From the Guidelines
The management of pruritus according to the National Institute for Health and Care Excellence (NICE) guidelines involves a stepwise approach, starting with identifying and treating the underlying cause, and considering various treatment options based on the underlying condition, such as iron replacement for iron deficiency, venesection or desferrioxamine infusion for iron overload, and specific treatments for lymphoma, polycythaemia vera, solid cancers, uraemia, liver disease, neuropathy, and psychological and emotional factors 1. The guidelines recommend a personalized approach, taking into account the underlying cause of pruritus, and considering various treatment options, including:
- Topical treatments, such as emollients and menthol, to maintain skin hydration and reduce itching
- Antihistamines, with non-sedating options preferred for daytime use and sedating antihistamines useful at night to help with sleep disturbance
- Topical corticosteroids for more severe or persistent pruritus
- Specific treatments for underlying conditions, such as:
- Iron replacement for iron deficiency
- Venesection or desferrioxamine infusion for iron overload
- Cimetidine, carbamazepine, gabapentin, or mirtazapine for lymphoma
- Cytoreductive therapy, aspirin, interferon-a, SSRIs, PUVA, UVB phototherapy, cimetidine, or atenolol for polycythaemia vera
- Paroxetine, mirtazapine, granisetron, or aprepitant for solid cancers
- Ensure adequate dialysis, normalize calcium-phosphate balance, control parathyroid hormone, correct anaemia with erythropoietin, and use simple emollients for uraemia
- Rifampicin as first-line treatment, cholestyramine as second-line treatment, and sertraline as third-line treatment for liver disease The guidelines also emphasize the importance of practical advice, such as avoiding triggers, wearing loose cotton clothing, and keeping fingernails short to minimize skin damage from scratching 1. In terms of specific treatment options, the guidelines recommend considering nonsedative antihistamines, such as fexofenadine or loratadine, as first-line treatment, and sedative antihistamines, such as hydroxyzine, as second-line treatment 1. Additionally, the guidelines suggest considering gabapentin or pregabalin for neuropathic pruritus or where other treatments have failed 1. Overall, the management of pruritus according to NICE guidelines involves a personalized and stepwise approach, taking into account the underlying cause and considering various treatment options to relieve symptoms and improve quality of life.
From the Research
Guidelines for Managing Pruritus
The guidelines for managing pruritus are not explicitly stated by the National Institute for Health and Care Excellence (NICE) in the provided studies. However, the following general guidelines can be inferred:
- Diagnosis and management of the underlying disease [(2,3,4,5)]
- Dermatological treatment of primary or secondary symptoms, such as dry skin or scratch lesions [(2,4,5)]
- Symptomatic antipruritic treatment, including topical corticosteroids, gabapentinoids, antidepressants, and mu-opioid-receptor antagonists 2
- Psychological or psychotherapeutic treatment in case of an underlying or associated psychological or psychosomatic condition [(4,5)]
- Interdisciplinary approach to diagnosis and therapy, including medical care and management of treatment and adverse events [(4,5)]
Treatment Options
Some treatment options for pruritus include:
- Emollients and topical corticosteroids 2
- Systemic therapies, such as gabapentinoids, antidepressants, and mu-opioid-receptor antagonists 2
- Novel agents, including systemic monoclonal antibodies, neurokinin-1 receptor antagonists, and opioid receptor modulators 2
- Prescription and over-the-counter medications, herbal remedies, hydrotherapy, phototherapy, and ultraviolet therapy 3