Antipruritics are medications used to treat itching and irritation of the skin relating to several conditions. These include eczema and hives.
- Treat itching that is caused by irritated skin.
- Can be used effectively alongside emollients (moisturisers).
- Mostly available as a topical treatment.
If you have any concerns about antipruritics and the conditions they treat, you can speak with one of our GMC-registered clinicians via our online video consultation service. Our clinicians are available from 9.30am - 4.30pm, Monday to Friday.
What are antipruritics?
Antipruritics are treatments that relieve itchy skin. There are many available, including over the counter products, such as Eurax, and prescription treatments, such as Trimovate. They can treat a broad range of conditions, from sunburn to insect bites, but the term ‘antipruritic’ is often used in the context of treatments that address symptoms of skin conditions, such as eczema and hives.
If you experience difficulty breathing or swallowing, find yourself becoming dizzy, nauseous or are vomiting, have an increased heart rate or notice a swelling of the mouth, face and throat, you should seek immediate medical attention as these are signs of a serious allergic reaction.
What is eczema?
Eczema, sometimes referred to as dermatitis, is a skin condition that is common in children, with the majority of cases presenting within 0-1 years old. It can occur at any age, however. It’s often a lifelong condition, although it can improve over time, and some children grow out of it as they get older.
What symptoms does eczema cause?
Symptoms of eczema include itchy, dry and cracked skin that becomes sore. They usually appear in flare-ups that can be triggered a few times per month. In cases where flare ups are less frequent, there is more relief from these symptoms.
Eczema can appear anywhere on the body, but it usually develops on the inside of the elbows, the hands, the fingers and on the backs of the knees. In children, it may be more likely to appear on the face and scalp. Eczema is typically red in colour on lighter shades of skin and brown or grey on darker shades of skin.
Once the rash subsides, it may leave noticeably darker patches, sometimes referred to as “footprints”. These will clear up once the skin returns to normal. The severity of the condition varies greatly from person to person.
Some people may experience small patches of mildly irritated skin infrequently, while in other instances there may be continuous outbreaks that are severe and widespread. In a small number of cases, eczema can lead to infections of the skin, the symptoms of which are fluid emanating from the rash, a yellow crust forming on the rash and a fever. You should seek medical attention if any of these symptoms appear as antibiotics will be required to clear up the infection.
Viral infections may also be triggered by the herpes simplex virus, eczema herpeticum, which causes symptoms including fluid oozing from the skin and a yellow crust on the skin’s surface. Viral infections like eczema herpeticum present with many of the same symptoms as a bacterial infection, but also cause painful sores. The antiviral aciclovir is required to clear up the infection.
What causes eczema?
What causes the condition depends on the type of eczema. For example, contact eczema, usually referred to as contact dermatitis, is caused by an allergic reaction to a substance. Varicose eczema is caused by problems with blood flow, usually in the legs. The most common form of eczema, however, is atopic.
Atopic eczema is likely triggered by a combination of things, but the main cause is likely to be having dry skin. This increases the risk of reacting to triggers, including allergens (weather, fur, dust mites and damp), irritants (soaps, detergents and bubble bath), food allergies, clothing (wool and synthetics), hormonal changes (often during the menstrual cycle) and infections of the skin.
How is eczema treated?
There is no known cure for eczema, although it can improve over time, particularly in children. Treatments focus on managing symptoms, such as itchy and sore skin. The two main medications for eczema include emollients that can be used to prevent flare ups (moisturisers that prevent the skin from becoming too dry) and topical steroids (which reduce swelling and irritation when flare ups occur). Other treatments include antihistamines and bandages that allow the skin to heal.
In more severe cases, a dermatologist may be able to provide a stronger treatment. Self-care is also important, in particular, refraining from scratching an itch when it occurs. You should also avoid triggers for the condition where applicable, such as irritants and allergens.
What is hives?
Hives, also known as urticaria, is different to eczema in that it is solely caused by histamine. Histamine is a substance created naturally in the body as an immune response to what the body sees as an invading force. Hives can appear in many different shapes and sizes and often cause the skin to feel itchy. People who experience it often describe it as a burning or stinging feeling.
Hives is caused when levels of histamine in the body increase. It can occur in response to the body coming into contact with certain substances, environments or emotional events, such as stress. A prescribing pharmacist can help you to manage the symptoms of hives with antihistamines, the most likely course of action, but avoiding the things that trigger the body’s reaction is the best method of managing the condition.
If you would like to speak to a GPhC-registered clinician about antipruritics and any of the above related conditions, you can use our online video consultation service. Our clinicians are available for appointments between 9.30am and 4.30pm, five days a week.
What side effects can antipruritics cause?
All medications carry risks of causing side effects, including those that are bought over the counter, so it’s important to understand what these are before starting treatment.
In most cases, antipruritics are well tolerated and few people experience significant side effects. In rare cases, however, serious symptoms such as allergic reactions can occur. Your prescribing clinician or pharmacist can highlight what these risks are, and you should refer to the patient information leaflet that comes with your medication, which lists all known side effects and their frequency.
The following information relates to the antipruritic trimovate and may not be relevant for your treatment. You should consult your prescribing doctor and the patient information leaflet if you have any concerns.
If you notice any of these symptoms during treatment, discontinue use and seek immediate medical attention: swelling of the face, lips, tongue or other parts of the body, difficulty breathing, your skin condition gets worse or your skin becomes swollen during treatment.
Extensive use of trimovate, or use under an airtight dressing, may cause the following symptoms: increased weight, obesity, rounding of the face, skin thinning, changes to the colour of your skin and increased body hair.
Other skin reactions that may occur are allergic reaction at the site of application, sensitivity to sunlight, itching, skin burning, pain, redness, rashes, hives, worsening of your condition and skin infections.
The following side effects may also occur in children: delayed increases in weight and reduced growth.
Side effects that may show up in blood tests or when your prescribing doctor gives you a medical examination include a reduction in the level of the hormone cortisol, increased levels of sugar in your blood or urine, high blood pressure, cataracts, glaucoma and osteoporosis.
Another reported symptom with unknown frequency is blurred vision.
Are antipruritics safe to use with other treatments?
All medications can interact with others when taken alongside each other, and these include topical treatments such as antipruritics. It’s important that you inform your prescribing clinician or pharmacist of any other treatments you are currently taking in order for them to prescribe or offer antipruritics safely.
Some medicines, including itraconazole and ritonavir, may affect how Trimovate works and increase the likelihood of side effects occurring.
Warnings and precautions for use of antipruritics
If you have any other condition, whether related to this treatment or not, it is important that you tell your prescribing doctor or pharmacist as antipruritics such as Trimovate may not be suitable for you.
Other considerations for treatments like Trimovate are nappies and airtight dressings, which can lead to this treatment passing through the skin more easily; in these circumstances, the dosage will need to be adjusted.
Trimovate may cause slight staining, which can be removed by washing.
Trimovate may cause greater sensitivity to sunlight. You should avoid sunlamps and spending prolonged periods of time in the sun during treatment. Use sunblock and protective clothing if this can’t be avoided.
You should avoid getting Trimovate in your eyes. If this occurs, wash them thoroughly with water.
You should take care when applying trimovate to the face, as it can lead to a significant thinning of the skin.
Trimovate should only be used for the duration of your treatment course, as determined by your clinician. If the treatment is not working, your doctor may prescribe a more extensive course of treatment, or an alternative treatment that may be more effective for you.
Is it safe to use antipruritics if you are pregnant?
Because many antipruritics are topical, there should be little reason to avoid their use whilst you are pregnant or breastfeeding. You should inform your doctor if you are pregnant or are thinking of becoming pregnant, however, so they can safely assess the risks involved. If you are breastfeeding, you should avoid applying creams to the breast area.
What types of antipruritics are available?
Antipruritics are available in various forms; some are over the counter treatments, such as Eurax (crotamiton), and some are prescription medications, such as Trimovate (clobetasone).
Will antipruritics affect my ability to drive?
Antipruritics should not affect your ability to drive, although they may cause drowsiness or blurred vision in some circumstances. If this does occur, avoid operating any form of heavy machinery and seek advice from your prescribing doctor.
Can antipruritics cause allergic reactions?
All medications carry some risk of causing an allergic reaction. You should inform your prescribing doctor or pharmacist of any allergies you are aware of before starting treatment with antipruritics. You should also refer to the patient information leaflet that comes with your medication and its list of ingredients.
Can I buy antipruritics over the counter?
It depends on the treatment. Many antipruritics are available to buy over the counter, while some require a prescription.
Can I buy antipruritics online?
Our GMC-registered clinicians can discuss antipruritics and any related conditions with you via our online video consultation service. You can book an appointment with them between 9.30am-4.30pm, Monday to Friday. They can also provide referral to specialists for treatment and fit notes, where suitable.