Management of Keloid Pruritus

First-Line Treatment Approach

Apply moderate-to-high potency topical corticosteroids (mometasone furoate 0.1% ointment or betamethasone valerate 0.1% ointment) to the keloid surface between intralesional treatments, as recommended by Praxis Medical Insights 1

Menthol 0.5% preparations can provide additional symptomatic relief for pruritus, according to the British Journal of Dermatology and Praxis Medical Insights 1, 2

Start with non-sedating antihistamines: fexofenadine 180 mg daily or loratadine 10 mg daily for daytime management, as suggested by the British Journal of Dermatology and Praxis Medical Insights 1, 2
For nighttime pruritus interfering with sleep, consider hydroxyzine 25-50 mg at bedtime, according to the British Journal of Dermatology and Praxis Medical Insights 1, 2
Use sedating antihistamines cautiously in elderly patients due to cognitive impairment risk, as recommended by Praxis Medical Insights 1

If antihistamines fail after 2-4 weeks, escalate to gabapentin 900-3600 mg daily or pregabalin 25-150 mg daily, as suggested by the British Journal of Dermatology and Praxis Medical Insights 1, 2

Do not use topical capsaicin for keloid pruritus, despite promotion for other pruritic conditions, as stated by the British Journal of Dermatology 2
Avoid calamine lotion, as there is no evidence supporting its use for keloid pruritus, according to the British Journal of Dermatology 2
Address the psychological impact, as keloid disease significantly affects quality of life due to disfigurement, intense pruritus, and pain; consider referral for psychological support in distressed patients, as recommended by the British Journal of Dermatology 3