What is the prescription mix for pruritus (itching)?

From the Guidelines

For pruritus, a common prescription mixture includes a topical corticosteroid such as hydrocortisone 1-2.5% cream or ointment combined with an antihistamine like loratadine 10mg daily for daytime relief or diphenhydramine 25-50mg orally every 6 hours as needed for nighttime relief, as recommended by recent guidelines 1.

Treatment Approach

When managing pruritus, it's essential to consider the underlying cause and tailor the treatment approach accordingly. The following steps can be taken:

• For mild cases, topical moderate/high-potency steroids or oral antihistamines may be used, as suggested by the ESMO clinical practice guidelines 1.
• For more severe cases, a combination of topical corticosteroids and oral antihistamines or GABA agonists (such as pregabalin or gabapentin) may be necessary, as recommended by the guidelines 1.
• In cases of pruritus associated with specific conditions, such as liver disease or lymphoma, targeted treatments like rifampicin or cimetidine may be considered, as outlined in the British Association of Dermatologists' guidelines 1.

Additional Considerations

• Patients should be advised to avoid hot showers, use mild soaps, and wear loose cotton clothing to prevent exacerbating the condition.
• Moisturizers like ceramide-containing creams can help maintain skin barrier function and reduce itching.
• In some cases, oral corticosteroids or immunosuppressive therapy may be indicated for temporary relief of severe pruritus, as suggested by the ESMO guidelines 1.

Key Takeaways

• Identify and address the underlying cause of pruritus while providing symptomatic relief.
• Use a combination of topical and oral treatments as needed to manage pruritus effectively.
• Consider the specific condition associated with pruritus and tailor the treatment approach accordingly, as recommended by recent guidelines 1.

From the FDA Drug Label

Hydrocortisone Butyrate Ointment, 0.1% is indicated for the relief of the inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses. Topical corticosteroids share anti-inflammatory, anti-pruritic, and vasoconstrictive actions.

Prescription for Pruritus:

• Hydrocortisone butyrate (TOP) is indicated for the relief of pruritic manifestations of corticosteroid-responsive dermatoses 2.
• The mechanism of anti-pruritic activity of topical corticosteroids is unclear, but hydrocortisone butyrate (TOP) has anti-pruritic actions 2. A possible mix prescription for pruritus could be hydrocortisone butyrate (TOP).

From the Research

Treatment Options for Pruritus

• General management of pruritus includes trigger avoidance, liberal emollient use, limiting water exposure, and administration of oral antihistamines and topical corticosteroids 3
• Topical hydrocortisone 17-butyrate 21-propionate is a medium potent, non-halogenated double-ester of hydrocortisone with a favorable benefit/risk ratio for the treatment of inflammatory skin disorders 4
• A variety of treatment approaches are available for cutaneous pruritus, including device-based physical therapies and medications that act on the itch-perception processing pathway from the skin, peripheral sensory nerves, the spinal cord, to the brain 5

Medications for Pruritus

• Oral antihistamines may be used to treat pruritus, although only a small percentage of patients with generalized pruritus respond to antihistamines (H1 receptor antagonists) 6
• Topical corticosteroids, such as hydrocortisone 17-butyrate 21-propionate, can be effective in treating inflammatory skin diseases, including atopic dermatitis and psoriasis vulgaris 4

Diagnosis and Management

• A thorough skin examination, including visualization of the finger webs, anogenital region, nails, and scalp, is essential in diagnosing pruritus 3
• An initial evaluation for systemic causes of pruritus may include a complete blood count with differential, creatinine and blood urea nitrogen levels, liver function tests, iron studies, fasting glucose or A1C level, and a thyroid-stimulating hormone test 3
• Individualized management and holistic assessment are key aspects of effective management of pruritus 7