Some Therapeutic Approaches to Itching

Topical therapy

May require ≥ 2 weeks for effect

Vegetable oil can help with removal

Initial burning sensation dissipates with time

Corticosteroid creams or ointments

Avoid face, moist skinfolds

Should not be used for prolonged periods of time (> 2 weeks)

These preparations have strong odors

Can cause dryness or irritation at application site

Should not be used for long periods of time or on children < 2 years

Ultraviolet B therapy

Sunburn-like adverse effects can occur

Long-term risk of skin cancer, including melanoma

Systemic therapy

Rarely can have a sedating effect in older patients

Adherence can be poor

Constipating, unpalatable

Can interfere with absorption of other drugs

Sedating, also helpful when given before bedtime

Sedating, also helpful when given before bedtime

Helpful in severe and chronic itching

Very sedating so taken at bedtime; reduce dose for older adults

Headache can be an adverse effect

Given after hemodialysis

Sedation can be a problem

Low doses to start and titrated up to clinical effect

Sedating, also helpful when given before bedtime

Rarely can have a sedating effect in older adults

Can lead to withdrawal symptoms in patients with tolerance to opioids