Topical Therapy for Pruritus

Topical Therapy for Pruritus

Wayne S. Rosenkrantz, Tustin, California

The use of topical therapeutics for pruritus in the form of shampoos, lotions, rinses, soaks, and spot-on products has gained increasing popularity. Topical treatment for pruritus can be used as sole therapy or as an adjunctive therapy, reducing the need for systemic treatment. Owner compliance can be a problem, although many owners want to participate actively in the management of their pet’s skin condition.

Familiarity with available products is important, and personal use of products on one’s own pets provides experience and insight, and constitutes a powerful recommendation to your clients. The frequency of application is patient and disease dependent; typically, applications as often as once daily are required. Contact time may be important for the best efficacy, and it is critical to know which products can be left on and which require complete rinsing to avoid irritation.

Specific Antipruritic Agents

Water

Water has therapeutic antipruritic properties, it moisturizes the skin, and when combined with emollients and moisturizing agents it can help maintain skin hydration and prevent transepidermal water loss. However, if used repeatedly without proper emollients and moisturizing agents, water also can dry out the skin by stripping its natural barriers. Decreased barrier function can lead to increased penetration of allergens, irritants, and infectious agents resulting in increased pruritus. In general, cool water is recommended for shampoo therapy, especially in cases of pruritic allergic skin disease.

Protectants and Moisturizing Agents

Protectants and moisturizing agents include oils and hygroscopic agents (vegetable oils, lanolin, phytosphingosine, propylene glycol, glycerin, colloidal oatmeal, urea, and lactic acid). Moisturizers increase the water content of the stratum corneum, are useful in hydrating and softening the skin, and work best if applied immediately after saturation of the stratum corneum with water. Formulations such as sprays and rinses that are left on are generally more effective than shampoos that are washed off (Table 95-1).

TABLE 95-1

Selected Topical Nonsteroidal Antipruritic Agents

Active Ingredient	Formulation	Brand Name
Diphenhydramine 1%, calamine 8%, camphor	Lotion	Caladryl
Hamamelis extract, menthol	Spray	Dermacool
Aluminum sulfate, calcium acetate	Soak	Domeboro
Diphenhydramine 2%	Spray	Histacalm
Pramoxine 1%	Spray, lotion, shampoo, rinse	Relief Dermal-Soothe ResiPROX
Fatty acids (hemp seed and neem seed oils), emollients	Spot-on	Dermoscent Essential 6
Ceramides and fatty acids	Spot-on	Allerderm Spot-on
Phytosphingosine	Spot-on	Douxo Seborrhea Spot-on
Pimecrolimus	Cream	Elidel
Tacrolimus 0.1%	Cream	Protopic
Moisturizers, ceramides, and rhamnose	Shampoo	Allergroom Allermyl
Moisturizers and fatty acids	Shampoo, rinse	HyLyt efa
Encapsulated moisturizers	Shampoo, rinse	Hydra-Pearls
Moisturizers, coconut oil, and safflower oil	Shampoo, rinse	DermaHypoCS
Colloidal oatmeal	Shampoo, rinse, soak	Epi-Soothe Allay Oatmeal ResiSOOTHE Aveeno
Phytosphingosine, hinokitiol	Shampoo, spray	Douxo Calm
Diphenhydramine	Shampoo, spray	Histacalm

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Jul 18, 2016 | Posted by admin in PHARMACOLOGY, TOXICOLOGY & THERAPEUTICS | Comments Off

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