II. Management: Avoid Precipitating Factors
- See Dry Skin Management
- Limit topicals to perfume and dye free products
- Avoid excessive heat
- Keep bedroom cool at night time
- Avoid factors that cause drying
- See Dry Skin Management
- Humidify indoor environment (e.g. winter)
- Avoid static electricity
- Change one sheet at a time
- Avoid rough clothing or fabrics
- Consider best fabric options
- Doubly rinsed cotton clothes
- Silk
- Avoid irritating fabrics
- Wool
- Smooth-textured cotton garments
- Avoid heat retaining fabrics (Synthetics)
- Add Alpha Keri to rinse cycle when washing sheets
- Consider best fabric options
- Avoid vasodilators if provoke itching
III. Management: Topical Agents for Pruritus
- Avoid Topical Anesthetics and Antihistamines
- Avoid topical Diphenhydramine (e.g. Benadryl or Allegra topical sticks, creams, gels, sprays)
- Avoid topical caines (e.g. Lidocaine, benzocaine)
- May sensitize exposed skin
- Risk of Contact Dermatitis
- Limit Topical Corticosteroids to localized regions and diagnoses
- Avoid prolonged or excessive use of empiric Topical Corticosteroids
- Risk of skin atrophy
- Consider mild to moderate Corticosteroids (e.g. Hydrocortisone to Triamcinolone) for focal areas, brief use (e.g. 2 weeks)
- Standard Topical antipruritic lotions
- Menthol/camphor (e.g. Sarna lotion)
- Cool Wraps
- Oatmeal Baths (e.g. Aveeno)
- Pramoxine (PrameGel, Prax, Pramosone)
- Calamine (on weeping lesions only, avoid if skin dry)
-
Doxepin 5% cream (Zonalon)
- Dose: Apply four times daily for up to 8 days
- Highly effective at reducing Pruritus
- High rate of Contact Dermatitis with prolonged use
- Miscellaneous Options
- Burow's Solution (Wet Dressings)
- Unna Boot (also protects area from scratching)
- Tar emulsion
IV. Management: Systemic Antipruritic agents
-
Aspirin
- Anti-inflammatory action offer symptomatic relief
- Effective if kinin or Prostaglandin mediated Pruritus
-
Doxepin (Sinequan)
- Dose: 25 mg PO qhs
- Highly effective antipruritic more potent than Atarax
-
Antihistamines
- Sedating Antihistamine: Hydroxyzine (Atarax)
- No antipruritic effect in Eczema
- Sedation allows sleep at night
- Dose: 0.5 mg/kg up to 25 to 50 PO qhs
- Non-Sedating Antihistamine: Cetirizine (Zyrtec)
- Metabolite of Hydroxyzine
- Reduces Pruritus more than others in its class
- Sedating Antihistamine: Hydroxyzine (Atarax)
V. Management: Specific Conditions
- Cholestasis associated Pruritus
-
Renal Failure Associated Pruritus
- See Uremic Pruritus
-
HIV Infection related Pruritus
- Responds to Antiretroviral therapy
- Consider other causes of Pruritus in HIV
- Psychiatric Illness related Pruritus
- Antidepressants
- Doxepin (Sinequan) 25 mg PO qhs
- Anxiolytics (e.g. Benzodiazepines)
- Consider for short-term bedtime use
- Pimozide
- May be indicated in Delusions of Parasitosis
- Transcutaneous Electric Nerve Stimulation (TENS)
- Neuropathic Pruritus
VI. Prevention: Superinfection from scratching
- Keep Fingernails short and clean
- Rub with palms for irresistible urge to scratch