Itch may be localized, or due to systemic disease. It can cause discomfort, frustration, poor sleep, anxiety and depression. Persistent scratching leads to skin damage – excoriation and thickening. Patients with itch usually have dry skin.

Management

• Use emollient/aqueous cream frequently (at least three times a day) as a moisturizer
• Treat underlying causes - e.g. biliary stenting or drainage for cholestasis
• Review medication to exclude a drug reaction, consider opioid switch
• Keep nails short
• Use loose fitting, cotton clothing and sheets and keep cool
• Dry skin by patting rather than rubbing, then apply moisturizer
• Avoid lanolin and perfumed products
• Add an emollient to bath water and use aqueous cream as a soap-substitute

Treatments

Topical agents

• Emollients (see 13.2.1 Emollients)
• Levomenthol cream 1% (see 13.3 Antipruritics)
• Crotamiton 10% cream (see 13.3 Antipruritics)
• Aqueous calamine cream (non-formulary)
• Topical corticosteroid (mild/moderate potency) once daily for 2-3 days if area inflamed, but not infected (see section 13.4 topical corticosteroids)

Systemic medication

• Antihistamine (stop if no benefit after a few days). Sedating antihistamines may be useful to aid sleep at night (see section 3.4.1 Antihistamines)
• Seek local specialist palliative care advice if the above not successful