Nonpharmacologic Treatment of Pruritus.
Topical anti-itch medications (Antipruritic Creams and Lotions)
Topical Menthol
Eucerin calming itch relief lotion. Contains Menthol 0.15%
Topical Antihistamines (Weak evidence of efficacy)
-Benadryl itch stopping cream (Diphenhydramine / Zinc acetate)
-Doxepin 5% cream (Zonalon). Drowsiness and sedation are common. Avoid in children.
Topical Anesthetics
Pramoxine 1% topical e.g. Caladryl cream.
Pramoxine/Menthol topical e.g. Gold Bond Rapid Relief.
Lidocaine/Prilocaine topical e.g. EMLA cream (Lidocaine 2.5% + prilocaine 2.5% cream)
Camphor/Menthol topical e.g. Sarna (Camphor 0.5% + menthol 0.5%) – for pts 2yo and older. Use PRN; Max: 4x/day.
Menthol/dimethicone topical e.g. Gold Bond Extra Strength Body Lotion
Itching + inflammation skin disease (e.g. Eczema)
-Topical steroids. Itchiness improves as inflammation is treated. Don’t use for pruritus without evidence of skin inflammation. Steroids are not directly antipruritic.
-Intralesional steroid injection for thick or nodular lesions.
Neuropathic itch
-Capsaicin 0.025 to 0.1% cream. An initial transient burning feeling is common.
Systemic anti-itch Medications
Antihistamines
H1 antihistamines (eg, hydroxyzine, diphenhydramine)
1st and 2nd-generation antihistamines for pruritus from urticaria or allergic dermatitis.
Further Reading
Habif, Thomas P. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. Edinburgh: Mosby, 2010; 5th ed, iii