What is the best treatment for pruritus (itchiness) on the hands, specifically interdigital skin?

Treatment for Itchy Skin Between Fingers

For itchy pink skin between the fingers, a topical moderate-potency corticosteroid is the most effective first-line treatment, followed by oral antihistamines if needed. 1

Diagnostic Considerations

Before treatment, it's important to consider the likely causes of interdigital itching:

• Hand eczema/dermatitis - Most common cause of itchy skin between fingers
• Scabies - Can present with characteristic burrows in interdigital spaces 2
• Contact dermatitis - Either irritant or allergic
• Fungal infections - Can cause interdigital scaling and itching

Key physical findings to assess:

• Presence of vesicles or blisters
• Scaling or fissuring
• Redness (erythema)
• Skin thickening (lichenification)
• Excoriations from scratching

Treatment Algorithm

Step 1: First-Line Treatment

• Apply a moderate-potency topical corticosteroid such as mometasone furoate 0.1% ointment or betamethasone valerate 0.1% ointment twice daily for 2 weeks 1
  • Apply a thin layer only to affected areas
  • Ointment formulations are preferred for dry, fissured skin
  • Cream formulations may be more comfortable for weepy lesions

Step 2: If inadequate response after 2 weeks

• Continue topical corticosteroid AND add oral antihistamines 1
  • Non-sedating antihistamines (daytime): Loratadine 10mg daily or Fexofenadine 180mg daily 1
  • Sedating antihistamines (nighttime): Diphenhydramine 25-50mg or Hydroxyzine 25-50mg to help break the itch-scratch cycle 1

Step 3: For severe or persistent cases

• Consider topical calcineurin inhibitors like pimecrolimus 1% cream 3
  • Particularly useful for long-term management as they don't cause skin thinning
  • Apply twice daily to affected areas
• For intense, widespread, or constant itching that limits daily activities:
  • Consider GABA agonists like pregabalin (25-150mg daily) or gabapentin (900-3600mg daily) 1

Additional Supportive Measures

1. Moisturize regularly

   • Apply emollients after washing hands and throughout the day
   • Choose fragrance-free, hypoallergenic products

2. Avoid irritants

   • Wear cotton-lined gloves for wet work or when using detergents/chemicals
   • Use lukewarm (not hot) water for washing
   • Pat dry rather than rubbing

3. Consider topical anti-itch preparations

   • Products containing menthol 0.5% can provide temporary relief 1
   • Lotions containing urea or polidocanol may soothe itching 1

Common Pitfalls to Avoid

• Overuse of topical steroids - Can lead to skin thinning and tachyphylaxis; limit moderate-potency steroids to 2-4 weeks of continuous use
• Inadequate barrier protection - Failure to protect hands from irritants can perpetuate the condition 4
• Missing underlying causes - Consider patch testing if allergic contact dermatitis is suspected 4
• Ignoring infection - Secondary bacterial infection may require antibiotic treatment
• Using sedating antihistamines long-term - May increase risk of dementia; avoid except in short-term or palliative settings 1

When to Consider Referral

• No improvement after 4-6 weeks of treatment
• Suspicion of scabies or other infectious etiology
• Spreading beyond hands or worsening despite treatment
• Significant impact on daily activities or sleep

By following this structured approach, most cases of interdigital itching can be effectively managed with topical treatments and appropriate skin care.