• Oral Antihistamines

There have been very few advances in the pharmacological management of itch. Oral antihistamines have been the backbone of therapy. However, less than half of patients with itch do not have adequate control with antihistamines.^{1-5, 13-15}

The H1 receptor antagonists are the agents most commonly used. Diphenhydramine (Benadryl) and hydroxazine (Atarax) are the most common. Cetirizinc (Zyrtec) has also been used, a selective H1 receptor antagonist as has Cimetidine, an H2 receptor antagonist with some success.¹³

• Topical Anesthetic Agents

The local anesthetic EMLA is composed of a 1:1 mixture of lidocaine and prilocaine. Its use for itch has not been well studied. However, the size of the wound will need to be relatively small given the expense and absorption of the lidocaine.¹³

• Pain Medication

Often narcotics or non-steroidal anti-inflammatory agents are used in an attempt to control discomfort. Neither will directly improve itch but can decrease the perception by a sedating effect. In addition, an element of pain may also be present.^1-6

• Topical Doxepin Cream^15-21

Doxepin is a tricyclic antidepressant, which has extremely potent antihistamine properties being 800 times more potent than diphenhydramine. The parent drug Doxepin is a very safe agent with the only side effect being some drowsiness. A 5% Doxepin cream has been used for over 15 years in the treatment of choice for itchy skin with excellent results.

Two recent studies in outpatient burn patients with itch burn wounds have demonstrated a rapid and significant decrease in itch and redness in the itchy wound compared to oral antihistamines.^21,22

In addition, when used over a 3-month period over half of the patients using the Doxepin cream no longer had an itching burn wound compared to less than 10% of the oral antihistamine group. Therefore the Doxepin cream not only decreased the itch, but also altered the wound so that the itch went away.
(For more details, see; Experience with 5% Doxepin Cream, Section VIII)