What is the management for body itching?

Management of Body Itching

For generalized body itching, first-line treatment includes emollients and moisturizers, with non-sedating antihistamines as second-line therapy and targeted treatments for specific underlying causes when identified. 1

First-Line Treatments

Topical Therapies

• Apply skin moisturizers and emollients daily to maintain skin hydration, which is the cornerstone of managing dry skin and associated pruritus 2, 1
• Use urea- or polidocanol-containing lotions to soothe pruritus 2
• Consider topical hydrocortisone for temporary relief of itching associated with minor skin irritations and inflammation (apply to affected area no more than 3-4 times daily) 3
• Topical doxepin can be used (limited to 8 days, 10% of body surface area, and 12g daily) 2
• Topical clobetasone butyrate or menthol preparations can provide relief 2
• Avoid alcohol-containing lotions or gels in favor of oil-in-water creams or ointments 2

Bathing Recommendations

• Avoid dehydrating body care such as hot showers and excessive use of soaps 2
• Use mild cleansers with low pH 4
• Consider adding emollients to bath water 2

Second-Line Treatments

Systemic Medications

• Non-sedating H1-antihistamines such as cetirizine, loratadine, or fexofenadine for moderate to severe pruritus 2, 1
• Consider combination of H1 and H2 antagonists (e.g., fexofenadine and cimetidine) if single antihistamine is ineffective 2
• Avoid long-term use of sedative antihistamines except in palliative care settings due to potential dementia risk 2

Treatment Based on Underlying Causes

For Drug-Induced Pruritus

• Consider trial cessation of suspected medications if risk-benefit analysis is acceptable 2
• For opioid-induced pruritus: naltrexone is first-line if opioid cessation is not possible 2
• For postoperative pruritus: consider diclofenac 100 mg rectally 2

For Hepatic Pruritus

• Rifampicin as first-line treatment 2
• Cholestyramine as second-line treatment 2
• Sertraline as third-line treatment 2
• Avoid gabapentin in hepatic pruritus 2

For Uremic Pruritus

• Optimize dialysis, normalize calcium-phosphate balance, control parathyroid hormone levels 2
• BB-UVB phototherapy is highly effective 2
• Consider capsaicin cream, topical calcipotriol, or oral gabapentin 2

For Pruritus in Elderly Patients

• Initial treatment with emollients and topical steroids for at least 2 weeks to exclude asteatotic eczema 2
• Use moisturizers with high lipid content 2

Special Considerations

For Secondary Infections

• Monitor for signs of secondary infection (impetiginization caused by staphylococci or streptococci) 2
• Take bacterial swabs and start appropriate anti-infective treatment if infection is suspected 2

For Psychological Factors

• Consider behavioral interventions, relaxation techniques, and cognitive restructuring 2
• Patient support groups can be beneficial for chronic pruritus management 2
• Referral to social workers, liaison psychiatry, or psychologists may be helpful in individual cases 2

When to Refer to a Specialist

• Refer to secondary care if there is diagnostic doubt or if primary care management does not relieve symptoms 2
• Consider dermatology referral for persistent, unexplained pruritus that doesn't respond to first and second-line treatments 2
• Patients with neuropathic pruritus should be referred to the relevant specialist 2

Monitoring and Follow-up

• Reassess after 2 weeks of treatment or at any worsening of symptoms 2
• Keep an open mind to the possibility of symptoms and signs of secondary pruritus developing later in apparent cases of generalized pruritus of unknown origin 2