Management of Pruritus

Often, patients present because of the pruritus associated with a skin condition rather than the skin condition itself. Itching associated with visible lesions often responds to relatively nonspecific antipruritic treatments. If the itching is generalized, patients may obtain temporary relief from cool or tepid baths with the addition of colloidal oatmeal (Aveeno). Soap should be avoided. Oral antihistamines can be given every 6 to 8 hours, especially at bedtime to promote sleep. Diphenhydramine (Benadryl) and hydroxyzine (Atarax, Vistaril) are first-generation antihistamines that are relatively

Table 33-2 Potency of Topical Corticosteroids


Generic Drugs

Brand Names

"Superpotent" (class 1)

Clobetasol, betamethasone dipropionate, halobetasol, fluocinonide

Clobex, Diprolene, Olux, Psorcon, Temovate, Ultravate, Vanos

High potency (classes 2 and 3)

Betamethasone dipropionate, mometasone, halcinonide, fluocinonide, desoximetasone, triamcinolone 0.1%, fluticasone, amcinonide

Diprolene, Elocon, Halog, Lidex, Psorcon, Topicort, Aristocort, Cutivate, Cyclocort

Midpotency (classes 4 and 5)

Prednicarbate, mometasone, betamethasone valerate, hydrocortisone probutate, fluocinolone, desoximetasone, hydrocortisone valerate, triamcinolone 0.025%

Dermatop, Elocon, Luxiq, Pandel, Synalar, Topicort, Westcort, Cordran, Cutivate, Locoid

Low potency (classes 6 and 7)

Alclometasone, desonide, fluocinolone, hydrocortisone

Aclovate, DesOwen, Synalar, Hytone, Desonate

safe and effective, although caution should be used in older adult patients. Second-generation antihistamines are similarly effective for reducing pruritus in the daytime, and are less sedating for some patients. These include fexofenadine (Allegra), loratadine (Claritin), and cetirizine (Zyrtec). Usually, second-generation antihistamines are given once daily.

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