Is there a steroid cream with lidocaine (local anesthetic) available to prevent itching?

Steroid-Lidocaine Combination Products for Itch Prevention

There is no commercially available pre-mixed steroid cream with lidocaine, but you can use these medications separately or in combination as an effective strategy for managing pruritic skin conditions. 1

Separate Application Strategy

The most evidence-based approach involves using high-potency topical corticosteroids and lidocaine 5% preparations as distinct products:

• Apply high-potency topical steroids (e.g., clobetasol propionate 0.05%) twice daily for inflammatory skin conditions causing itch 1
• Add lidocaine 5% cream or patches to painful or intensely pruritic areas to enable activities of daily living 1

This combination is specifically recommended in ESMO guidelines for hand-foot skin reactions from cancer therapies, where both agents are used concurrently but separately 1.

Clinical Context and Evidence

For anticancer therapy-induced skin reactions: Guidelines explicitly recommend topical high-potency steroids twice daily PLUS lidocaine 5% patches or cream for grade 1-2 hand-foot skin reactions 1. This dual approach addresses both inflammation (steroid) and neuropathic pain/itch (lidocaine) through different mechanisms 1.

For general pruritic conditions: While topical steroids remain first-line for inflammatory itch 1, 2, lidocaine can provide rapid symptomatic relief by blocking sensory neurons involved in itch transmission 3. Recent research demonstrates lidocaine alleviates both inflammation and pruritus in atopic dermatitis by blocking NaV 1.8+ sensory neurons 3.

Important Caveats

• Over-the-counter hydrocortisone (low-potency) does NOT effectively reduce itching in most dermatologic conditions 1. Studies of poison ivy/oak dermatitis found 0.2%-2.5% hydrocortisone preparations ineffective 1.
• High-potency steroids that work require prescription - only these combined with systemic steroids have demonstrated itch reduction 1.
• Avoid topical steroids under dermatologist supervision only for certain conditions to prevent perioral dermatitis and skin atrophy 1.

Practical Application Algorithm

1. For acute inflammatory itch: Start high-potency topical steroid (e.g., clobetasol 0.05%) twice daily 1
2. If pain/severe itch persists: Add lidocaine 5% cream or patches to affected areas 1
3. For maintenance: Consider intermittent medium-potency steroid (twice weekly) to prevent flares 1
4. Adjunctive measures: Apply urea 10% cream 2-3 times daily for dry skin contributing to itch 4

The combination approach using separate products provides superior symptom control compared to either agent alone, particularly for treatment-resistant pruritic conditions. 1