Gentle skin care—The cornerstone of treatment for itchy skin is to first ensure that patients are properly moisturizing, and also not overly irritating their skin with scented products and harsh cleansing techniques. Mild non-soap cleansers (such as unscented Dove™ or Cetaphil™) are recommended; patients are advised to limit their bath or shower to lukewarm water, and only 5–10 min in duration; patients should use only their hands to apply soap (instead of loofahs or washcloths), and for those with very dry skin, should only apply soap to axillae, groin, and feet; and finally, thick unscented emollients (instead of lotions or oils) should be applied immediately after bathing to wet skin (some examples include Cetaphil™ cream, petroleum jelly, Aquaphor™, Eucerin™, or Aveeno™). Finally, laundry care is part of gentle skin care practices, and recommendations include fragrance-free/dye-free products (such as ALL Free and Clear™ or Seventh Generation™), avoiding fabric softeners, and using only unscented dryer sheets.

Antihistamines—As histamine is one of the primary mediators of itch, suppressive therapy can be helpful for symptom relief (but is rarely curative). Typical doses would be diphenhydramine 25 mg PO qhs, or hydroxyzine 10–25 mg PO qhs. Caution should be exercised in those who are on other sedating medications, in the elderly, or those with hepatic disease.

Rule out systemic causes—If the review of systems indicates concern for metabolic or neoplastic phenomena, then appropriate blood work and screening examinations should be performed. Additionally, for patients who return for a follow-up visit and appear to have well-hydrated skin and are following good skin care practices, but are still complaining of pruritus, further workup is warranted.