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Management of Pruritus (Itching)

• It is important to try and make a diagnosis, including by looking for and treating any primary skin disease.
• If the skin is dry, liberal quantities of emollient should be applied.  An emollient may also help even when the skin does not feel dry.
• Keep the environment cool, as pruritus is temperature-dependent .
• Avoid hot bath/shower and use unperfumed cleanser.
• A sedating antihistamine may be used in intractable pruritus where sedation is acceptable (see section 3.4) .
• Look carefully for the burrows of scabies.  Crotamiton cream is useful for the itch of this condition, which may take some weeks to settle after successful treatment .
• In the absence of skin inflammation, consider:
  -     renal disease
  -     liver disease/cholestasis
  -     iron deficiency
  -     polycythaemia
  -     thyroid disease (over or underactive)
  -     lymphoma
  -     drug reaction
• Topical corticosteroids should only be used if there are visible signs of inflammation.

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