How to manage pruritis (itching) in a hospital setting?

From the Guidelines

Management of pruritus in a hospital setting should prioritize identifying and treating the underlying cause, while providing symptomatic relief with non-pharmacological measures and pharmacological treatments tailored to the individual patient's condition and comorbidities.

Non-Pharmacological Measures

• Keeping the patient's skin moisturized with emollients
• Maintaining a cool room temperature
• Using mild soaps
• Ensuring patients wear loose cotton clothing

Pharmacological Management

• Topical treatments like menthol 1% in aqueous cream or calamine lotion can provide immediate relief
• Antihistamines are effective for histamine-mediated pruritus, with options including diphenhydramine (25-50mg every 6 hours), hydroxyzine (25mg every 6 hours), or non-sedating alternatives like cetirizine (10mg daily) or fexofenadine (180mg daily) 1
• For moderate to severe pruritus, gabapentin (starting at 300mg daily, increasing to 300mg three times daily) or pregabalin (starting at 75mg twice daily) may be effective, particularly for neuropathic itch
• Severe cases might require short courses of systemic corticosteroids like prednisolone (20-30mg daily for 5-7 days)

Specific Conditions

• For uremic pruritus in renal patients, optimizing dialysis and using UVB phototherapy can help 1
• Cholestatic pruritus responds to cholestyramine (4g three times daily) or rifampicin (150mg twice daily) 1
• In patients with generalized pruritus associated with HIV, consider indomethacin 25 mg three times per day, orally, or hypnosis to relieve itch 1

Key Considerations

• Pruritus management should be tailored to the individual patient, considering the cause, comorbidities, and potential drug interactions
• Regular reassessment of treatment efficacy is crucial to adjust the management plan as needed
• The most recent and highest quality studies, such as those published in 2018 by the British Association of Dermatologists 1, should guide treatment decisions to ensure optimal outcomes for patients with pruritus in hospital settings.

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

To manage pruritis (itching) in a hospital setting, hydrocortisone cream can be applied to the affected area not more than 3 to 4 times daily for adults and children 2 years of age and older. For external anal and genital itching, clean the affected area with mild soap and warm water and rinse thoroughly before applying the cream. It is recommended to gently dry the area by patting or blotting with toilet tissue or a soft cloth before application. For children under 2 years of age or under 12 years of age for external anal and genital itching, consult a doctor for advice 2 2.

From the Research

Management of Pruritus in a Hospital Setting

To manage pruritus in a hospital setting, it is essential to identify and treat the underlying cause of the itch. The following are some strategies that can be employed:

• Identify the underlying cause of pruritus, which can be localized or systemic 3
• Avoid frequent bathing, especially when xerosis plays a role, and use topical emollients or short-term therapy with low-potency steroids 3
• Use oral antihistamines to provide nonspecific relief for patients with intractable pruritus 3
• Employ a rational therapeutic ladder for symptomatic therapy until the final diagnosis has been confirmed 4
• Consider the pathophysiology of the itch and its underlying disease when developing a treatment strategy 4

Therapeutic Options

The following therapeutic options can be considered:

• Topical anti-inflammatory therapies such as hydrocortisone (2.5%), triamcinolone (0.1%), or tacrolimus ointment for inflammatory chronic pruritus 5
• Neuropathic topical treatments such as menthol, pramoxine, or lidocaine for neuropathic pruritus 5
• Systemic oral or injectable treatments such as dupilumab or methotrexate for patients who do not respond to topical therapies 5
• Gabapentin, antidepressants such as sertraline or doxepin, or opioid receptor agonist/antagonists such as naltrexone or butorphanol for neuropathic pruritus 5

Nursing Care and Management

Nursing care and management of patients with pruritus involve:

• Good history taking to identify the underlying cause of pruritus 6
• Topical treatments and measures to alleviate the patient's symptoms, such as avoiding frequent bathing and using topical emollients 6
• Providing education and support to patients to manage their symptoms and improve their quality of life 6