezafibrate or rifampicin may be recommended, as seen in 1. The most recent and highest quality study, 1, suggests that the combination of systemic corticosteroids and high-potency topical corticosteroids can reduce the duration of itching, highlighting the importance of a multi-faceted approach to treating itching.

Some key considerations in managing itching include:

• Using emollients to prevent dryness of skin
• Avoiding hot baths or showers
• Using cooling gels (e.g., menthol gels) for affected skin areas
• Keeping nails shortened
• Considering alternative treatments like bezafibrate for specific conditions, as noted in 1
• Using antihistamines or other medications as needed for symptom relief, as discussed in 1.

Overall, the treatment of itching should be tailored to the individual patient's needs and underlying condition, with a focus on reducing symptoms and improving quality of life.

From the FDA Drug Label

Uses temporarily relieves itching associated with minor skin irritations, inflammation, and rashes due to: eczema psoriasis poison ivy, oak, sumac insect bites detergents jewelry cosmetics soaps seborrheic dermatitis temporarily relieves external anal and genital itching 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 For itching, we use hydrocortisone (TOP), which can be applied to the affected area not more than 3 to 4 times daily for skin irritation, inflammation, and rashes due to various causes, including:

• Eczema
• Psoriasis
• Poison ivy, oak, sumac
• Insect bites
• Detergents
• Jewelry
• Cosmetics
• Soaps
• Seborrheic dermatitis It can also be used for external anal and genital itching 2 2

From the Research

Treatments for Itching

• Topical therapies, such as emollients, mild cleansers, topical anaesthetics, steroids, calcineurin inhibitors, and coolants (menthol) are used as first-line treatments for itch 3
• Systemic therapies, such as non-sedating antihistamines, sedating antihistamines, anticonvulsants, antidepressants, mu-opioid antagonists, kappa-opioid agonists, and phototherapy, can be used to treat chronic itch, depending on the cause of the itch 3
• Antihistamines that block the activation of the histamine H₁receptor, H₁R, have been shown to be effective therapeutics for the treatment of pruritus associated with urticaria, allergic rhinitis, and allergic conjunctivitis 4
• H₁-receptor antagonists are the first-line drugs for urticarias, and H₂-receptor antagonists may be added for refractory patients 5
• Oral H1 antihistamines as 'add-on' therapy to topical treatment for eczema may lead to a small reduction in patient-assessed symptoms of pruritus, but the evidence is limited due to poor study design and imprecise results 6

Safety Considerations

• Topical diphenhydramine can be lethal in rare instances, especially in children, due to its potential for toxicity 7
• Antihistamines can have side effects, such as somnolence, anticholinergic effects, and sedation, especially in conventional H1-blockers 5
• New antihistamines without depressive effects on the central nervous system have been introduced to minimize these side effects 5