II. Management: Avoid Precipitating Factors

  1. See Dry Skin Management
  2. Limit topicals to perfume and dye free products
  3. Avoid excessive heat
    1. Keep bedroom cool at night time
  4. Avoid factors that cause drying
    1. See Dry Skin Management
    2. Humidify indoor environment (e.g. winter)
  5. Avoid static electricity
    1. Change one sheet at a time
  6. Avoid rough clothing or fabrics
    1. Consider best fabric options
      1. Doubly rinsed cotton clothes
      2. Silk
    2. Avoid irritating fabrics
      1. Wool
      2. Smooth-textured cotton garments
    3. Avoid heat retaining fabrics (Synthetics)
    4. Add Alpha Keri to rinse cycle when washing sheets
  7. Avoid vasodilators if provoke itching
    1. Avoid Caffeine
    2. Avoid Alcohol
    3. Avoid spices
    4. Avoid hot water

III. Management: Topical Agents for Pruritus

  1. Avoid Topical Anesthetics and Antihistamines
    1. Avoid topical Diphenhydramine (e.g. Benadryl or Allegra topical sticks, creams, gels, sprays)
    2. Avoid topical caines (e.g. Lidocaine, benzocaine)
    3. May sensitize exposed skin
    4. Risk of Contact Dermatitis
  2. Limit Topical Corticosteroids to localized regions and diagnoses
    1. Avoid prolonged or excessive use of empiric Topical Corticosteroids
    2. Risk of skin atrophy
    3. Consider mild to moderate Corticosteroids (e.g. Hydrocortisone to triamcinolone) for focal areas, brief use (e.g. 2 weeks)
  3. Standard Topical antipruritic lotions
    1. Menthol/camphor (e.g. Sarna lotion)
    2. Cool Wraps
    3. Oatmeal Baths (e.g. Aveeno)
    4. Pramoxine (PrameGel, Prax, Pramosone)
    5. Calamine (on weeping lesions only, avoid if skin dry)
  4. Doxepin 5% cream (Zonalon)
    1. Dose: Apply four times daily for up to 8 days
    2. Highly effective at reducing Pruritus
    3. High rate of Contact Dermatitis with prolonged use
  5. Miscellaneous Options
    1. Burow's Solution (Wet Dressings)
    2. Unna Boot (also protects area from scratching)
    3. Tar emulsion

IV. Management: Systemic Antipruritic agents

  1. Aspirin
    1. Anti-inflammatory action offer symptomatic relief
    2. Effective if kinin or Prostaglandin mediated Pruritus
  2. Doxepin (Sinequan)
    1. Dose: 25 mg PO qhs
    2. Highly effective antipruritic more potent than Atarax
  3. Antihistamines
    1. Sedating Antihistamine: Hydroxyzine (Atarax)
      1. No antipruritic effect in Eczema
      2. Sedation allows sleep at night
      3. Dose: 0.5 mg/kg up to 25 to 50 PO qhs
    2. Non-Sedating Antihistamine: Cetirizine (Zyrtec)
      1. Metabolite of Hydroxyzine
      2. Reduces Pruritus more than others in its class

V. Management: Specific Conditions

  1. Cholestasis associated Pruritus
    1. See Cholestasis associated Pruritus
  2. Renal Failure associated Pruritus
    1. See Uremic Pruritus
  3. HIV Infection related Pruritus
    1. Responds to Antiretroviral therapy
    2. Consider other causes of Pruritus in HIV
  4. Psychiatric Illness related Pruritus
    1. Antidepressants
    2. Doxepin (Sinequan) 25 mg PO qhs
    3. Anxiolytics (e.g. Benzodiazepines)
      1. Consider for short-term bedtime use
    4. Pimozide
      1. May be indicated in Delusions of Parasitosis
    5. Transcutaneous Electric Nerve Stimulation (TENS)
  5. Neuropathic Pruritus
    1. Gabapentin (Neurontin)
    2. Pregabalin (Lyrica)

VI. Prevention: Superinfection from scratching

  1. Keep Fingernails short and clean
  2. Rub with palms for irresistible urge to scratch

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