From the Guidelines
For pruritus, the most effective treatment approach is to identify and address the underlying cause, and in the case of hepatic pruritus, rifampicin is considered the first-line treatment, as recommended by the British Association of Dermatologists' guidelines 1. When considering treatment options, it's essential to evaluate the patient's specific condition and medical history.
- For patients with iron deficiency, iron replacement is recommended 1.
- For those with lymphoma, treatments such as cimetidine, carbamazepine, gabapentin, or mirtazapine may be effective 1.
- In cases of uraemic pruritus, ensuring adequate dialysis, normalizing calcium-phosphate balance, and controlling parathyroid hormone levels are crucial, along with considering treatments like capsaicin cream, topical calcipotriol, or oral gabapentin 1.
- For hepatic pruritus, rifampicin is the first-line treatment, followed by cholestyramine as a second-line option, and sertraline as a third-line treatment 1. It's also important to note that sedative antihistamines should be avoided in the long term, except in palliative care, due to the risk of dementia 1. In all cases, a thorough medical evaluation is necessary to determine the underlying cause of pruritus and develop an effective treatment plan.
From the FDA Drug Label
For use in the management of pruritus due to allergic conditions such as chronic urticaria and atopic and contact dermatoses and in histamine-mediated pruritus: adults, 25 mg t.i.d. or q.i.d. ; children under 6 years, 50 mg daily in divided doses; children over 6 years, 50 to 100 mg daily in divided doses. Useful in the management of pruritus due to allergic conditions such as chronic urticaria and atopic and contact dermatoses and in histamine-mediated pruritus
Hydroxyzine (PO) can be used as a medicine for pruritus due to allergic conditions. The recommended dosage for adults is 25 mg t.i.d. or q.i.d. 2. It is also useful in the management of pruritus due to allergic conditions such as chronic urticaria and atopic and contact dermatoses and in histamine-mediated pruritus 2.
- Key points:
- Dosage: 25 mg t.i.d. or q.i.d. for adults
- Conditions: chronic urticaria, atopic and contact dermatoses, histamine-mediated pruritus
- Age: children under 6 years, 50 mg daily in divided doses; children over 6 years, 50 to 100 mg daily in divided doses 2
From the Research
Puritus Medicine
- Puritus, or itch, can be caused by various dermatologic and systemic conditions, and its management involves a thorough skin examination and evaluation for systemic causes 3.
- Antihistamines, particularly H1 antihistamines, are commonly used to treat pruritus, although their efficacy is limited in certain diseases where histamine does not play a significant role in the pathogenesis of pruritus 4, 5.
- The use of antihistamines in the treatment of atopic dermatitis is inconclusive, with some studies suggesting that they may provide relief by central sedation, but more clinical trials are needed to determine their therapeutic efficacy 6.
- Nonpharmacologic therapies, such as moistur moisturization, can be effective in treating pruritus, especially in cases of xerosis and eczema, and can be used as a first-line treatment before moving on to topical and systemic approaches 7.
- In some cases, antihistamines may not be effective, and other treatments such as topical corticosteroids and consultation with a specialist may be necessary 3.
- The histamine H4 receptor has been shown to play a role in mediating pruritic signals, and H4 receptor antagonists may have therapeutic potential for the treatment of pruritus not controlled by antihistamines that target the H1 receptor 5.