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Nonspecific Management of Pruritus
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Nonspecific Management of Pruritus
, Pruritus Management
See Also
Pruritus
Pruritus Causes
Dry Skin Management
Management
Avoid precipitating factors
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
Avoid vasodilators if provoke itching
Avoid
Caffeine
Avoid
Alcohol
Avoid spices
Avoid hot water
Management
Topical Agents for
Pruritus
Avoid
Topical Anesthetic
s and
Antihistamine
s
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
Avoid
Topical Corticosteroid
s
Risk of skin atrophy
Mild
Corticosteroid
s (e.g.
Hydrocortisone Cream
) could be used briefly
Standard Topical antipruritic lotions
Menthol
/camphor (e.g. Sarna lotion)
Oatmeal Bath
s (e.g.
Aveeno
)
Pramoxine (PrameGel, Prax, Pramosone)
Calamine (on weeping lesions only, avoid if skin dry)
Doxepin 5% cream (Zonalon)
Dose: Apply qid 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
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
Antihistamine
s
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
Management
Specific Conditions
Cholestasis associated Pruritus
See
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
Antidepressant
s
Doxepin (Sinequan) 25 mg PO qhs
Anxiolytic
s (e.g.
Benzodiazepine
s)
Consider for short-term bedtime use
Pimozide
May be indicated in
Delusions of Parasitosis
Transcutaneous Electric Nerve Stimulation (
TENS
)
Prevention
Superinfection from scratching
Keep
Fingernail
s short and clean
Rub with palms for irresistible urge to scratch
References
See
Pruritus
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