RISK FACTORS: Any pre-existing pruritic dermatosis, Obsessive-compulsive personality or anxiety, Exposure to irritants
GENERAL MEASURES
β’ Patient education
β’ Treat pruritus to interrupt the scratch-itch cycle
β’ Occlusive dressings, especially at night, may be beneficial for preventing scratching and rubbing
β’ Nail trimming
ACTIVITY As tolerated. Encourage exercise in those cases where stress may play a role.
DIET Regular
PATIENT EDUCATION
β’ Patients should understand the cause of this disease and their role in helping resolve the condition
β’ Various stress reduction techniques can also be used in those patients in whom stress plays a significant role
β’ Emphasize that scratching and rubbing must stop in order for lesions to heal
DRUG(S) OF CHOICE
. Topical steroids
. High potency steroids alone, such as 0.05% betamethasone dipropionate cream or 0.05% clobetasol
propionate cream can be used initially, but these should not be used on the face, anogenital region, or
intertriginous areas. They should be used on small areas only, and for no longer than two weeks.
. An intermediate potency steroid such as 0.1% triamcinolone cream may be used initially under an occlusive dressing for one to two weeks instead
. Switch to intermediate or low potency steroids alone as response allows
. An intermediate potency steroid, such as 0.025% or 0.1% triamcinolone cream may be used for initial treatment of the face and intertriginous areas and for maintenance treatment of other areas. A low potency
steroid, such as 1% hydrocortisone cream should be used for maintenance treatment of the face and
intertriginous areas.
. Steroid tape, fl urandrenolide (Cordran)
. Optimized penetration
. Provides some barrier to further trauma
ALTERNATIVE DRUGS
β’ Menthol 0.25% solution can help relieve pruritus
β’ Cold Burowβs solution compresses: 1 packet of Domeboro powder in one quart ice cold water applied with a
cloth for 15 minutes as needed
β’ Coal tar preparations are useful but cosmetically less appealing
β’ Topical doxepin cream 5%
β’ Topical capsaicin cream
β’ Oral antihistamines can be used for both their antipruritic and sedative effects.
β’ For resistant cases, consider a course of prednisone 40 mg/day for 2 weeks
β’ Intralesional corticosteroids: Inject 5-10 mg of Kenalog-10 (10 mg/ml) diluted with an equal amount of sterile
saline intradermally or subcutaneously, directly under the lesion, using 26-30 gauge needle and Luer-Lok
syringe. Spread solution around as needle is advanced. May repeat every 2-3 weeks as needed until resolution. Atrophy at injection site is a potential complication.
β’ Botulinum toxin A injected intradermally has been reported to produce a significant improvement in patients
with recalcitrant pruritus
β’ Topical aspirin has been shown to be helpful
β’ Anxiolytics or tricyclic antidepressants (e.g., lorazepam or amitriptyline)
β’ Unna boot for barrier protection
β’ Oral antibiotics if secondary infection is present
PATIENT MONITORING Patients should be followed closely and regularly for response to therapy,
complications from therapy, and secondary infections
PREVENTION/AVOIDANCE Avoid irritants and other known causative agents
POSSIBLE COMPLICATIONS
β’ Secondary infection
β’ Complications related to therapy, as mentioned in medication precautions
EXPECTED COURSE/PROGNOSIS
β’ Often chronic and recurrent
β’ The prognosis is good for those patients in whom the scratch-itch cycle can be broken
β’ After healing, the skin should have a normal appearance unless secondary infection has occurred