What are the recommended anti-itch medications for a child?

Recommended Anti-Itch Medications for Children

Oral antihistamines are recommended as first-line therapy for reducing pruritus in children, with topical corticosteroids being the mainstay of therapy for itchy skin conditions like atopic dermatitis. 1

First-Line Treatments

Topical Therapies

• Hydrocortisone (0.5-1%): For children 2 years and older, apply to affected area no more than 3-4 times daily; for children under 2 years, consult a doctor 2
• Emollients: Should be used liberally as the cornerstone of treatment for dry, itchy skin in all pediatric age groups 3
• Mild cleansers: Low pH cleansers help maintain skin barrier function 4
• Coolants: Menthol-containing products can provide temporary itch relief 4

Systemic Therapies

• Oral antihistamines: Recommended as adjuvant therapy for reducing pruritus, particularly for conditions like atopic dermatitis 1
  • Non-sedating antihistamines: Helpful for urticaria where itch is primarily histamine-mediated 4
  • Sedating antihistamines: Can be used at night to break the itch-scratch cycle, especially in eczema 4

Age-Specific Considerations

Infants and Toddlers (<2 years)

• Topical corticosteroids: First-line medication-based therapy for conditions like atopic dermatitis 3
• Pimecrolimus: May be used in infants as young as 3 months as a topical calcineurin inhibitor 3
• Caution: Special attention to dosing and application frequency is needed due to higher body surface area to weight ratio 5

Children (2-12 years)

• Topical corticosteroids: Remain first-line therapy 3
• Topical calcineurin inhibitors: Safe alternative, especially for sensitive areas like face and skin folds 1, 5
• Topical PDE4 inhibitors: Crisaborole has been approved for mild to moderate atopic dermatitis in patients aged 3 months and above 1

Adolescents (>12 years)

• All previous options plus:
• Biologic agents: For severe cases of conditions like psoriasis or atopic dermatitis that don't respond to other treatments 1, 3

Special Considerations

For Atopic Dermatitis

• Avoid topical antihistamines: Current evidence from randomized controlled trials is insufficient to demonstrate efficacy, and they might increase the risk of contact dermatitis 1
• Bleach baths: May be useful for some patients, but benefits and risks should be weighed prior to application 1

For Urticaria

• Oral antihistamines: First-line treatment 1
• Epinephrine: For severe cases with laryngeal angioedema or anaphylaxis 1

For Head Lice

• Topical pediculicides: Should be rinsed from hair over a sink rather than in shower/bath to limit skin exposure 1
• Topical corticosteroids and oral antihistamines: May be beneficial for relieving itching or mild burning of the scalp caused by inflammation in response to topical pediculicides 1

Medication Safety Concerns

• Renal impairment: Dose adjustments needed for certain antihistamines; acrivastine should be avoided in moderate renal impairment 1
• Hepatic impairment: Several antihistamines should be avoided in severe liver disease 1
• Pregnancy: Best to avoid all antihistamines, especially during the first trimester 1
• Epilepsy: Special caution with certain antihistamines; ketotifen is contraindicated, while convulsions have been reported with cyproheptadine, chlorphenamine, and loratadine 1

Long-term Management

• Avoid long-term use of topical antibiotics: Increases risk of resistance and sensitization 1
• Avoid long-term oral corticosteroids: Not recommended in chronic conditions due to unfavorable risk-benefit profile 1
• Monitor for side effects: Regular assessment for medication side effects and disease complications is essential 6
• Address psychosocial needs: Consider supplemental disease management education for children and families dealing with chronic pruritus 7