Generalised pruritus without a rash
Tip: Look for sparing at sites that are hard to reach e.g. central back. Skin will appear normal in the absence of skin pathology.
What is the role of phototherapy?
Patients will need to attend either WCH, Bodmin Hospital or RCHT twice weekly for 6-12 weeks and be able to stand independently for several minutes during treatments.
Primary care management prior to referral for phototherapy:
1. Investigations have been carried out to look for an underlying cause
FBC, UE, LFT, bone, TFT, HBA1C, ferritin, CRP, antimitochondrial antibody, urinalysis, Ig + PE (in older patients) and CXR.
2. Trial of topical treatments
- 1 or 2% menthol in aqueous cream
- Balneum Plus cream
- 5% doxepin hydrochloride can be useful for localized areas of itch
3. Sedative antihistamines
- Hydroxyzine 25-50mg on.
Such treatments should be used periodically, long term use should be avoided if possible. Please see cautions in the BNF.
What to include in the referral letter:
What treatments have been trialled in primary care and for how long.
The Advice and Guidance service can be useful in challenging cases.