Pruritus

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Pruritus or itching is an unpleasant sensation on the skin that provokes the desire to rub or scratch the area. Itching can cause discomfort and frustration. In severe cases it  can lead to disturbed sleep, anxiety and depression. Constant scratching to obtain relief can damage the skin and reduce its effectiveness as a major protective barrier. Treatment of pruritus must address the underlying condition. Diagnosis therefore needs to be made for effective treatment. 

TreatmentTreatment Objectives

  • To relieve symptoms
  • To identify and treat underlying disorder

Non-pharmacological treatment

  • Avoid or minimize exposure to any identifiable causative agents e.g. soaps, detergents, drugs, clothes or fabric, foods etc.
  • Good personal hygiene
  • Counselling (for psychogenic pruritus) 

Pharmacological treatment 

See sections below

Referral Criteria

  • Refer to a dermatologist as soon as possible if diagnosis is unclear.

For treatment of Scabies 

Evidence Rating: [A]

  • Permethrin lotion 1%, topical,  

Adult

Apply to whole body and wash off after 8-12 hours 

Repeat after 7 days

Children

Apply to whole body and wash off after 8-12 hours

Repeat after 7 days

< 2 months; not recommended

Note: Avoid contact with the mouth. Refer patient to the clinical pharmacist for counselling on the use of permethrin lotion in children and for breastfeeding mothers.

Evidence Rating: [C]

  • Benzyl benzoate 25% lotion, topical, 

Adults

Apply over the whole body after a bath at night (except the face and head) for 3 nights [and wash off the next morning] 

Children (> 2 years) (25% - half strength dilution) 

Apply over the whole body after a bath at night (except the face and  head) for 3 nights [and wash off the next morning] 

Note: Treat all contact cases in same manner simultaneously. Consult the clinical pharmacist for appropriate dilution and counselling on the use of benzylbenzoate in children.

Or 

  • Malathion 0.5%, topical,

Adults

Apply to whole body. Leave on for 24 hours and wash off. Repeat application after 7 days

Children 

Apply to whole body. Leave on for 24 hours and wash off. Repeat application after 7 days

< 6 months; not recommended 

Note: Clothing and bed linen must be changed and washed daily with a strong disinfectant and should be well dried and ironed or dry-cleaned. Sexual and household contacts should also be treated.

For treatment of Candidiasis

  • Clotrimazole 1%, topical,

Adults

Apply to affected area 12 hourly for 14 days

Children

Apply to affected area 12 hourly for 14 days

Or

  • Miconazole 2%, topical

Adults

Apply to affected area 12 hourly for 14 days

Children

Apply to affected area 12 hourly for 14 days

 

For treatment of Pediculosis (lice)

  • Malathion 0.5%, topical,

Adults

Apply to whole body. Leave on for 24 hours and wash off. Repeat application after 7 days

Children 

Apply to whole body. Leave on for 24 hours and wash off. Repeat application after 7 days

< 6 months; not recommended