What is the treatment for itching caused by diabetes?

Treatment of Itching Caused by Diabetes

The first-line treatment for itching caused by diabetes is regular use of moisturizing emollients combined with proper skin care, as dry skin (xerosis) is the most common cause of diabetic pruritus. 1

Understanding Diabetic Pruritus

Itching is a common but often underestimated problem in diabetes, affecting approximately 18.4% to 27.5% of diabetic patients 2. Two main factors contribute to diabetic pruritus:

1. Skin xerosis (dry skin)
2. Diabetic polyneuropathy 2

Treatment Algorithm

First-Line Treatments

1. Moisturizing Therapy

   • Apply emollients at least once daily to affected areas 1
   • Consider urea-based creams, particularly for foot care 3
   • Avoid alcohol-containing lotions which may worsen skin dryness 1

2. Proper Skin Care

   • Use mild soaps for gentle skin cleansing 1
   • Avoid hot showers which can exacerbate skin dryness 1
   • Maintain good glycemic control to reduce overall skin complications

Second-Line Treatments

If moisturizing therapy is insufficient:

1. Topical Treatments

   • Apply low to moderate-potency topical corticosteroids for limited periods (2-3 weeks) 1
     • Face: hydrocortisone 1-2.5%
     • Body: mometasone furoate 0.1% or betamethasone valerate 0.1%
   • Consider topical antipruritic agents containing menthol 0.5% 1
   • Capsaicin cream: Apply a thin film 3-4 times daily to affected areas 4

2. Oral Medications

   • Non-sedating antihistamines for daytime relief: loratadine 10mg or cetirizine 10mg daily 1
   • First-generation antihistamines for nighttime relief: diphenhydramine 25-50mg or hydroxyzine 25-50mg 1
   • For severe cases, consider GABA agonists like pregabalin (25-150mg daily) or gabapentin (900-3600mg daily) 1, 5

For Refractory Cases

• Consider P2Y12 receptor antagonists like ticagrelor, which has shown promise in research settings for treating diabetic pruritus 6
• Evaluate for other causes of pruritus that may coexist with diabetes
• Consider referral to dermatology if symptoms persist despite adequate treatment 1

Special Considerations

For Elderly Diabetic Patients

When treating elderly diabetic patients with pruritus, be mindful that strict glucose control may not be necessary, especially in palliative care situations 7. Focus on comfort, prevention of distressing symptoms, and preservation of quality of life 7.

For Patients with Diabetic Neuropathy

In patients with diabetic polyneuropathy-related itching, neurogenic treatments may be more effective than traditional antipruritic treatments. Consider gabapentin or pregabalin as they target neuropathic pathways 1, 5.

For Patients Using Diabetes Technology

Be aware that continuous glucose monitoring (CGM) devices and insulin pumps can cause skin irritation and itching in up to 74.5% of users, which may increase diabetes-related emotional distress 8. Regular site rotation and proper skin care at insertion sites are essential.

Monitoring and Follow-up

• Reassess after 2 weeks to evaluate treatment response 1
• Monitor for signs of skin infection, which can complicate diabetic pruritus
• Consider regular foot examinations as part of comprehensive skin care in diabetes 7

Prevention

• Maintain good glycemic control
• Regular skin moisturizing
• Proper foot care, including daily inspection for any skin changes 7
• Avoid irritating fabrics and harsh soaps
• Stay well-hydrated

By addressing both the dermatological and neurological components of diabetic pruritus with appropriate skin care and targeted treatments, most patients can achieve significant relief from this bothersome symptom.