What medication is prescribed for itchy skin?

Management of Itchy Skin

For itchy skin, first-line treatment includes topical corticosteroids for mild to moderate cases, with oral antihistamines as adjunctive therapy for symptom relief. 1

Treatment Algorithm Based on Severity

Mild Itching (Localized)

• Topical treatments:

  • Apply topical corticosteroids:
    • For face: Low-potency (hydrocortisone 1-2.5%) 1, 2
    • For body: Moderate-potency (mometasone furoate 0.1%, betamethasone valerate 0.1%) 1
  • Apply 1-2 times daily for 2-3 weeks 1
  • Consider topical antipruritic agents containing menthol 0.5% 1
  • Use emollients regularly to prevent dry skin 1

• Oral medications:

  • Non-sedating antihistamines for daytime relief:
    • Loratadine 10 mg daily 1
    • Cetirizine 10 mg daily 1

Moderate Itching (Widespread or Intermittent)

• Continue topical treatments as above, but may increase to moderate/high-potency steroids for non-facial areas 1, 2
• Oral medications:
  • First-generation antihistamines for nighttime relief:
    • Diphenhydramine 25-50 mg daily 1, 3
    • Hydroxyzine 25-50 mg daily or at bedtime 1
  • Warn patients about sedative effects that may impair driving or operating machinery 1

Severe Itching (Intense, Widespread, Affecting Sleep or Daily Activities)

• Temporarily interrupt any causative medication if applicable 1
• Oral medications:
  • GABA agonists for refractory cases:
    • Pregabalin 25-150 mg daily 1
    • Gabapentin 900-3600 mg daily 1
  • Short course of oral corticosteroids for severe cases:
    • Prednisone 0.5-1 mg/kg/day for 7 days with tapering over 2-3 weeks 1, 2

Special Considerations

For Medication-Induced Itching

• If related to EGFR inhibitors or other targeted therapies:
  • Continue medication at current dose for grade 1-2 reactions 1
  • For grade 3 reactions, interrupt treatment until symptoms improve to grade ≤2 1
  • Apply emollients regularly according to body area guidelines 1

For Itching Associated with Skin Infections

• Assess for signs of superadded infection 1
• Consider topical antibiotics in alcohol-free formulations for at least 14 days 1
• For suspected bacterial infection, consider oral antibiotics (e.g., tetracycline for ≥2 weeks) 1

Important Caveats and Pitfalls

1. Topical corticosteroid use:

   • Avoid prolonged use of high-potency steroids on face, genitals, and intertriginous areas due to risk of skin atrophy 4
   • Use lower potencies and shorter durations in children 4
   • Do not use topical corticosteroids when infection is the known cause of the condition 5

2. Antihistamine effectiveness:

   • Antihistamines are most effective for histamine-mediated itching (like urticaria) 6
   • For non-histamine-mediated itching, sedating antihistamines may help break the itch-scratch cycle but won't directly treat the cause 6
   • Only a limited proportion of patients with EGFR inhibitor-related rash derive symptomatic benefit from antihistamines 1

3. Monitoring:

   • Reassess after 2 weeks to evaluate response 1
   • If symptoms worsen or don't improve, consider referral to dermatology 1
   • For chronic itching (>6 weeks), further investigation for underlying causes may be needed 6

By following this algorithm and considering the specific cause of itching, most patients can achieve significant symptom relief while minimizing adverse effects from treatments.