From the Guidelines
The best treatment for itching is to identify and treat the underlying cause, and for moderate to severe pruritus, pharmacological treatment with bezafibrate or rifampicin is recommended, as supported by the most recent and highest quality study 1. When considering treatment options, it's essential to prioritize the underlying cause of the itching, as this will guide the most effective treatment approach.
- For patients with liver disease, such as primary sclerosing cholangitis, bezafibrate or rifampicin may be effective in alleviating pruritus, as shown in the FITCH trial 1.
- In cases of intrahepatic cholestasis of pregnancy, ursodeoxycholic acid (UDCA) is the recommended first-line treatment for maternal symptoms of pruritus, with a typical starting dose of 10-15 mg/kg per day 1.
- For patients with uraemic pruritus, ensuring adequate dialysis, normalizing calcium-phosphate balance, and controlling parathyroid hormone levels are crucial, and topical capsaicin or oral gabapentin may be considered as additional treatment options 1.
- In general, it's essential to avoid scratching, wear loose cotton clothing, keep fingernails short, and maintain cool, humid environments to help alleviate itching symptoms.
- Identifying and treating the underlying cause of itching is crucial for long-term relief, and consulting a healthcare provider is necessary if itching persists, is severe, or is accompanied by other symptoms.
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 Purpose Anti-itch
The best treatment for itching is hydrocortisone (TOP), which can be applied to the affected area not more than 3 to 4 times daily for adults and children 2 years of age and older. For children under 2 years of age, and children under 12 years of age with external anal and genital itching, a doctor should be consulted 2, 2, 2.
From the Research
Treatment Options for Itching
- Topical corticosteroids are a common treatment for inflammatory skin conditions such as psoriasis and atopic dermatitis, which can cause itching 3.
- The strength and potency of topical corticosteroids can vary, and the risk of adverse effects increases with prolonged use, large area of application, and higher potency 3.
- Antihistamines, such as H1 antihistamines, can be used to treat allergic conditions like allergic rhinitis and urticaria, which can cause itching 4, 5.
- Second-generation H1 antihistamines are preferred over first-generation antihistamines due to their safer profile and less sedation 4, 5.
- Corticosteroids can be used systemically or topically to treat inflammation and diseases of immune function, but prolonged use can cause adverse effects 6.
Administration and Usage
- Topical corticosteroids can be applied once or twice per day for up to three weeks for super-high-potency corticosteroids or up to 12 weeks for high- or medium-potency corticosteroids 3.
- Antihistamines can be used orally or intranasally, and the choice of formulation depends on patient preference, access, and costs 4.
- Corticosteroids can be administered systemically or topically, and dosing strategies are designed to minimize the risk of adverse effects 6.
Considerations and Precautions
- Topical corticosteroids should be used with caution in children, pregnant or lactating women, and patients with thinner skin 3.
- Antihistamines can cause sedation, and newer antihistamines are preferred due to their safer profile 4, 5.
- Corticosteroids can cause systemic effects, and prolonged use can suppress the hypothalamic-pituitary-adrenal axis 6.