dermatologic disorders
Itching
Treatment of Itching
Any underlying disorder is treated. Supportive treatment involves the following (see also table): Local skin care Topical treatment Systemic treatment Itching due to any cause benefits from use of cool or lukewarm (instead of hot) water when bathing, mild or moisturizing soap, limited bathing duration and frequency, frequent lubrication, humidification of dry air, and avoidance of irritating clothing. Avoidance of contact irritants (eg, wool clothing) also may be helpful. Topical medications may help localized itching. Options include lotions or creams that contain camphor and/ormenthol,pramoxine,capsaicin, or corticosteroids. Corticosteroids are effective in relieving itch caused by inflammation but should be avoided for conditions that have no evidence of inflammation. Topicalbenzocaine,diphenhydramine, anddoxepinshould be avoided because they may sensitize the skin. Systemic medications are indicated for generalized itching or local itching resistant to topical agents. Antihistamines, most notablyhydroxyzine, are effective, especially for nocturnal itch, and are most commonly used. Sedating antihistamines must be used cautiously in older adults during the day because they can lead to falls; newer nonsedating antihistamines such asloratadine,fexofenadine, andcetirizinecan be useful for daytime itch. Other medications includedoxepin(typically taken at night due to high level of sedation),cholestyramine(for renal failure, cholestasis, and polycythemia vera), opioid antagonists such asnaltrexone(for biliary pruritus), and possiblygabapentin(for uremic pruritus). Physical agents that may be effective for itching include ultraviolet phototherapy. 