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Pruritus (PDQ®): Supportive care - Health Professional Information [NCI] - Interventions

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Product selection and recommendations must be made in consideration of each patient's unique needs and should incorporate such variables as the individual's skin, the desired effect, the consistency and texture of the preparation, its cost, and acceptability to the patient.[3][Level of evidence: IV] Emollient creams or lotions should be applied at least two or three times daily and after bathing. Recommended emollient creams include Eucerin or Nivea or lotions such as Lubriderm, Alpha Keri, or Nivea.[4] Gels with a local anesthetic (0.5%–2% lidocaine) can be used on some areas, as often as every 2 hours if necessary.[8][Level of evidence: IV]

Some topical agents including talcum powders, perfumed powders, bubble baths, and cornstarch can irritate the skin and cause pruritus. Cornstarch has been an acceptable intervention for pruritus associated with dry desquamation related to radiation therapy, but it should not be applied to moist skin surfaces, areas with hair, sebaceous glands, skin folds or areas close to mucosal surfaces, such as the vagina and rectum.[9,10] Glucose is formed when cornstarch is moistened, providing an excellent medium for fungal growth.[10] Agents with metal ions (i.e., talcum and aluminum used in antiperspirants) enhance skin reactions during external beam radiation therapy and should be avoided throughout the course of radiation therapy. Other common ingredients in over-the-counter lotions and creams that may enhance skin reactions include alcohol and menthol. Topical steroids can reduce itching, but they reduce blood flow to the skin, resulting in thinning of the skin and increased susceptibility to injury.[11][Level of evidence: IV]

Skin Cleansing

The goal of skin cleansing is to remove dirt and prevent odor, but actual hygienic practices are influenced by skin type, lifestyle, and culture. Extensive bathing aggravates dry skin, and hot baths cause vasodilation, which further promotes itching. Many soaps are salts of fatty acids with an alkali base. Soap is a degreaser and can also irritate skin. Older adults or individuals with dry skin should limit use of soaps to those areas with apocrine glands. Plain water should suffice for other skin surfaces. Mild soaps have less soap or detergent content. Superfatted soaps deposit a film of oil on the skin surface, but there is no proof that they are less drying than other soaps and they may be more expensive.

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