Management of pruritus

Management of pruritus

In patients with pruritus, self care advice should be offered

• short baths with tepid or lukewarm water using mild cleansers with a low pH
• soap should be washed off completely and when drying, the skin should be patted lightly rather than vigorous drying
• a cool ambient environment rather than humid environment
• wearing light cool clothes and avoid irritating clothes
• avoiding foods which may cause vasodilation e.g. - alcohol and hot or spicy foods or drinks
• keep the nails short
• rub the skin rather than scratching to avoid damage (1,2)

Use of an emollient is beneficial in patients with dry skin conditions. Emollients acts as substances which occlude the skin surface and encourages build up of water in the stratum corneum.

• emollients can be wash products (skin cleansers and bath additives) and leave-on products (lotions, creams, gels and ointments)
• when prescribing, an individual's preference and lifestyle should be taken into account, however for dry skin - ointments, moderately dry - cream or gel and slightly dry - a lotion, are usually appropriate
• a leave on topical emollient should be used frequently to keep the skin hydrated and the quantity will vary from individual to individual e.g. - for a child - around 250g/week and for an adult between 500-600g/week (3)

Systemic agents are used in case of specific indication or when conservative measures fail (4)

• antihistamine
  • some (but not all) cases of pruritus could be managed effectively with antihistamines (2)
  • first generation antihistamines e.g. piriton, are preferred, due to its sedating effect it should be given in the night time; second or third generation antihistamines may help daytime symptoms (4)
• additional drugs used in the management of pruritus
  • tricyclic antidepressant(TCA) - doxepin
  • serotonin selective reuptake inhibitor (SSRI) - paroxetine
  • other antidepressants eg mirtazapine (4)
  • antiepileptics - gabapentin (useful in generalized pruritus of unknown origin which does not respond to usual therapy) (5)

Management of pruritus due to a systemic disease is aimed at relieving the underlying cause which will eliminate the itching sensation (2).

Reference:

• 1. Twycross R et al. Itch: scratching more than the surface. Q J Med 2003; 96: 7-26
• 2. Lovell P, Vender RB. Management of pruritus. Skin Therapy Letter 2007;12(1), 1-6
• 3. Dermatology UK (2007) Best practice in emollient therapy: a statement for healthcare professionals
• 4. Lynde, C.B., Kraft, J.N. and Lynde, C.W. Novel agents for intractable itch. Skin Therapy Letter 2008;13(1), 6-9
• 5. Yesudian PD, Wilson NJ. Efficacy of gabapentin in the management of pruritus of unknown origin. Arch Dermatol. 2005;141(12):1507-9