From the Guidelines
The most effective treatment for itching is bezafibrate, which has been shown to alleviate moderate to severe itch in people with primary sclerosing cholangitis (PSC) and primary biliary cholangitis (PBC) 1.
Causes of Itching and Treatment Options
Itching can be caused by various factors, including liver disease, kidney disease, and skin conditions. The treatment of itching depends on the underlying cause.
- For liver disease, bezafibrate is recommended as the first-line pharmacological treatment for moderate to severe pruritus in PSC and other forms of fibrosing cholangiopathy 1.
- For kidney disease, ensuring adequate dialysis, normalizing calcium-phosphate balance, controlling parathyroid hormone, and correcting anemia with erythropoietin are essential before using other treatment strategies 1.
- For skin conditions, topical treatments such as 1% hydrocortisone cream or calamine lotion can provide relief [@Example@].
Additional Treatment Options
Other treatment options for itching include:
- Rifampicin, which may be used as a second-line treatment for cholestasis-associated pruritus 1.
- Naltrexone, which may be used as a third-line treatment for cholestasis-associated pruritus, starting at a low dose of 12.5 mg to avoid side effects 1.
- Phototherapy, such as broadband UVB (BB-UVB) or narrowband UVB (NB-UVB), which may be effective in treating uraemic pruritus and other forms of pruritus 1.
Importance of Medical Evaluation
If itching persists beyond 2 weeks, worsens, or is accompanied by other symptoms such as rash or fever, medical evaluation is necessary to identify and treat the underlying cause, which may require prescription-strength medications or specific treatments [@Example@].
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 In these studies, patients applied either ELIDEL Cream or vehicle cream twice daily to 5% to 96% of their BSA for up to 6 weeks More ELIDEL patients (57%) had mild or no pruritus at 6 weeks compared to vehicle patients (34%)
The best treatment for itching is applying hydrocortisone or pimecrolimus cream to the affected area.
- For hydrocortisone, apply to the affected area not more than 3 to 4 times daily 2.
- For pimecrolimus, apply twice daily for up to 6 weeks 3. Key points:
- Hydrocortisone can be used for itching of skin irritation, inflammation, and rashes 2.
- Pimecrolimus can be used for mild to moderate atopic dermatitis 3.
From the Research
Treatment Options for Itching
- Pimecrolimus and topical corticosteroids are two common treatments for itching, particularly in cases of atopic dermatitis 4, 5.
- Pimecrolimus has anti-inflammatory and immunomodulatory activity, and has been shown to be effective in treating a variety of skin conditions, including atopic dermatitis 4.
- Topical corticosteroids, such as hydrocortisone 1% cream, are widely used to treat atopic dermatitis, but can have unwanted side effects, including skin atrophy and telangiectasia 6.
Comparison of Pimecrolimus and Topical Corticosteroids
- A study comparing pimecrolimus cream 1% and topical corticosteroids in adults with moderate to severe atopic dermatitis found that pimecrolimus had a favorable safety profile and was effective in treating the condition 5.
- Another study found that treatment with hydrocortisone 1% cream led to a significant decrease in epidermal thickness, while treatment with pimecrolimus 1% cream did not have a significant effect on epidermal thickness 6.
- Pimecrolimus may be a safer option for treating atopic dermatitis in sensitive skin areas, such as the face, especially when repeated application is required 6.
Safety and Efficacy
- Pimecrolimus has been shown to be effective in treating atopic dermatitis, with a significant proportion of patients able to be maintained without topical corticosteroids for up to 1 year 5.
- The incidence of skin infections was significantly lower in patients treated with pimecrolimus compared to those treated with topical corticosteroids 5.
- Topical corticosteroids, on the other hand, can have unwanted side effects, including skin atrophy and telangiectasia, particularly with long-term use 6.