What treatment can be given in a hospital setting for severe pruritis of the groin?

From the Guidelines

Severe pruritus of the groin in a hospital setting can be treated with oral antihistamines such as loratadine 10mg daily for daytime relief, and diphenhydramine 25-50mg daily or hydroxyzine 25-50mg daily for nighttime relief due to their sedative properties. When considering treatment options, it's essential to prioritize those that address the underlying causes of pruritus while providing symptomatic relief.

• Topical corticosteroids and antifungal creams may be used to reduce inflammation and treat fungal infections, but the primary focus should be on systemic therapies that can provide immediate relief from itching.
• According to the most recent guidelines 1, non-sedating antihistamines like loratadine are recommended as the first choice for systemic therapy during the daytime, while first-generation antihistamines like diphenhydramine and hydroxyzine may be considered for nighttime use due to their sedative effects.
• Other treatment options, such as tricyclic antidepressants and neurokinin-1 receptor antagonists, may be considered for refractory cases, but the evidence for these treatments is less robust 1.
• Ultimately, the goal of treatment should be to reduce morbidity, mortality, and improve quality of life by providing effective relief from pruritus and addressing the underlying causes of the condition.
• In a hospital setting, it's crucial to prioritize treatments that are evidence-based and have the strongest support from recent, high-quality studies, such as the use of antihistamines for severe pruritus of the groin 1.

From the FDA Drug Label

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 children under 2 years of age: ask a doctor for external anal and genital itching, adults: when practical, clean the affected area with mild soap and warm water and rinse thoroughly gently dry by patting or blotting with toilet tissue or a soft cloth before applying apply to affected area not more than 3 to 4 times daily children under 12 years of age: ask a doctor

Hydrocortisone cream can be given in a hospital setting for severe pruritis of the groin. The treatment involves applying the cream to the affected area not more than 3 to 4 times daily. It is recommended to clean the affected area with mild soap and warm water and gently dry before applying the cream. For children under 12 years of age, a doctor should be consulted before administering the treatment 2.

From the Research

Treatment Options for Severe Pruritis of the Groin in a Hospital Setting

• Topical corticosteroids can be used to treat severe pruritis of the groin, as they are effective in reducing inflammation and itching 3.
• However, long-term use of topical corticosteroids can lead to suppressive effects on the connective tissue, such as skin atrophy or resistance to therapy 4.
• Topical noncorticosteroid immunomodulators, such as tacrolimus and pimecrolimus, can be used as an alternative to topical corticosteroids, as they have been shown to be effective in treating atopic dermatitis with minimal side effects 4.
• Antihistamines, such as hydroxyzine and cetirizine, can be used to relieve itching, but they can also cause cutaneous drug eruptions in some patients 5.
• Ceramide-containing formulations with 1% pramoxine hydroxide can provide rapid and long-lasting relief of itching, and are well-tolerated with aesthetic appeal 6.
• Intravenous corticosteroids, such as dexamethasone, may not be effective in improving the treatment of severe pruritus from uncomplicated acute urticaria, and may even be associated with persistent urticaria activity 7.

Considerations for Treatment

• The choice of treatment should be based on the severity of the pruritis, the patient's medical history, and the potential side effects of the treatment.
• Topical treatments, such as topical corticosteroids and ceramide-containing formulations, may be preferred over systemic treatments, such as antihistamines and intravenous corticosteroids, due to their targeted action and minimal side effects.
• Patients should be monitored for potential side effects, such as skin atrophy, resistance to therapy, and cutaneous drug eruptions, and the treatment should be adjusted accordingly.