What is the most efficient medication for extreme body itching, also known as pruritus?

From the Guidelines

For extreme body itching, bezafibrate is recommended as the first-line pharmacological treatment, as it has shown a clear-cut benefit in alleviating moderate to severe itch in people with sclerosing cholangitis and primary biliary cholangitis, according to the most recent study 1.

Key Points to Consider

• Bezafibrate has been shown to have a sustained antipruritic effect under cholestatic conditions and can be used in combination with ursodeoxycholic acid (UDCA) for additive anticholestatic effects.
• Rifampicin, previously considered the most effective treatment for cholestasis-associated pruritus, may induce drug-induced hepatitis in up to 12% of cholestatic patients, making bezafibrate a safer alternative.
• Topical treatments such as calamine lotion, hydrocortisone cream (1%), or pramoxine can provide immediate relief when applied to affected areas 2-4 times daily.
• Moisturizing regularly with fragrance-free lotions and taking cool baths with colloidal oatmeal can also help soothe itchy skin.

Important Considerations

• It is essential to exclude underlying conditions that may be causing the itching, such as bile duct strictures or other cholestatic syndromes, as identified in the British Association of Dermatologists' guidelines 1.
• Patients with uraemic pruritus may benefit from BB-UVB phototherapy, as recommended in the British Association of Dermatologists' guidelines 1.
• In cases of hepatic pruritus, rifampicin or cholestyramine may be considered as second-line treatments, as suggested in the British Association of Dermatologists' guidelines 1.

From the FDA Drug Label

Purpose Anti-itch PRINCIPAL DISPLAY PANEL - 28.4 g Tube Carton TopCare health ™ MAXIMUM STRENGTH • OUR PHARMACISTS RECOMMEND • NDC 36800-099-02 Hydrocortisone 1% Cream ANTIPRURITIC (ANTI-ITCH) Intensive Healing Formula † NET WT 1 OZ (28.4 g) The most efficient medication for extreme body itching is hydrocortisone (TOP), as it is labeled as an anti-itch and antipruritic medication 2 2.

• Key benefits: Anti-itch and antipruritic properties
• Medication name: Hydrocortisone (TOP)

From the Research

Treatment Options for Extreme Body Itching

• The most efficient medication for extreme body itching is not explicitly stated in the provided studies, as they focus on the diagnosis and treatment of cutaneous pruritus, rather than comparing the efficacy of specific medications 3, 4, 5.
• Antihistamines are commonly used to treat itch, but their effectiveness can vary, and some patients may experience hypersensitivity reactions to these medications 6, 7.
• The 2020 guidelines for the diagnosis and treatment of cutaneous pruritus suggest that antihistamines (H1 receptor antagonists) are only effective in a small percentage of patients with generalized pruritus, and that other itch mediators and mechanisms may be involved in non-responsive patients 5.
• Nonpharmacologic therapies, such as frequent moisturization, may be effective in treating generalized itch, particularly in patients with xerosis and eczema 4.
• Topical and systemic therapies, including device-based physical therapies, may also be used to treat cutaneous pruritus, but the choice of treatment depends on the underlying cause of the itch and the patient's individual needs 3, 4, 5.

Considerations for Treatment

• The diagnosis of cutaneous pruritus can be challenging, and a comprehensive diagnostic workup is necessary to identify the underlying cause of the itch 3, 5.
• The treatment of cutaneous pruritus should be tailored to the individual patient, taking into account the underlying cause of the itch, the patient's medical history, and any potential allergies or hypersensitivities 6, 7.
• Further research is needed to fully understand the mechanisms underlying itch and to develop more effective treatments for cutaneous pruritus 3, 4, 5.