Challenges and Advances in Vulvovaginal Disorders_OnDemand-2. Severe Itch Scratch Itch Cycle Tips

2. Severe Itch Scratch Itch Cycle Tips

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This document provides a comprehensive approach to managing severe itch and breaking the itch-scratch cycle. Key recommendations include:

1. <strong>Nighttime Sleep Aids</strong>: Amitriptyline 25 mg taken orally about 2 hours before bedtime is suggested to promote deep sleep and reduce itching. The dose may be increased gradually up to 150 mg nightly, with caution for potential medication interactions and contraindications in the elderly and with alcohol use. Alternatives include hydroxyzine (25-50 mg nightly) or gabapentin, starting at 300 mg daily, gradually increasing to a maximum of 1200 mg three times daily.

2. <strong>Steroid Therapy</strong>: Oral prednisone is recommended at 40 mg every morning for 5 days, then tapered to 20 mg for 10 days. If ineffective, a longer steroid taper may be needed. Intramuscular triamcinolone injections (up to 80 mg) may be given every 1-2 months, up to three times. Steroids require caution in diabetics and can cause side effects such as menstrual irregularities.

3. <strong>Antibiotics</strong>: Cefadroxil 500 mg twice daily for 10 days is advised to treat any secondary skin inflammation.

4. <strong>Yeast Culture</strong>: Performing a yeast culture to detect fungal infection is encouraged. If positive and the patient is on amitriptyline, topical antifungals should be used instead.

5. <strong>Physical Aids</strong>: Wearing cotton gloves at night and opting for comfortable nighttime clothing such as a nightgown without underwear or cotton pajama pants is recommended to reduce irritation.

6. <strong>Skin Care</strong>: Tepid tap water soaks following baths and application of petrolatum help soothe the skin. Short-term estrogen therapy may be considered if appropriate.

7. <strong>Daytime Itching</strong>: For daytime symptoms, SSRIs like citalopram (20-40 mg daily) can be used but should not be combined with amitriptyline.

8. <strong>Topical Steroids</strong>: After 4-5 days, once skin is less raw, clobetasol propionate ointment 0.05% can be applied nightly, then switched to triamcinolone acetonide 0.1%. If itching persists, tacrolimus ointment can be alternated with steroids.

These combined therapies aim to provide symptom control and prevent skin damage from persistent scratching.

Keywords

severe itch management

itch-scratch cycle

amitriptyline

steroid therapy

prednisone taper

cefadroxil antibiotic

yeast culture

physical aids for itching

topical steroids

SSRIs for itching