What medications can be taken for pruritus skin?

Medications for Pruritic Skin

For pruritic skin, first-line treatment includes topical corticosteroids for mild to moderate cases, with oral antihistamines as adjunctive therapy for symptom relief. 1, 2

Topical Treatments

First-Line Options:

• Topical corticosteroids:
  • Low-potency (hydrocortisone 1-2.5%) for face 2, 3
  • Moderate-potency (mometasone furoate 0.1%, betamethasone valerate 0.1%) for body 1, 2
  • Apply 1-2 times daily for 2-3 weeks 2

Additional Topical Options:

• Topical antipruritic agents containing menthol 0.5% 1, 4
• Lotions containing urea or polidocanol 1
• Topical pramoxine or lidocaine (for neuropathic itch) 4

Systemic Treatments

Antihistamines:

• Non-sedating (second-generation) antihistamines:

  • Loratadine 10 mg daily 1, 5
  • Cetirizine 10 mg daily 2
  • Best for daytime use and first choice for systemic therapy 1

• Sedating (first-generation) antihistamines:

  • Diphenhydramine 25-50 mg daily 1
  • Hydroxyzine 25-50 mg daily 1
  • Best for nighttime use due to sedative properties 1, 2

Second-Line Options (for refractory cases):

• Antiepileptic agents:
  • Pregabalin 25-150 mg daily 1, 2
  • Gabapentin 900-3600 mg daily 1, 4
  • Particularly effective for neuropathic pruritus 4

Other Medications:

• Tricyclic antidepressant doxepin (topical or oral) 1, 4
• Aprepitant (NK-1 receptor antagonist) - for refractory cases 1
• Systemic corticosteroids (0.5-2 mg/kg daily) for severe, temporary relief 1
  • Short course of oral prednisone (0.5-1 mg/kg/day for 7 days with tapering over 2-3 weeks) 2

Treatment Algorithm Based on Severity

Mild or Localized Pruritus:

1. Topical moderate/high-potency corticosteroids 1
2. Reassess after 2 weeks; if not improving, proceed to next step

Moderate to Severe Pruritus:

1. Topical moderate/high-potency corticosteroids
2. Add oral antihistamines:
   • Non-sedating for daytime
   • Sedating for nighttime
3. If inadequate response after 2 weeks, add GABA agonists (pregabalin/gabapentin) 1, 2

Severe or Refractory Pruritus:

1. Consider short course of systemic corticosteroids
2. Add GABA agonists if not already using
3. Consider specialty referral if no improvement after 2 weeks 2

Important Considerations

Underlying Causes:

• Treat any underlying skin dryness with regular moisturizing 1, 2
• Assess for and treat any superadded infection 2
• Consider if pruritus is inflammatory, neuropathic, or mixed etiology 4

Pitfalls to Avoid:

• Antihistamines alone have limited efficacy in non-histamine mediated pruritus 6, 7
• Avoid hot showers, excessive soaps, alcohol-containing lotions 2
• Sedating antihistamines may impair driving or operating machinery 2
• Long-term use of high-potency topical steroids can cause skin atrophy

Monitoring:

• Reassess after 2 weeks to evaluate response 1, 2
• If symptoms worsen or don't improve, consider referral to dermatology 2

Remember that the etiology of pruritus often guides appropriate treatment selection, with histamine-mediated conditions responding better to antihistamines and neuropathic pruritus responding better to agents like gabapentin 8, 4.