Rajani Katta, MD discusses highlights from her lecture on Itching at the 2021 Elevate-Derm Conference.
In this video
Dr. Katta frames itch as one of dermatology's most challenging problems and starts by asking whether it's "skin first or itch first" — if a skin condition is driving the itch, she attacks the skin condition, but for neurogenic itch like brachioradial pruritus, notalgia paresthetica, burning scalp, or male genital dysesthesia, she turns to a different toolkit. Among topicals, she loves starting with emollients, which sometimes do the trick alone, and reaches for pramoxine or, in some cases, topical lidocaine.
When topicals aren't enough, Dr. Katta moves to oral therapy. One of her favorites for neurogenic pruritus is gabapentin, started at a "baby dose" of 100 mg at bedtime, with counseling about drowsiness and dizziness. She also still relies on low-dose doxepin — a sedating antihistamine that's a very powerful anti-itch agent at low doses — beginning at 10 mg at bedtime, noting it can knock down itch "when nothing else will" while warning patients about sedation.
- Ask "skin first or itch first" — treat the skin condition when it's driving the itch, and treat the itch differently when it's neurogenic.
- Start topical therapy with emollients, which alone can be enough; add pramoxine or topical lidocaine as needed.
- For neurogenic pruritus (notalgia paresthetica, burning scalp, male genital dysesthesia), gabapentin is a favorite, starting at 100 mg at bedtime.
- Counsel patients that gabapentin can cause drowsiness and dizziness.
- Low-dose doxepin, 10 mg at bedtime, is a powerful anti-itch option that can work when nothing else does — but warn about its sedating effect.
