ANTIPRURITIC AGENTS

Antihistamines
Topical antihistamines, such as diphenhydramine, are associated with a high
incidence of contact sensitization29 and cross-reactivity, and rarely with
photoallergic reactions.30 Given the availability of other effective topical agents,
topical antihistamines should be avoided.
Doxepin
Tricyclic compounds, particularly doxepin hydrochloride, given orally are known to
have antipruritic properties. Doxepin cream 5% may be used to treat pruritus,
although the mechanism of its effect is uncertain. However, doxepin has an affinity
for H1 and H2 receptors and may also exert its antipruritic effect through the
antagonism of -adrenergic, muscarinic, and serotonergic receptors and through
inhibition of norepinephrine and serotonin neuronal reuptake and the inhibition of
platelet-activating factor production. Topical doxepin has a potential for
sensitization. It is effective for atopic dermatitis, chronic urticarias, prurigos, and
neurodermatitis.31 Doxepin cream may also be used as an adjuvant to
glucocorticoids in treatment of pruritus.
Menthol
Menthol is a highly lipid-soluble cyclic terpene alcohol, often used interchangeably
with or in addition to camphor. It is a naturally occurring plant oil obtained from the
Mentha species. Menthol is a known chemical activator of cold-sensitive A delta
fibers. Menthol does not decrease the duration or magnitude of histamine-induced
pruritus.32
Phenol
Phenol in low concentrations acts as an antipruritic agent through its anesthetic
effect. It may be percutaneously absorbed and should be avoided in pregnant
women and infants.33 It is a common ingredient in over-the-counter preparations
for pruritus.
Pramoxine Hydrochloride
Pramoxine hydrochloride, a topical anesthetic, is effective in cases of mild to
moderate pruritus. It is available in combination with menthol, petrolatum, and
hydrocortisone. It is a sensitizer less frequently than other topical anesthetics.