13.3 Antipruritics

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Management of eczema Psoriasis management Treatment of seborrhoeic dermatitis Treatment of itching skin (pruritus) Management of urticaria Treatment of acne Treatment of rosacea Treatment of actinic keratoses Management of hyperhidrosis Management of skin conditions 13.2 Emollient and barrier preparations 13.3 Antipruritics 13.4 Topical corticosteroids 13.5 Preparations for eczema and psoriasis 13.6 Acne and rosacea 13.7 Preparations for warts and calluses 13.8 Sunscreens and camouflagers 13.9 Shampoos and other preparations for scalp and hair conditions 13.10 Anti-infective skin preparations 13.11 Skin cleansers, antiseptics, and desloughing agents 13.12 Antiperspirants 13.13 Miscellaneous skin preparations

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First Line

Second Line

Specialist

Hospital Only

An emollient may be of value where the pruritus is associated with dry skin.

NHS England (NHSE) has published new prescribing guidance for various common conditions for which over the counter (OTC) items should not be routinely prescribed in primary care (quick reference guide). One of these conditions is mild irritant dermatitis.

Many of these products are cheap to buy and are readily available OTC along with advice from pharmacies. Some self-care medicines are available from shops and supermarkets. Please click here for further information, exceptions, and a patient leaflet.

Antihistamines: A non-sedating antihistamine may be of some value in relieving severe itching or urticaria associated with eczema. A sedating antihistamine can be used if itching causes sleep disturbance (see section 3.4.1). Fexofenadine has been added for the treatment of chronic idiopathic urticaria in patients not adequately treated with cetirizine (see section 3.4.1).

Crotamiton dries skin, and is therefore not suitable for use in eczema. Lotion appears to be more soothing than cream.

Calamine preparations are often ineffective and have little proven benefit. In addition they dry the skin and cause the pruritus to worsen.

Crotamiton

Cream 10% (£5.60 = 100g)

Indications

Pruritus (including pruritus after scabies)

Dose

Apply 2–3 times daily

Notes

Exclude scabies before use as crotamiton masks this and it is not fully effective as an acaricide.

Levomenthol Cream, BP (Menthol in Aqueous Cream)

Cream 0.5%, 1%, 2% (£18.64 = 1% x 500g)

Doxepin

Cream 5% (£13.66 = 30g)

Indications

Localised areas of itch (e.g. pruritis ani) only

Dose

Apply thinly 3-4 times daily

Difelikefalin

Solution for injection vials 50micrograms/1ml

Notes

NICE TA890: Difelikefalin (Kapruvia) is recommended, within its marketing authorisation, for treating moderate to severe pruritus in adults with chronic kidney disease (CKD) having in-centre haemodialysis, only if the company provides it according to the commercial arrangement (May 2023).

Formulary