What topical treatments are recommended for managing pruritus in patients with eczema or dermatitis?

Topical treatments recommended for managing pruritus in patients with eczema or dermatitis include:

• Emollients: These are the foundation of management for eczema and should be used regularly to maintain skin hydration and reduce dryness and itching. Emollients should be applied liberally and frequently on the whole body, even when eczema is clear, as they help manage pruritus by improving skin barrier function.
• Topical corticosteroids: Mild-potency corticosteroids are used for mild eczema, moderate-potency for moderate eczema, and potent corticosteroids for severe eczema. These reduce inflammation and pruritus during flares. Treatment should start as soon as symptoms appear and continue for about 48 hours after symptoms subside.
• Topical calcineurin inhibitors (tacrolimus or pimecrolimus): These are second-line treatments for moderate to severe eczema not controlled by topical corticosteroids, especially in sensitive areas like the face and neck. They reduce inflammation and itching without the risk of skin atrophy associated with corticosteroids. Their use should be initiated by clinicians experienced in dermatology.

Oral antihistamines are not routinely recommended for managing pruritus in eczema but may be considered in specific cases with severe itching or urticaria.

Additional supportive treatments such as medicated dressings or bandages may be used in certain chronic or lichenified eczema areas but require specialist advice.

Overall, the primary approach to managing pruritus in eczema is regular use of emollients combined with appropriate potency topical corticosteroids or calcineurin inhibitors depending on severity and location of eczema.

¹