What are the causes of pruritus (itchiness)?

From the Guidelines

For patients with generalized pruritus, the first line of treatment should include simple self-care advice, such as keeping nails short, and the use of emollients, followed by a short trial of a nonsedating antihistamine if warranted. This approach is recommended by the British Association of Dermatologists' guidelines for the investigation and management of generalized pruritus in adults without an underlying dermatosis, 2018 1. The guidelines emphasize the importance of general practitioners' input in diagnosis and management due to their broad view of the individual's overall health status.

When considering treatment options, it's crucial to identify the underlying cause of pruritus, as it may significantly impact the choice of therapy. For instance:

• In cases of iron deficiency, iron replacement is recommended 1.
• For patients with uraemic pruritus, ensuring adequate dialysis, normalizing calcium-phosphate balance, and controlling parathyroid hormone levels are essential before considering other treatments, with BB-UVB being an effective treatment option 1.
• In hepatic pruritus, rifampicin is considered a first-line treatment, while cholestyramine and sertraline may be used as second and third-line treatments, respectively 1.

It's also important to note that for patients with neuropathic pruritus, referral to the relevant specialist for treatment is recommended 1, and for those with psychological and emotional factors contributing to their pruritus, psychosocial and behavioral interventions may be beneficial 1.

In all cases, a thorough assessment and follow-up by a healthcare provider are crucial to manage pruritus effectively and address any underlying conditions. If itching persists beyond two weeks, worsens, or is accompanied by a rash or other symptoms, consultation with a healthcare provider is necessary to determine the underlying cause and appropriate treatment 1.

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

• Itchiness (Pruritus) can be temporarily relieved by hydrocortisone (TOP) for conditions such as eczema, psoriasis, and insect bites 2.
• The product is used for minor skin irritations, inflammation, and rashes.
• It also provides relief for external anal and genital itching.

From the Research

Itchiness (Pruritus) Overview

• Itchiness, or pruritus, is a common and stressful symptom in medicine with cutaneous manifestation 3.
• Therapy for pruritus remains a challenge for physicians and patients due to the many causes and triggers, as well as the lack of approved systemic therapies 3.

Treatment Options for Pruritus

• Topical treatment is selected for every degree of severity, while patients with severe symptoms and chronic disease course have to be treated with systemic and topical options 3.
• Tacrolimus and pimecrolimus are new treatment options for atopic dermatitis, which is a chronic skin disease that can lead to itchiness 4, 5, 6.
• Pimecrolimus has been shown to be effective in treating eczema, but its efficacy and safety compared to existing treatments remains unclear 5.
• The combination of pimecrolimus cream 1% with fluticasone may provide an alternative treatment for patients with severe atopic dermatitis, with faster clearance of disease flares and reduced duration of topical corticosteroid treatment 7.

Efficacy and Safety of Treatment Options

• Tacrolimus has been shown to be effective in treating atopic dermatitis, with over 90% improvement in 75% of patients after 1-year treatment 4.
• Pimecrolimus has been shown to be less effective than moderate and potent corticosteroids and 0.1% tacrolimus, but its therapeutic role is uncertain due to the absence of key comparisons with mild corticosteroids 5.
• The safety profile of pimecrolimus cream 1% combined with fluticasone is similar to that of fluticasone alone in pediatric patients with severe atopic dermatitis 7.