Treatment

In recent years, research has gained a number of new insights into the neuronal basis and the clinical course of pruritus. This has also significantly improved the medical care and therapy options for patients suffering from pruritus.

Experts recommend the creation of an individual therapy plan taking into account age, existing diseases and medication. The severity of the symptoms (duration, quality, intensity of the pruritus) as well as possible limitations of the quality of life and expected side effects must also be included in the therapy planning.

Usually the following procedure is used

- First, the patient should be informed about general pruritus alleviating measures (see also box "What can the patient do himself?").
- Careful diagnosis and therapy of the underlying disease have absolute priority over further symptomatic therapy.
- In case of high suffering pressure, however, symptomatic treatment may be necessary at the same time.
- If the pruritus is not significantly reduced by the treatment of the underlying disease or if no cause is found, a combined or consecutive, step-by-step, symptomatic therapy is necessary (see also table 1).

What can the patient do himself?

Those who suffer from pruritus often desperately look for ways and means to alleviate or even eliminate it. But what helps? The following list provides information about this.

- Make sure that your skin is not too dry (for example, regularly apply a moisturizing and cooling skin cream or lotion).

- Use products for short-term pruritus reduction, e. g. for nightly pruritus: creams / lotions / sprays with urea, camphor, menthol, polidocanol, tanning agents, moist or cooling compresses or fat-moist compresses, cool showers, black tea compresses, etc.

- Avoid frequent washing and bathing in too warm water. It dries out the skin (a short refreshment in the shower at a slightly cooler water temperature is better).

- Avoid excessive heat.

- Wear cotton clothing and avoid skin-irritating synthetic fibres.

- Remove alcohol and hot spices from your menu.

- Relax and avoid chronic stress (it can be helpful to ask a psychologist for advice).

- Do not scratch yourself with sharp objects.

- Shorten your nails.

- Wear gloves at night.

In the case of chronic pruritus, experts recommend a step-by-step procedure (see table 1).

Table 1: Stepwise symptomatic-therapeutic approach in chronic pruritus [according to 2]

Step 1
- General therapeutic measures, especially basic therapy with moisturizers
- Initial symptomatic therapy: systemic H1 antihistaminics, topical corticosteroids

Step 2
- Symptomatic causative adapted therapy if origin is unknown

Step 3
- In pruritus of unknown origin or therapy refractory cases in the 2nd step: symptomatic topical and/or systemic therapy, e.g. capsaicin, calcineurin inhibitors, cannabinoid agonists, naltrexone, gabapentin, UV phototherapy, immunosuppressives (cyclosporine)

Concomitant treatment in every step
• Diagnostics and treatment of underlying disease
• General therapeutic measures
• In sleep disorders: sedative H1-antihistaminics, tranquilizers, tricyclical antidepressants or neuroleptics
• Psychosomatic care, behavioural therapy for scratch behaviour
• In erosive scratch lesions: disinfecting measures, topical corticosteroids