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13.3 Topical local anaesthetics and antipruritics

Topical antipruritics

Emollient preparations may be useful for pruritus due to dry skin; sedating oral antihistamines may be helpful for itch (see section 3.4.1)

1st     CROTAMITON is useful for pruritus associated scabies
2nd       1% MENTHOL in AQUEOUS cream 

Topical local anaesthetics

Topical local anaesthetics may be absorbed through mucosal surfaces.  Local anaesthetics may occasionally cause sensitisation.

1st       TETRACAINE (AMETOP) gel   
2nd       LIDOCAINE/PRILOCAINE (EMLA) cream  

Chronic urticaria (see section 3.4.1 of the BNF)

When treating chronic urticaria, long acting, non-sedating antihistamines need to be given regularly and in sufficient dosage to prevent the urticaria.  If standard (hay fever) doses do not control symptoms, the dose may need to be increased above those recommended by the manufacturer, these regimens are recommended by dermatologists (see BAD guidelines) however, unlicensed e.g. cetirizine 10-40mg daily, fexofenadine 180-720mg daily.

1st      FEXOFENADINE 180mg 
2nd     CETIRIZINE
2nd     LORATADINE
      DESLORATADINE
        CHLORPHENAMINE or HYDROXYZINE may be added at night if sleep is disturbed by itching.  Cimetidine or ranitidine may also be added for resistant cases.

 

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