From the Guidelines
For a 79-year-old female experiencing itching, I recommend starting with a gentle skin care approach, including moisturizing with fragrance-free lotions like CeraVe or Eucerin, and considering topical moderate-potency steroids or oral antihistamines like cetirizine 10mg once daily, as suggested by the most recent guidelines 1. When managing pruritus in older adults, it's essential to consider the potential for dry skin, medication side effects, or underlying medical conditions that may be contributing to the itching.
- The British Association of Dermatologists' guidelines for the investigation and management of generalized pruritus in adults without an underlying dermatosis 1 provide recommendations for relieving itch, including nonsedative antihistamines, sedative antihistamines, and other medications like paroxetine, fluvoxamine, and gabapentin.
- However, the most recent guidelines from the ESMO clinical practice guidelines 1 suggest a more tailored approach, considering the severity of pruritus and recommending gentle skin care, topical moderate-potency steroids, and oral antihistamines or GABA agonists for more intense or widespread itching.
- Additionally, the SITC toxicity management working group guidelines 1 provide recommendations for managing pruritus associated with immune checkpoint inhibitors, including topical corticosteroids, oral antihistamines, and oral corticosteroids for more severe cases.
- Given the potential for medication side effects and interactions in older adults, it's crucial to carefully evaluate the underlying cause of itching and consider the most appropriate treatment approach, prioritizing gentle skin care and topical or oral medications as needed, and monitoring for any changes in severity or response to treatment 1.
From the FDA Drug Label
Uses temporarily relieves itching associated with minor skin irritations, inflammation, and rashes due to: eczema psoriasis poison ivy, oak, sumac insect bites detergents jewelry cosmetics soaps seborrheic dermatitis temporarily relieves external anal and genital itching Directions for itching of skin irritation, inflammation, and rashes: adults and children 2 years of age and older: apply to affected area not more than 3 to 4 times daily The treatment for pruritus in a 79-year-old female is to apply hydrocortisone (TOP) to the affected area not more than 3 to 4 times daily 2 2.
- Key considerations:
- The patient should follow the directions for use as indicated on the label.
- If the itching persists, the patient should consult a doctor for further advice and supervision.
From the Research
Treatment Options for Pruritus
The treatment for pruritus in a 79-year-old female can be challenging due to the high rates of comorbidities and polypharmacy in elderly patients 3. The following treatment options are available:
- Emollients for dry skin
- Topical therapies
- Phototherapy
- Systemic agents for CP of various origins
Initial Treatment Approach
For multimorbid patients, topical substances and phototherapy constitute the best initial options 3. If systemic drugs are needed, the potential side-effects need to be closely monitored.
Step-Wise Symptomatic Therapy
In cases where the origin of pruritus remains unknown, a step-wise symptomatic therapy is recommended 3. The therapeutic choices should be made on an individual basis after carefully outweighing possible risks and benefits.
Novel Agents
Novel agents such as neurokinin-1 receptor antagonists and opioid-targeting drugs show promising antipruritic effects on refractory CP and seem to be well tolerated 3. They may be useful for elderly patients who cannot tolerate conventional systemic agents.
Other Treatment Modalities
Other treatment modalities for pruritus include:
- Antihistamines, which can provide relief of pruritus by central sedation, and can also be used therapeutically for concomitant allergic conditions associated with AD 4
- Phototherapy, which is an effective treatment modality for many types of pruritus, and can reduce itch through immune suppression and/or neural modulation 5
- Device-based physical therapies, such as phototherapy, and medications that act on the itch-perception processing pathway from the skin, peripheral sensory nerves, the spinal cord, to the brain 6