Table 6 Chronic itch management

General measures

• Bathing in tepid water with syndet/oil cleanser and skin hydration with emollients

• Overheating and dry environment avoidance

• Relaxation techniques and patient education to cope with the vicious itch–scratch cycle

Therapeutic options

• Short courses of topical mid-potency steroids

• Sedating antihistamines (e.g. hydroxyzine) and/or tricyclics with anti-H1 antihistaminic action (doxepin) as first-line treatment*

• Low-dose gabapentin (Neurontin®) or pregabalin (Lyrica®) as second-line treatment

• Anti-inflammatory agents (e.g. cyclosporine, thalidomide or topical tacrolimus) to be cautiously considered as third-line treatment only in severe cases**