Pruritus

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Refer to section 13.3 and National Patient Pathways

  • It is important to look for and treat any primary skin disease, eg eczema. 
  • Look carefully for the burrows of scabies, refer to section 13.10, to local guidance and to National Patient Pathways.
  • If the skin is dry, apply liberal quantities of emollient. An emollient may also help even when the skin does not feel dry. Refer to section 13.2 and to guidance
  • Keep the environment cool, as pruritus is temperature-dependent.
  • Avoid hot baths/showers and use unperfumed cleansers.   Balneum Plus® bath oil is a good antipruritic. 
  • Zerobase® cream is a good soap substitute. 
  • Menthol 1% in aqueous cream is a useful first-line topical antipruritic emollient.
  • A sedating antihistamine may be used at night in intractable pruritus where sedation is desirable (see section 3.4). 
  • Crotamiton cream is useful for the itch of scabies, which may take some weeks to settle after successful treatment. 
  • In the absence of skin inflammation or lesions, consider:
    • renal disease (U&E profile)
    • diabetes (glucose)
    • liver disease/cholestasis (LFT profile)
    • iron deficiency (ferritin profile)
    • polycythaemia and other blood dyscrasias (FBC and ESR or plasma viscosity)
    • thyroid disease (over or underactive) (TFT profile)
    • lymphoma and solid tumours, especially breast and lung cancer (chest x-ray)
    • drug reaction
    • hyper/hypocalcaemia (calcium and phosphate profiles).
  • Only use topical corticosteroids if there are visible signs of inflammatory skin disease 
  • Application of a bland moisturiser, such as Zerobase® cream, is useful for the symptomatic relief of itch from chickenpox etc.
Editorial Information

Last reviewed: 31 December 2016

Next review: 31 December 2018

Author(s): Skin Review Group

Version: 8

Approved By: TAM Subgroup of ADTC