CLASS | INTERVENTION | INDICATION | LEVEL OF EVIDENCE* |
---|---|---|---|
Nonpharmacologic therapies | Moisturization | All patients | III |
Cool environment | All patients | III | |
Avoid irritants | All patients | III | |
Break itch-scratch cycle | All patients | III | |
Behavioural therapy, relaxation, stress reduction | All patients, but especially for atopic dermatitis and other chronic itch | II | |
Topical therapies | Corticosteroids | Inflammatory dermatoses | I |
Calcineurin inhibitors | Inflammatory dermatoses | I | |
Capsaicin | Localized itch (eg, neuropathic) | III | |
Menthol | Localized itch (eg, neuropathic) | III | |
Pramoxine or eutectic mixture of lidocaine and prilocaine | Postburn, uremic, or neuropathic pruritus | II | |
Doxepin | Atopic dermatitis | I | |
Systemic therapies | Nonsedating antihistamines | Urticaria, insect bite reactions, mastocytosis, drug reactions | I |
First-generation antihistamines | Nocturnal itch | III | |
μ-Opioid receptor antagonists | Cholestatic pruritus, chronic urticaria, atopic dermatitis | I | |
κ-Opioid receptor agonists | Opiate-induced pruritus, uremic pruritus | I | |
SSRIs (paroxetine, fluvoxamine, sertraline) | Palliative care | I | |
Atopic dermatitis, systemic lymphoma, solid carcinoma, uremic pruritus, cholestatic pruritus | II | ||
Doxepin | Atopic dermatitis, HIV-related pruritus, allergic cutaneous reactions, urticaria | II | |
Anticonvulsants (gabapentin, pregabalin) | Uremic pruritus | I | |
Neuropathic pruritus, idiopathic pruritus | II | ||
Ursodeoxycholic acid | Intrahepatic cholestasis of pregnancy | I | |
Oral immunosuppressants (cyclosporine, azathioprine, mycophenolate mofetil) | Inflammatory dermatoses | I | |
Corticosteroids | Inflammatory dermatoses | I |
SSRI—selective serotonin reuptake inhibitors.
↵* Level I evidence requires at least 1 properly conducted randomized controlled trial, systematic review, or meta-analysis. Level II evidence includes other comparison trials, non-randomized, cohort, case-control, or epidemiologic studies, and preferably more than 1 study. Level III evidence includes expert opinion or consensus statements.