Management of Pruritus

Initial Approach for All Patients

The British Journal of Dermatology recommends that all patients with pruritus should receive emollients and basic skin care regardless of etiology 1, 2
Apply emollients at least once daily to prevent xerosis, which commonly triggers pruritus, as suggested by the British Journal of Dermatology 3
Avoid physical triggers including wool clothing and harsh soaps, as advised by the British Journal of Dermatology 2
Keep skin dry after bathing and use clean, separate towels, as recommended by the British Journal of Dermatology 4

The British Journal of Dermatology suggests that topical doxepin is the most evidence-based topical agent for GPUO, but must be limited to 8 days, maximum 10% body surface area, and 12 grams daily due to contact dermatitis and toxicity risks 1, 5, 2
Topical clobetasone butyrate or menthol may provide benefit for GPUO, as recommended by the British Journal of Dermatology 1, 5, 2
The British Journal of Dermatology advises against using crotamiton cream, as it has no significant antipruritic effect versus vehicle 1, 5, 2
The British Journal of Dermatology also advises against using topical capsaicin or calamine lotion, as there is no evidence of efficacy in GPUO 1, 5, 2

The British Journal of Dermatology recommends topical corticosteroids as first-line for inflammatory causes, with hydrocortisone 2.5% or triamcinolone 0.1% as effective options 4
Apply moderate to high potency topical corticosteroids 3-4 times daily for up to 7 days maximum, as advised by the British Journal of Dermatology 4

The British Journal of Dermatology recommends rifampicin as the first-line treatment for hepatic pruritus, with a Strength A recommendation 1
The British Journal of Dermatology advises against using gabapentin for hepatic pruritus 1
For uremic pruritus, ensure adequate dialysis, normalize calcium-phosphate balance, control parathyroid hormone, and correct anemia with erythropoietin, as recommended by the British Journal of Dermatology 1, 3
The British Journal of Dermatology suggests that naltrexone is the first-choice treatment for opioid-induced generalized pruritus when cessation is impossible, with a Strength B recommendation 1

The British Journal of Dermatology recommends implementing psychosocial and behavioral interventions for distressed patients with chronic pruritus of likely psychogenic origin 1
Education on trigger avoidance and treatment application, lifestyle interventions, relaxation techniques, and cognitive restructuring may be beneficial, as suggested by the British Journal of Dermatology 1

The British Journal of Dermatology recommends identifying and treating the underlying cause while providing symptomatic relief with topical corticosteroids for vulvar pruritus 4
Most common cause of vulvar pruritus is candidiasis, which can be treated with 7 days of azole topical treatment, as recommended by the British Journal of Dermatology 4

The British Journal of Dermatology recommends reevaluating patients after 2 weeks if no improvement or worsening occurs to advance to next treatment step or investigate for underlying systemic disease 4