From the Guidelines
To manage pruritus, patients should be advised to avoid scratching, take cool baths with colloidal oatmeal or baking soda, and apply fragrance-free moisturizers while skin is still damp to lock in moisture. The most recent and highest quality study 1 provides guidelines for the prevention and management of dermatological toxicities related to anticancer agents, including pruritus. Key recommendations for discharge instructions include:
- Avoiding scratching to prevent skin infections
- Taking cool baths with colloidal oatmeal or baking soda for 10-15 minutes to soothe the skin
- Applying fragrance-free moisturizers while skin is still damp to lock in moisture
- Using over-the-counter antihistamines like diphenhydramine (Benadryl) 25-50mg every 4-6 hours or cetirizine (Zyrtec) 10mg daily to reduce itching
- Topical treatments such as calamine lotion, hydrocortisone cream (0.5-1%) applied thinly 2-3 times daily for up to 7 days, or menthol-containing lotions for temporary relief
- Wearing loose-fitting, cotton clothing and keeping the environment cool and humid to reduce itching
- Avoiding known irritants, including fragranced products, harsh soaps, and hot water If itching persists beyond 2 weeks, worsens, or is accompanied by a spreading rash, fever, or severe discomfort, patients should seek medical attention for further evaluation and potential prescription-strength medications. Additionally, patients with underlying conditions such as liver disease may benefit from specific treatments like rifampicin as first-line treatment 1. It is essential to follow up with patients to assess the effectiveness of treatments and adjust the management plan as needed.
From the FDA Drug Label
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 children under 2 years of age: ask a doctor for external anal and genital itching, adults: when practical, clean the affected area with mild soap and warm water and rinse thoroughly gently dry by patting or blotting with toilet tissue or a soft cloth before applying apply to affected area not more than 3 to 4 times daily children under 12 years of age: ask a doctor
The discharge instructions for pruritus are to:
- Apply hydrocortisone to the affected area not more than 3 to 4 times daily for adults and children 2 years of age and older
- Ask a doctor for children under 2 years of age
- Clean the affected area with mild soap and warm water and gently dry before applying for external anal and genital itching in adults
- Ask a doctor for children under 12 years of age 2
From the Research
Discharge Instructions for Pruritus
The following are general guidelines for discharge instructions for pruritus:
- Trigger avoidance: Patients should avoid triggers that exacerbate pruritus, such as certain foods, stress, or environmental factors 3.
- Emollient use: Liberal use of emollients, such as moisturizers, can help to relieve pruritus by moisturizing the skin 3, 4.
- Water exposure: Limiting water exposure, especially in terms of frequency and duration of bathing or showering, can help to prevent dry skin and reduce pruritus 3.
- Oral antihistamines: Administration of oral antihistamines can help to relieve pruritus, especially in cases where the pruritus is caused by an allergic reaction 3.
- Topical corticosteroids: Topical corticosteroids can be used to treat pruritus, especially in cases where the pruritus is caused by inflammation 3, 5.
- Topical therapies: Topical therapies, such as cooling agents, capsaicin, and immunomodulators, can be used to treat pruritus, especially in cases where the pruritus is localized 6, 4.
- Systemic therapies: Systemic therapies, such as antihistamines, opioid antagonists/agonists, antiepileptic drugs, and antidepressants, can be used to treat pruritus, especially in cases where the pruritus is severe or generalized 6, 3.
Special Considerations
- Patients with chronic generalized pruritus should be evaluated for malignancy, especially in older patients 3.
- Patients with psychogenic etiologies of pruritus may require consultation with a specialist 3.
- Community pharmacists can play an important role in instructing patients on the proper use of topical glucocorticoids to avoid glucocorticoid-induced pruritus 5.