What are the treatment options for pruritus (itching)?

From the Guidelines

For anti-itch relief, I recommend topical moderate/high-potency steroids, oral antihistamines, or GABA agonists (pregabalin/gabapentin) as first-line treatments, as suggested by the most recent and highest quality study 1. The choice of treatment depends on the severity of the itch, with mild or localized itch treated with topical moderate/high-potency steroids, and intense or widespread itch treated with a combination of topical and oral medications. Some key points to consider when treating itch include:

• Topical moderate/high-potency steroids, such as hydrocortisone cream, can be effective for mild or localized itch 1.
• Oral antihistamines, such as diphenhydramine (Benadryl) or cetirizine (Zyrtec), can provide relief for itching, especially in cases of intense or widespread itch 1.
• GABA agonists, such as pregabalin or gabapentin, may also be effective in reducing itch sensation, especially in cases of neuropathic itch 1.
• Emollients and moisturizers can help to soothe and calm the skin, reducing itch and inflammation 1.
• Avoiding irritants, such as hot water, harsh soaps, and tight clothing, can also help to reduce itch and prevent further irritation 1. It's essential to consult a healthcare provider if the itching is severe, persists beyond a week, covers large body areas, or is accompanied by other concerning symptoms like fever or spreading rash, as prescription-strength treatments may be necessary.

From the FDA Drug Label

Uses temporarily relieves itching associated with minor skin irritations, inflammation, and rashes due to: eczema psoriasis poison ivy, oak, sumac insect bites detergents jewelry cosmetics soaps seborrheic dermatitis temporarily relieves external anal and genital itching 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 Directions Adults and children 18 years of age and older: Apply a thin film of cream to affected area and gently rub in until fully absorbed. Unless treating hands, wash hands thoroughly with soap and water immediately after application. For best results, apply 3 to 4 times daily.

Anti-itch medicines include:

• Hydrocortisone (TOP) 2, which can be used to relieve itching associated with minor skin irritations, inflammation, and rashes.
• Capsaicin (TOP) 3, which can be applied to affected areas to relieve itching. Key uses of these medicines include:
• Relieving itching associated with eczema, psoriasis, and insect bites
• Temporarily relieving external anal and genital itching Important usage instructions:
• Apply hydrocortisone (TOP) to affected areas not more than 3 to 4 times daily 2
• Apply capsaicin (TOP) 3 to 4 times daily 3
• Children under certain ages should consult a doctor before using these medicines 2, 2, 3

From the Research

Anti-Itch Medicine

• There are various types of anti-itch medicines, including corticosteroids, which have been studied for their effectiveness in relieving itching sensations 4, 5, 6, 7, 8
• A study published in 2007 found that the application of topical corticosteroid cream to sites of positive immediate-type allergy skin tests did not provide relief of itching 4
• Another study published in 1998 discussed the use of systemic corticosteroids in the treatment of numerous medical conditions, including their potency and potential side effects 5
• A 2020 study examined the effect of hydrocortisone on mortality and organ support in patients with severe COVID-19, finding that treatment with hydrocortisone resulted in a high probability of superiority with regard to the odds of improvement in organ support-free days within 21 days 6
• The clinical pharmacology of corticosteroids was reviewed in a 2018 study, which discussed their anti-inflammatory and immunosuppressive effects, as well as potential adverse effects associated with their use 7
• A comparative study published in 1975 examined the effects and side effects of different corticosteroids, including hydrocortisone, prednisone, triamcinolone, and dexamethasone 8

Types of Anti-Itch Medicines

• Corticosteroids, such as hydrocortisone and prednisone, are commonly used to treat itching sensations 4, 5, 6, 7, 8
• Topical corticosteroid creams, such as 2.5% hydrocortisone in moisturizing cream, have been studied for their effectiveness in relieving itching sensations 4
• Systemic corticosteroids, such as prednisone and methylprednisolone, are used to treat various medical conditions, including allergic reactions and inflammatory diseases 5

Effectiveness of Anti-Itch Medicines

• The effectiveness of anti-itch medicines, such as corticosteroids, can vary depending on the individual and the specific condition being treated 4, 5, 6, 7, 8
• A study published in 2007 found that the application of topical corticosteroid cream to sites of positive immediate-type allergy skin tests did not provide relief of itching, suggesting that this practice should be abandoned 4
• Other studies have found that corticosteroids can be effective in treating various medical conditions, including severe COVID-19 and allergic reactions 5, 6