What medication can be used to relieve itching?

Medications for Relieving Itching

For itching relief, topical corticosteroids such as hydrocortisone 1% cream are the first-line treatment, with oral antihistamines as effective adjunctive therapy, especially for moderate to severe cases. 1, 2, 3

First-Line Topical Treatments

Topical Corticosteroids

• Mild to moderate itching: Hydrocortisone 1% cream or ointment applied 1-2 times daily 3
• Moderate to severe itching: Higher potency corticosteroids such as:
  • Mometasone furoate 0.1% ointment
  • Betamethasone valerate 0.1% ointment 1, 2

Application Guidelines

• Apply a thin layer to affected areas
• For facial application: Use only low-potency hydrocortisone to avoid skin atrophy 2
• For scalp application: Solutions or foams penetrate better than creams 2
• Duration: Use for short periods (1-2 weeks) to minimize side effects 4

Other Topical Options

• Menthol 0.5% containing products 1, 2
• Lotions containing urea or polidocanol 1
• Pramoxine 1% (topical anesthetic) for rapid relief 5

Systemic Treatments

Oral Antihistamines

• For daytime use: Non-sedating second-generation antihistamines
  • Loratadine 10mg daily
  • Fexofenadine 180mg daily 1, 2
• For nighttime itching: First-generation antihistamines with sedative properties
  • Diphenhydramine 25-50mg
  • Hydroxyzine 25-50mg 1, 2

Second-Line Systemic Options

• GABA agonists for refractory itching:
  • Pregabalin 25-150mg daily
  • Gabapentin 900-3600mg daily 1, 2
• Other options for severe or refractory cases:
  • Doxepin (tricyclic antidepressant with antihistamine properties)
  • Selective serotonin reuptake inhibitors (paroxetine, fluvoxamine, sertraline)
  • Combination of H1 and H2 antagonists (e.g., fexofenadine with cimetidine) 2
  • Short courses of systemic corticosteroids (0.5-2mg/kg daily) for severe cases 1

Treatment Algorithm Based on Severity

Mild Itching

1. Hydrocortisone 1% cream applied 1-2 times daily
2. Add non-sedating antihistamine if needed

Moderate Itching

1. Moderate-potency topical corticosteroid (mometasone 0.1%)
2. Non-sedating antihistamine for daytime
3. First-generation antihistamine for nighttime if sleep is affected

Severe or Widespread Itching

1. Potent topical corticosteroid
2. Combination of non-sedating and sedating antihistamines
3. Consider GABA agonists if inadequate response
4. Consider short course of oral corticosteroids for severe cases

Special Considerations

Cause-Specific Treatment

• Contact dermatitis (poison ivy, oak, sumac): Immediate washing with soap and water can remove oils and reduce symptoms 1
• Dry skin-related itching: Regular application of emollients 1, 2
• Cancer therapy-induced itching: May require specialized approach with combination therapy 1

Important Caveats

• Topical corticosteroid limitations: Application to positive allergy skin test sites does not provide immediate itch relief 6
• Risk of skin thinning: Higher with prolonged use of potent corticosteroids; use lowest effective potency 4
• Elderly patients: Avoid sedating antihistamines; prefer high lipid content moisturizers 2
• Treatment duration: Reassess after 2 weeks; if no improvement, consider alternative diagnosis or referral to dermatology 2

Efficacy Evidence

• Moderate-potency topical corticosteroids are probably more effective than mild ones (52% vs 34% treatment success) 4
• Potent topical corticosteroids show greater efficacy compared to mild ones (70% vs 39% treatment success) 4
• Once-daily application of potent topical corticosteroids is as effective as twice-daily application 4
• Topical corticosteroids may reduce wheal size in urticaria (ratio of means 0.47,95% CI 0.38-0.59) 7

By following this evidence-based approach to treating itching, clinicians can provide effective symptom relief while minimizing potential adverse effects of medications.