Itch/ Pruritus

Causes include:

• Drug allergy.
• Hepatic disease (Obstructive Jaundice).
• Uraemia - See Advanced or End-stage Kidney Disease.
• Active Lymphoma especially Non Hodgkins Lymphoma.
• Drugs, e.g. vasodilators, opioids.

Management

• Treat/ remove cause(s).
• Apply topical agents, e.g. D.P.Lotion (no part-charge on prescription), Alpha-Keri™ lotion, 0.25-1% Menthol in aqueous cream.
• Night sedation may be helpful.
• Use emulsifying ointment or Pinetarsol instead of soap.
• Evening primrose oil 100 mg bd may be helpful.
• Biliary stenting may be the most effective management if appropriate.
• UVB phototherapy may be helpful for uraemic itch.

Consider drug treatment

• Anti-histamines, e.g. Promethazine HCl 10-25 mg nocte or a non-sedating alternative for daytime use. Cetirizine if there is liver involvement as it is not liver metabolised.
• Cholestyramine (Questran Light™) ½ - 1 sachet BD/TDS for obstructive jaundice as it binds bile salts.
• H₂ Antagonist (acting via histamine receptors in the skin), e.g. Cimetidine 400 mg BD. (Note: check drug interactions.)
• Steroids – particularly for lymphoma or other active malignancies.
• Low dose Paroxetine (5 mg) – beware of nausea.
• Rifampicin for chronic cholestasis.
• NSAIDs, e.g. diclofenac.
• Ondansetron has been reported to be helpful (beware of constipation).
• Uraemic Pruritus:
  • Gabapentin is approved for this indication via special authority for chronic kidney disease associated pruritis.
  • Must dose reduce for degree of renal failure and use of dialysis.
  • Evening primrose oil may also be beneficial.

Topic Code: 4134