From the Guidelines
Pruritus, or itching, can be effectively managed with a combination of topical and systemic approaches, with the most recent and highest quality evidence recommending rifampicin as first-line treatment for hepatic pruritus, and broadband UVB phototherapy for uraemic pruritus, as stated in the British Association of Dermatologists' guidelines 1. The treatment of pruritus depends on its underlying cause, and a thorough investigation is necessary to determine the best course of action.
- For patients with iron deficiency, iron replacement is recommended 1.
- For patients with liver disease, rifampicin is considered first-line treatment, with cholestyramine as second-line treatment, and sertraline as third-line treatment 1.
- For patients with uraemic pruritus, broadband UVB phototherapy is the treatment of choice, with onset of effect noticed from 2 weeks into treatment and lasting up to 7 months 1.
- For patients with neuropathic pruritus, referral to a specialist for treatment is recommended 1.
- For patients with psychological and emotional factors contributing to pruritus, psychosocial and behavioural interventions, including education, lifestyle interventions, relaxation techniques, and cognitive restructuring, may be beneficial 1. It is essential to note that the effectiveness of these treatments may vary depending on the individual patient and the underlying cause of their pruritus.
- Identifying and treating the underlying cause, whether it's dry skin, allergies, or systemic disease, is crucial for long-term relief.
- Avoiding triggers like hot showers, harsh soaps, and scratching is essential for management.
- Keeping fingernails short and wearing cotton clothing can prevent further skin damage. The British Association of Dermatologists' guidelines provide a comprehensive approach to the management of generalized pruritus in adults without an underlying dermatosis, and should be consulted for further guidance on treatment options 1.
From the Research
Treatment Options for Pruritus
The treatment of pruritus (itching) can be challenging due to its complex pathophysiology and various underlying causes. According to 2, a rational therapeutic ladder for symptomatic therapy is useful until the final diagnosis has been confirmed. The following are some treatment options for pruritus:
- Topical and systemic therapies addressing peripheral mediators, and a top-down approach targeting the brain and spinal cord, as mentioned in 3
- Device-based physical therapies, such as phototherapy, as discussed in 4
- Medications that act on the itch-perception processing pathway from the skin, peripheral sensory nerves, the spinal cord, to the brain, as mentioned in 4
- Symptomatic antipruritic treatment, as recommended in 5
- Psychological/psychotherapeutic treatment in case of an underlying or associated psychological or psychosomatic condition, as suggested in 5
- Prescription and over-the-counter (OTC) medications, herbal remedies, hydrotherapy, and ultraviolet therapy, as mentioned in 6
Approaches to Treatment
The approach to treating pruritus may vary depending on the underlying cause and the severity of the symptoms. According to 3, a combination of topical and systemic therapies may be preferable to a single agent approach. Additionally, 5 recommends an interdisciplinary approach, including diagnosis and management of the underlying disease, dermatological treatment of primary or secondary symptoms, symptomatic antipruritic treatment, and psychological/psychotherapeutic treatment.
Emerging Therapies
There are also emerging therapies for the treatment of pruritus, including novel antipruritic medications and targeted biologic agents, as discussed in 3 and 4. These new therapies aim to target specific receptors, neuropeptides, and cytokines involved in itch sensation and transmission, and may offer new hope for patients with chronic pruritus.