Itching (pruritus) can be managed quite effectively by general measures, failing which medications can be taken, as outlined below. If the itching does not respond to these measures, you should consult a doctor, preferably a dermatologist (skin specialist) for further investigations and diagnosis of any underlying disease that is leading to the itching.
Bathe only once daily, for not more than 5-10 min., with warm water that is not too hot. Use mild soap or cleansers which are soap-free. Use soap only on certain body areas (e.g., armpits, groin, feet, etc.). Pat (and not rub) the skin dry.
Apply emollients soon after bathing. Emollients can be lotions, creams (most desirable cosmetically), or ointments (greasy). Additives like urea and lactic acid can decrease the dryness and enhance the hydration of skin. Use a humidifier when it is cold, particularly during winter.
Colloidal oatmeal and baking soda solutions can be very useful for soaking the dry and pruritic areas. Trim the fingernails and use cotton gloves at night if you are having difficulty in controlling scratching during sleep. Avoid any items that may be acting as irritants, such as alcohol, caffeine, hairspray, cosmetics or jewelry.
Switching To An Alternative Drug
Drugs that can cause itching include certain antibiotics, antifungal drugs, blood thinners (anticoagulants), antidiabetic drugs, antihypertensives (taken for controlling blood pressure), opiates, and some pain relievers. If you are taking any such drugs, it may help to switch to an alternative drug to control the itching.
Medications For Itchy Skin Treatment
If you are having severe symptoms that are proving resistant to the above general measures, then one of the medications below or any combination of them can be beneficial.
The topical steroids that can be used are hydrocortisone 0.5-2.5% or dexamethasone 0.01%, which have low potency, or fluocinolone acetonide 0.2% or triamcinolone acetonide 0.5%, which have higher potency. Generally, ointments are more potent than creams, which in turn are more potent than lotions of corticosteroids.
Lesions which are thick or on soles and palms are more difficult to treat than lesions which are thinner or on other parts of the body. Start with a low potency topical steroid, reserving the high potency steroids for thicker lesions on palms or soles.
Side effects of topical steroids include local skin atrophy, striae, decreased pigmentation, acne, or dermatitis around mouth. Systemic side effects (for example, cataracts, glaucoma, endocrine disorders, bone thinning, etc.) are more common if they are used on greater percentage of body surface, are more potent and are used for longer duration.
Topical antihistamines (for example diphenhydramine) or doxepin (an antidepressant) can be used for the relief of itching. They need to be applied 3-4 times/day (doxepin should not be used for more than 8 days). Allergic contact dermatitis is a side effect.
They mainly work by causing sedation. They should be used as adjuvant short-term therapy along with topical treatment. The second-generation antihistamines cause less sedation, but are also less efficacious compared to first-generation agents.
First-generation antihistamines include: hydroxyzine (25–100 mg 6–8 hrly) and diphenhydramine (25–50 mg 4–6 hrly, max 400 mg/day; should not be used in very young children) – use lower doses in children.
Second-generation antihistamines include loratadine (10 mg once daily), fexofenadine (180 mg once daily/60 mg twice daily), cetirizine (5–10 mg once daily) – lower doses should be used in children less than 6 years.
Tricyclic antidepressants reduce the itching and promote sleep (for example doxepin 10 mg at bedtime, increasing to 25 mg if necessary; not to be used in children). Caution should be exercised in their use by those taking other sedatives, the elderly, those with conduction defects of heart, and those with prostatic hypertrophy.
These are useful in those not responding to above measures. Prednisone 40-60 mg/day can be taken for 4–5 days without tapering. Longer therapy needs to be started with 60 mg/day for a few days and tapered slowly. This minimizes the side effects that can occur with long-term therapy, such as growth disturbance, bone thinning, cataracts, and suppression of immunity. Oral corticosteroids should be used with caution in children.
Alternative Remedies For Itching
Warm compresses of herbal vinegars like plantain, lavender and rose can be helpful. Oral vitamin E and flaxseed oil can help by rehydrating the dry skin. A number of Chinese medicines are touted to be effective for itching, such as Cnidium tincture.
Hypnosis and transcutaneous electrical nerve stimulation (TENS) are effective in some cases. There are also plenty of herbal remedies for external application like aloe vera, cattail juice, evening primrose oil, marigold, myrrh, Sage leaves, St. John’s wort, tea tree oil and yellow dock tea bath.