13.3 Topical local anaesthetics and antipruritics

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% (£4.35 = 100g)

Indications

  • Pruritus (including pruritus after scabies)

Dose

  • Apply 2–3 times daily

Notes

  1. 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% (£15.30 = 500g x 1%)
Doxepin
  • Cream 5% (£11.70 = 30g)

Indications

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

Dose

  • Apply thinly 3-4 times daily

 

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