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Many skin disorders have itch, also known as pruritus, as a symptom, and sometimes itch can be seen with no sign of skin rash. Chronic itch can significantly impair quality of life, and can be quite difficult to treat.
Topical Treatments For Itch
Emollients alone are often helpful for treating itch. Over-the-counter moisturizers and eczema creams may provide symptomatic relief. Over-the-counter creams with menthol and pramoxine are helpful as well. Topical steroids often relieve itch. Eucrisa (crisaborole), a topical phosphodiesterase-4 inhibitor, can also help itch, especially that associated with eczema. Numerous compounded formulations are also used, prepared by compounding pharmacies, and containing ingredients such as lidocaine, ketamine and amitriptyline.
Systemic Treatments For Itch
Dupixent (dupilumab), a monocolonal antibody targeting the IL-4 pathway, is approved for treating atopic dermatitis, and can help with itch in this condition. Other systemic immunosuppressants can sometimes treat itch. These include methotrexate, azathioprine, cyclosporine and mycophenolate mofetil. The sleep medication Mirtazapine can help for night time itch. Gabapentin is used for itch as well as neuropathic pain. Butorphanol can also help with intractable itch. For itch caused by chronic cholestasis (a form of liver disease), bezafibrate has been shown to be helpful.
Is there a workup for itch?
Sometimes intractable itch can be a sign of underlying systemic illness. A cancer screening with a primary care doctor might be warranted. Routine lab work can screen for a variety of underlying medical problems that can be associated with itch. Markers of inflammation, such as erythrocyte sedimentation rate and C-reactive protein, iron studies, complete cell count, metabolic profile, thyroid panel and screening for hepatitis may all be warranted. A stool sample for ova and parasites may be helpful, especially if there is a history of overseas travel. Medications can also cause itch, and a complete medication list should be reviewed.
Whatever the cause of itch, discuss it with your dermatologist today.
