What is the recommended treatment for generalized body itchiness?

Management of Generalized Body Itchiness

For generalized body itchiness, first-line treatment includes topical corticosteroids such as hydrocortisone 1% cream for mild to moderate pruritus, along with non-sedating antihistamines such as fexofenadine 180mg, loratadine 10mg, or cetirizine 10mg daily. 1

Diagnostic Approach

Before initiating treatment, it's important to determine if the pruritus is:

• Primary (with visible skin lesions) → Treat underlying dermatological condition
• Secondary (without visible skin lesions) → Investigate systemic causes

Essential investigations include:

• Complete blood count
• Liver function tests
• Urea and electrolytes
• Thyroid function tests 1

Treatment Algorithm

First-Line Treatments

1. Topical Therapies

   • Topical corticosteroids (first-line for mild-moderate pruritus) 1
     • Hydrocortisone 1% cream applied to affected areas 3-4 times daily 2
     • Limit application duration to avoid skin thinning
   • Emollients and moisturizers (especially for elderly patients) 1
   • Topical coolants containing menthol 3

2. Systemic Therapies

   • Non-sedating H1-antihistamines 1, 4
     • Fexofenadine 180mg daily
     • Loratadine 10mg daily
     • Cetirizine 10mg daily

Second-Line Treatments

1. For persistent pruritus:

   • Increase antihistamine dosage up to 4 times the standard dose 4
   • Gabapentin (900-3600mg daily) or pregabalin (25-150mg daily) - particularly beneficial in elderly patients 1
   • Topical doxepin for localized areas (limited to 8 days, 10% body surface area, maximum 12g daily) 1

2. For severe pruritus:

   • Systemic corticosteroids (0.5-2 mg/kg daily) for temporary relief 1

Special Considerations

Elderly Patients

• Prefer emollients with high lipid content
• Consider gabapentin for persistent pruritus
• Avoid sedating antihistamines due to risk of falls and cognitive impairment 1

Drug-Induced Pruritus

• Identify and discontinue suspected causative medications (except for essential treatments like anticancer drugs)
• Common culprits include opioids, antimalarials, and hydroxyethyl starch 5

Non-Pharmacological Measures

• Prevent skin from drying
• Avoid hot showers
• Avoid scrubbing and excessive sun exposure 4
• Use mild cleansers with low pH 3

When to Refer to Specialist Care

• Diagnostic uncertainty
• Failure to respond to initial treatment
• Suspected systemic disease with negative investigations 1

Common Pitfalls to Avoid

1. Using sedating antihistamines as first-line therapy (non-sedating options are preferred for better compliance) 6
2. Prolonged use of topical corticosteroids without monitoring for adverse effects
3. Failing to investigate underlying systemic causes of persistent pruritus
4. Not distinguishing between histamine-mediated pruritus (responds well to antihistamines) and non-histamine-mediated pruritus (may require alternative approaches) 3
5. Overlooking the psychological impact of chronic pruritus, which can significantly affect quality of life 3, 7