In absence of signs of skin disease patients require a thorough history and an examination that should place special emphasis on examining for enlarged lymph nodes and hepatosplenomegaly

Azadeh Shirazi, MD, FAAD,a board-certified dermatologist at La Jolla Dermatology and Laser Surgery Center in California The only way of knowing if the drug is responsible is by discontinuing the medication for a few weeks (if possible) and seeing if symptoms improve mild steroid cream (usually for only a few days) for small, inflamed areas – hydrocortisone cream is available from pharmacies over the counter, or your GP can prescribe a steroid cream for you This is a steroid anti-itch cream, which is good for inflammation. But if you want to dull the annoying itch that comes with many bug bites, you might prefer an antihistamine cream instead.We all know not every itch is the same. While some creams work well for that general dry skin itch, others are specially formulated for eczema, so we reached out to dermatologists to determine what they recommend for what type of itch and why. We also had a board-certified allergist on our Medical Expert Board review this article for medical and scientific accuracy. Ingredients to avoid include lidocaine and benzocaine, which, like menthol and pramoxine hydrochloride, numbs the skin and distracts the receptors from itchiness. However, Cynthia Bailey, MD, board certified dermatologist and founder of Dr. Bailey Skin Care, advises against products with these ingredients because they might cause allergic reactions and skin rashes. In addition to being effective for relieving itch from bug bites, the cream also works to relieve minor symptoms related to poison ivy, a skin rash, or allergic reaction, among other minor skin ailments that cause itchy skin. The antifungal ingredient in this cream is called butenafine hydrochloride. It is used to treat both fungal and yeast infections, although this particular cream is not approved for the treatment of vaginal yeast infections. About 2% of pregnant women have pruritus without any obvious dermatological cause. In some cases the itch is due to cholestasis (pooling of bile in the gall bladder and liver). It usually occurs in the 3rd trimester and is relieved after giving birth.

In elderly patients with very dry skin use an emollient ointment as a moisturiser, and a trial of a topical steroid if asteatotic eczema is suspected For individuals with sensitive skin, it is important to find a cream that cuts out any harsh ingredients that might cause irritations, such as fragrances and parabens. Sarna Sensitive Anti-Itch Lotion removes any ingredients that might cause irritation for those with skin sensitivities. Instead, the lotion’s formula includes pramoxine hydrochloride—a local anesthetic, non-steroid alternative to hydrocortisone that works to numb the skin to both reduce inflammation and itch.

What causes pruritus?

Gabapentin - small doses can be effective eg 100 mg OD to TDS, gradually increasing upto 300 mg TDS if needed. Gabapentin can be increased up to 600 mg three times a day over 3–4 weeks if there is no effect at a smaller dose The way scratching stops itching has been explained by an interaction with pain pathways within the dorsal horn of the spinal cord. What causes pruritus? There is no cure for eczema, but different over-the-counter and prescription products can help manage the symptoms.

One study identified the risk of manifesting any malignancy as significantly higher in the first three months after developing itch. I n general, healthy patients with normal screening blood tests do not require detailed investigations to look for internal malignancy, however, the following groups of patients will require further investigations - Consider Capsaicin ® cream 0.075% cream. Apply thinly once a day and increase gradually up to a maximum of four times a day (or whatever the patient can tolerate) over a period of two weeks. Treat for eight weeks. If the patient cannot manage 0.075% try 0.025% cream Scratching a localised itch may lead to lichen simplex, prurigo or prurigo nodularis. Systemic causes of pruritus

What is the outcome for pruritus?

Treatments may be available to help relieve an itch and reduce the risk of skin damage caused by scratching. You should ask your GP or pharmacist about what’s most suitable for you. Medication Brachioradial pruritus and notalgia paraestheticaaretwo well-defined conditions causing localised areas of itching / burning Creams, such as aqueous cream with menthol, are safe to use in pregnancy and can provide some relief from itching.

Localised pruritus is pruritus that is confined to a certain part of the body. It can occur in association with a primary rash (eg dermatitis) or may occur because of hypersensitive nerves in the skin ( neuropathic pruritus). Neuropathic pruritus is due to compression or degeneration of nerves in the skin, on route to the spine or in the spine itself. Neuropathic itch is sometimes associated with reduced or absent sweating in the affected area of skin. Anti-epileptic drugs such as sodium valproate, gabapentinand pregabalin may also be of benefit to some patients, e.g., those with itch associated with renal failure or neuropathic itch. The mechanism of action is uncertain. Some women find that products with strong perfumes can irritate their skin, so you could try using unperfumed lotion or soap. Mild itching is not usually harmful to you or your baby, but it can sometimes be a sign of a more serious condition, particularly if you notice it more in the evenings or at night. Aspirin is sometimes effective if pruritus is mediated by kinins or prostaglandins and is noted to be effective in patients with pruritus due to polycythaemia vera. Note: aspirin may cause or aggravate itch in some patients.Other measures that can be useful in preventing pruritus include avoiding precipitating factors such as rough clothing or fabrics, overheating, and vasodilators if they provoke itching (eg, caffeine, alcohol, spices). Fingernails should be kept short and clean. If the urge to scratch is irresistible then rub the area with your palm. You may report side effects to the FDA at 1-800-332-1088. You may also report side effects at https://www.fda.gov/medwatch. Isolated case reports in severe itch associated with malignancy have reported success with the NKR1 antagonist, aprepitant (normally used short-term for postoperative or chemotherapy-induced nausea). This is under investigation for neuropathic itch and nodular prurigo. Pathogenesis and treatment of pruritus in cholestasis. Kremer AE, Beuers U, Oude-Elferink RP, Pusl T. Drugs. 2008;68(15):2163-82. Medline.