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.

Systemic diseases may cause generalised pruritus. This is sometimes called metabolic itch. There is nothing wrong with the skin itself, at least until it's been scratched.

Thank You

Menthol and camphor are considered natural analgesics or pain-relievers. This means they work by helping numb the itch, explains Azadeh Shirazi, MD, FAAD, a board-certified dermatologist at La Jolla Dermatology and Laser Surgery Center. Menthol provides an additional cooling sensation that can help to relieve pain. Hydrocortisone is one of the many forms of cortisone medicines; cortisone is the class of steroid medicines and hydrocortisone is one member of that class,” Dr. Bailey says. There are several classes of steroid medications on the market, and each of them have different strengths and grades, Dr. Waldman adds. Cortisone is one class of steroids, and hydrocortisone is within that class.

Cannabinoid receptors, CB1 and CB2, are expressed on cutaneous sensory nerve fibers, mast cells and keratinocytes. 70 When administered topically to patients via patch delivery, a cannabinoid receptor agonist attenuated histamine-induced itch in humans. This effect was thought to be due to decreased neurogenic stimulation as opposed to decreased histaminergic activity since histamine-induced protein extravasation was still elevated in the skin as measured by microdialysis. 71 N-palmitoylethanolamine, a cannabinoid receptor CB2 agonist, has been compounded into creams and shown to reduce pruritus within days in patients with AD, lichen simplex chronicus, prurigo nodularis, and uremic pruritus. 72– 74 Thus far, compounds with N-palmitoylethanolamine have been tolerated well with few to no side effects. 74 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. It may help to apply an emollient before and after swimming. Leave enough time for it to be absorbed into your skin before you swim. Uraemic pruritus can be difficult to alleviate and patients with pruritus often have decreased quality of life such as poor sleep and depression. In cohort studies, it is associated as an independent predictor of morbidity, mortality, and leads to other poor patient outcomes. One study showed moderate to severe pruritus was associated with a 17% increase in mortality rate. 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.

What treatment is available for itch?

There are over 30 different topical steroid formulations available in the United States and these are prepared in different bases (e.g. solution, lotion, cream or ointment). Topical corticosteroids range in potency from low (Class VII) to high or ultra-potent (Class I). It is generally accepted that the clinical efficacy to treat inflammation, and indirectly pruritus, correlates with steroid potency. Treatment with TCIs has been shown to be effective at reducing pruritus within 48 hours of initial application, and its anti-pruritic effects are maintained during prolonged use. 22 In multiple large double-blind, randomized, vehicle-controlled trials in pediatric patients, tacrolimus ointment was shown to offer rapid relief from pruritus and other the symptoms of AD, with significant improvement observed within the first week of treatment. 27– 29 Similarly, in a randomized, double-blind, vehicle-controlled trial of pimecrolimus cream in atopic pediatric patients, 44.2% of pimecrolimus-treated patients versus 25.7% of those on vehicle reported a reduction in pruritus from moderate/severe to absent/mild within 1 week of twice daily application and the anti-pruritic effect persisted during a 6-week treatment course. 30 An extension phase of this study demonstrated continued control of AD lesions and pruritus over an additional 20-week period of open label use. 31 Several active-comparator studies have shown that tacrolimus ointment is more efficacious than pimecrolimus cream in the treatment of AD symptoms including pruritus, while sharing a similar safety profile. 32, 33 While TCIs are well-tolerated and superior to vehicle alone in preventing relapse of AD, a recent meta-analysis suggested that topical tacrolimus may not be as efficacious as topical fluticasone propionate to prevent flares of AD and pruritus. 34– 36