Table 2.

Summary of interventions and the most appropriate indications

Nonpharmacologic therapiesMoisturizationAll patientsIII
Cool environmentAll patientsIII
Avoid irritantsAll patientsIII
Break itch-scratch cycleAll patientsIII
Behavioural therapy, relaxation, stress reductionAll patients, but especially for atopic dermatitis and other chronic itchII
Topical therapiesCorticosteroidsInflammatory dermatosesI
Calcineurin inhibitorsInflammatory dermatosesI
CapsaicinLocalized itch (eg, neuropathic)III
MentholLocalized itch (eg, neuropathic)III
Pramoxine or eutectic mixture of lidocaine and prilocainePostburn, uremic, or neuropathic pruritusII
DoxepinAtopic dermatitisI
Systemic therapiesNonsedating antihistaminesUrticaria, insect bite reactions, mastocytosis, drug reactionsI
First-generation antihistaminesNocturnal itchIII
μ-Opioid receptor antagonistsCholestatic pruritus, chronic urticaria, atopic dermatitisI
κ-Opioid receptor agonistsOpiate-induced pruritus, uremic pruritusI
SSRIs (paroxetine, fluvoxamine, sertraline)Palliative careI
Atopic dermatitis, systemic lymphoma, solid carcinoma, uremic pruritus, cholestatic pruritusII
DoxepinAtopic dermatitis, HIV-related pruritus, allergic cutaneous reactions, urticariaII
Anticonvulsants (gabapentin, pregabalin)Uremic pruritusI
Neuropathic pruritus, idiopathic pruritusII
Ursodeoxycholic acidIntrahepatic cholestasis of pregnancyI
Oral immunosuppressants (cyclosporine, azathioprine, mycophenolate mofetil)Inflammatory dermatosesI
CorticosteroidsInflammatory dermatosesI
  • 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.