Treatment of itching skin (pruritus)

Whilst skin conditions such as eczema, dry skin and scabies are the commonest causes of generalised itch, it is important to conduct a thorough general examination to exclude systemic causes. If the cause of the itch is not readily diagnosable on appearance or by skin biopsy, consider causes such as:

• Anaemia (FBC and ferritin)
• Uraemia (check U&Es)
• Obstructive jaundice (check LFTs)
• Thyroid disease (check TFTs)
• Lymphoma (especially in young adults)
• Carcinoma (colonic Ca)
• Diabetes (HbA1c)
• Other tests should be guided by history and examination findings (for example chest radiography, urinalysis, faecal occult bloods).

Topical treatments

Crotamiton

• Apply two or three times a day
• Exclude scabies before use as crotamiton masks this and it is not fully effective as an acaricide.
• See 13.6 Pruritis

Doxepin cream

• Apply three or four times a day
• Use for localised areas of itch (e.g. pruritus ani) rather than generalised itching.
• See 13.6 Pruritis

Oral treatments

Chlorphenamine

• 4mg four to six hourly (maximum). Useful for night time use
• See 3.4. Antihistamines, hyposensitisation, and allergic emergencies

Hydroxyzine

• Initially 25mg at night
• See 3.4. Antihistamines, hyposensitisation, and allergic emergencies

Amitriptyline

• Use low doses
• See 4.3 Antidepressant drugs

 

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