Skin itchiness, also known as pruritus, is a common ailment that can be associated with many diseases and conditions. Most people have experienced itchiness to some degree, whether it be due to a mosquito's feast, hives, liver or kidney disease or even cancer. Thankfully, myriad medications can help alleviate this bothersome symptom. The choice of what medicine to use typically depends on factors such as the cause, duration and severity of symptoms, as well as any previous treatment.
Topical Antihistamines and Antiinflammatories
Topical agents -- such as lotions, sprays and ointments -- are the first choice for minor skin itching. Topical diphenhydramine (Banophen, Benadryl Anti-itch, Dermamine) is an antihistamine product, which works by blocking histamine, a chemical released into the skin that provokes itchiness.
Steroid creams and ointments, such as hydrocortisone (Cortaid, Westcort), are an effective option for itching caused by hives or dermatitis, but it's less effective for insect bites. Hydrocortisone is available over the counter as a 0.5 or 1.0 percent formulation. Higher strengths and other more potent steroid creams require a prescription. Topical steroids should not be used for longer than 7 days unless your doctor advises you otherwise.
Other Topical Agents
Over-the-counter topical products containing cooling agents like camphor or menthol (Sarna Original lotion, Eucerin Skin Calming lotion) or pramoxine (Sarna Sensitive) can be helpful for itching associated with eczema, sunburn, insect bites or poison ivy/sumac. Pramoxine is a nerve-blocking agent.
Other topical agents containing benzocaine or similar topical anesthetics (Americaine, Solarcaine) work by temporarily numbing the skin to promote relief. Topical capsaicin (Capzasin, Zostrix) may be useful in chronic, localized itching. Capsaicin can cause a burning sensation when first applied, a side effect that tends to dissipate after a few days. Most topical agents provide rapid relief and are available in a wide variety of formulations.
For more severe itching or widespread itching, oral antihistamines are a more potent option. Antihistamines are categorized as first or second generation. First-generation antihistamines such as diphenhydramine (Benadryl, Diphenhist) and hydroxyzine (Atarax, Vistaril) cause more drowsiness than their second-generation counterparts, including fexofenadine (Allegra), loratadine (Alavert, Claritin) and cetirizine (Zyrtec). All antihistamines can cause some degree of sedation, which can be a helpful side effect if the antihistamine is taken at bedtime and promotes more comfortable sleep.
Most antihistamines are safe for the general population; however, it is important to consult a doctor before taking this type of medicine, especially if you are pregnant or breastfeeding, have an enlarged prostate or glaucoma.
Oral Steroids and Immunosuppressants
Another potent option is an oral steroid, such as prednisone. Steroids calm the inflammation associated with itching and are very effective for hives and allergic reactions. A short course of steroids, such as 1 to 2 weeks, is often recommended for the best results. Side effects due to oral steroid use can be bothersome. Fluid retention, insomnia and digestive system upset are some of the side effects associated with even short-term use. Long-term use may cause increases in blood sugar and bone loss.
Itching related to severe, chronic skin conditions like psoriasis or atopic dermatitis may be relieved by prescription immunosuppressant medications if other treatments have been ineffective. Examples include cyclosporine (Neoral) and methotrexate (Rasuvo). Because these powerful medications suppress the immune system -- which is thought to cause skin inflammation -- the risk for developing infections increases while on therapy.
Antidepressants and Neuroleptics
Some antidepressants may be beneficial in alleviating itch but are usually second- or third-choice options if itching does not respond to other medications. Sertraline (Zoloft) and fluoxetine (Prozac) primarily work on a neurotransmitter called serotonin, which is thought to play a role in the perception of an itch. Tricyclic antidepressants, such as doxepin (Silenor), also have an effect on histamine and can promote sleep and alleviate anxiety. Antidepressants are a suitable option when severe itching is accompanied by anxiety, avoidance of activities and loss of sleep.
Drugs known as neuroleptics, such as gabapentin (Neurontin) and pregabalin (Lyrica), may also aid in relieving itch if other forms of treatment fail. The exact mechanism by which these medicines affect itchiness remains unclear, but researchers theorize that they interfere with itch pathways in the brain and spinal cord.
Liver disease can cause severe itching through a buildup of bile acid. Cholestyramine (Prevalite) counters this buildup by binding to bile acids in the intestine; they are then passed in the stool. Medications known as opioid agonists and antagonists can help to relieve itching caused by liver and renal disease, atopic dermatitis and burns. Examples of these medications include naltrexone (Revia) and butorphanol. Use of these drugs for the treatment of chronic, severe itchiness is limited by side effects.
Warnings and Precautions
See your doctor right away if itchiness is prolonged or is worsening or not improving with topical or over-the-counter treatments -- especially if accompanied by other symptoms such as fever or swelling or redness of the involved area. Seek emergency medical attention if you experience sudden itchiness with shortness of breath or swelling of the face, lips or tongue. If itching is caused by another condition, such as liver disease or cancer, it is important to be followed by a doctor to discuss treatment options.
- Dermatology Nursing: Practical Guidelines for the Relief of Itch
- Expert Opinion on Pharmacotherapy: Therapy of Pruritis
- International Journal of Dermatology: New Insights Into the Pathophysiology and Treatment of Chronic Itch in Patients With End-stage Renal Disease, Chronic Liver Disease, and Lymphoma
- Hepatology: Sertraline as a First-Line Treatment for Cholestatic Pruritus
- National Eczema Association: Immunosuppressants
- DailyMed: Prednisone Tablet