What are the most effective antihistamines for treating itchy skin conditions. How do hives and angioedema differ from other allergic reactions. What are the diagnostic methods and treatment options for these skin conditions.

Understanding Allergic Skin Reactions: Hives and Angioedema

Allergic skin reactions can manifest in various forms, with hives (urticaria) and angioedema being two of the most common and troublesome conditions. These reactions occur when the body’s immune system overreacts to an allergen, triggering the release of histamines and other inflammatory chemicals.

What are Hives?

Hives, medically known as urticaria, are characterized by red, raised, and itchy welts on the skin. These welts can vary in size and shape, and may appear anywhere on the body. Hives can be acute (lasting less than six weeks) or chronic (persisting for more than six weeks).

What is Angioedema?

Angioedema is a condition often associated with hives, but it affects deeper layers of skin. It causes swelling, particularly around the eyes, lips, hands, feet, and genitals. Unlike hives, angioedema is often more painful than itchy and can take longer to resolve.

Common Triggers for Hives and Angioedema

Understanding the triggers for these allergic reactions is crucial for both prevention and treatment. Some common triggers include:

• Foods (e.g., nuts, shellfish, eggs)
• Medications (e.g., antibiotics, NSAIDs)
• Insect stings or bites
• Pollen and other environmental allergens
• Latex
• Physical stimuli (e.g., pressure, cold, heat)
• Stress

Identifying specific triggers can be challenging, as reactions may occur hours after exposure. Keeping a detailed log of activities, foods consumed, and any new products used can help pinpoint potential allergens.

Diagnosis of Hives and Angioedema

Diagnosing hives and angioedema typically involves a thorough medical history and physical examination. In some cases, additional tests may be necessary to identify underlying causes or rule out other conditions.

Physical Examination

During a physical exam, a healthcare provider will assess the appearance, distribution, and characteristics of the skin lesions. They may also check for signs of systemic reactions or associated conditions.

Allergy Testing

Allergy tests can help identify specific triggers. These may include:

1. Skin prick tests
2. Blood tests (e.g., specific IgE tests)
3. Patch tests (for contact dermatitis)

Additional Diagnostic Tests

In cases of chronic or recurrent hives and angioedema, further testing may be necessary to rule out underlying conditions. These tests might include:

• Complete blood count
• Thyroid function tests
• Liver function tests
• Erythrocyte sedimentation rate (ESR)
• Complement levels

Treatment Options for Hives and Angioedema

The primary goals of treatment for hives and angioedema are to relieve symptoms, prevent complications, and address underlying causes when possible. Treatment options range from over-the-counter medications to prescription drugs and lifestyle modifications.

Antihistamines: The First Line of Defense

Antihistamines are the cornerstone of treatment for hives and angioedema. These medications work by blocking the effects of histamine, the primary chemical responsible for allergy symptoms.

Types of Antihistamines

• First-generation antihistamines (e.g., diphenhydramine, chlorpheniramine)
• Second-generation antihistamines (e.g., cetirizine, loratadine, fexofenadine)

Second-generation antihistamines are often preferred due to their longer-lasting effects and reduced sedation. In some cases, higher doses or combinations of antihistamines may be recommended by a healthcare provider.

Other Medications

For severe or persistent cases, additional medications may be prescribed:

• Oral corticosteroids (e.g., prednisone)
• Leukotriene modifiers (e.g., montelukast)
• Omalizumab (for chronic spontaneous urticaria)
• Cyclosporine (for refractory cases)

Choosing the Best Antihistamine for Itching Skin

Selecting the most effective antihistamine for itching skin depends on several factors, including the severity of symptoms, individual response, and potential side effects. Here’s a comparison of some popular options:

Cetirizine (Zyrtec)

Cetirizine is a potent second-generation antihistamine known for its rapid onset of action and long-lasting effects. It’s particularly effective for hives and can be taken once daily.

Loratadine (Claritin)

Loratadine is another second-generation antihistamine that causes less drowsiness than first-generation options. It may be less potent than cetirizine for some individuals but is generally well-tolerated.

Fexofenadine (Allegra)

Fexofenadine is known for its non-sedating properties and is less likely to cause drowsiness compared to other antihistamines. It can be effective for both hives and angioedema.

Diphenhydramine (Benadryl)

While a first-generation antihistamine, diphenhydramine can be particularly useful for nighttime relief due to its sedating effects. However, it should be used cautiously during the day due to potential drowsiness.

Natural Remedies and Lifestyle Modifications

In addition to medications, several natural remedies and lifestyle changes can help manage hives and angioedema:

• Cool compresses to soothe itchy skin
• Oatmeal baths to reduce inflammation
• Wearing loose, breathable clothing
• Avoiding known triggers
• Stress reduction techniques (e.g., meditation, yoga)
• Maintaining a balanced diet rich in anti-inflammatory foods

While these methods can provide relief, they should not replace medical treatment, especially for severe or chronic cases.

When to Seek Medical Attention

While many cases of hives and angioedema can be managed at home, certain situations warrant immediate medical attention:

• Difficulty breathing or swallowing
• Dizziness or fainting
• Swelling of the throat or tongue
• Persistent or worsening symptoms despite treatment
• Signs of infection (e.g., fever, pus)

These symptoms may indicate a severe allergic reaction (anaphylaxis) or other serious complications that require prompt medical intervention.

Prevention Strategies for Hives and Angioedema

Preventing hives and angioedema involves a combination of allergen avoidance and proactive measures. Here are some strategies to consider:

Allergen Identification and Avoidance

Working with an allergist to identify specific triggers through allergy testing can be invaluable. Once known, avoiding these allergens is crucial. This may involve:

• Reading food labels carefully
• Using hypoallergenic personal care products
• Avoiding known environmental triggers
• Being cautious with new medications

Skin Protection

Protecting your skin from potential irritants and allergens can help prevent flare-ups:

• Wear protective clothing when outdoors
• Use fragrance-free, hypoallergenic skincare products
• Apply a barrier cream before engaging in activities that may expose you to allergens

Stress Management

Stress can exacerbate hives and angioedema in some individuals. Implementing stress-reduction techniques can be beneficial:

• Regular exercise
• Mindfulness meditation
• Adequate sleep
• Time management strategies

Dietary Considerations

While food allergies are not always the cause of hives and angioedema, maintaining a balanced diet and being mindful of potential food triggers can help:

• Keep a food diary to track potential reactions
• Consider an elimination diet under medical supervision
• Incorporate anti-inflammatory foods (e.g., omega-3 rich fish, leafy greens, berries)

By implementing these prevention strategies and working closely with healthcare providers, many individuals can significantly reduce the frequency and severity of hives and angioedema outbreaks.

Best Antihistamine for Allergic Skin Rash – Curist

By Elena Dang, The University of Texas at Austin College of Pharmacy

Curist delivers FDA-approved allergy medicines to your door at half the price of traditional brands. We hope everyone stays safe and healthy during this time.

If you were recently outdoors and returned home noticing a red, itchy patch on your skin, you may have an allergic skin rash. Have you ever wondered what an allergic skin rash is, what causes it, and what antihistamines can best treat an allergic skin rash? Continue reading to learn more!

An allergic skin rash is also known as contact dermatitis, which simply means skin inflammation from touching something that makes your body’s immune system overreact. An allergic skin rash may appear when your body comes into contact with an irritant or an allergen causing a patch of your skin to be itchy, red, and inflamed. It can appear within minutes, hours, or several days of coming into contact with the irritant or allergen.

An allergic skin rash is caused by allergens which cause the immune system in some people to overreact. Some common allergens include plants like poison ivy, jewelry made of nickel, soaps, fragrances, or cosmetics. It is even possible to develop an allergy over time to things you have used before! 

On the other hand, non-allergic skin rashes are caused by irritants, which are substances that would cause an immune system response with anyone who comes into contact with it. Common irritants like permanent hair dyes, harsh detergents, or chemicals can cause a non-allergic skin rash which typically results in a painful skin rash that appears quickly after contact. 

In both cases, the skin symptoms are most severe where you touch the allergen or irritant. If you want to know what substances may be causing your skin rash, you can see an allergist for a skin patch test, where they will help you identify the problematic substances. It will help your doctor if you write notes with details surrounding the skin rash such as where it touched your skin, how much of the substance you encountered before the reaction, and any activities 1-2 days before the skin rash appeared.  

The two most common types of allergic skin rashes are hives (urticaria) and eczema:

• Hives (Urticaria) appear on the skin as red, raised bumps that are usually itchy, burning or stinging. Hives can result from an insect sting, pollen (like appear in spring allergy season or fall allergy season), pet dander (like that from dogs or cats), medications such as those for high blood pressure, antibiotics, or aspirin as well as certain fresh foods like nuts, fish or eggs.
• Eczema (Atopic Dermatitis) is a more long-term sensitivity to environmental allergens that generally appears around the eyes, feet, hands, inside of elbows, and back of knees as cracked, inflamed, red, itchy, dry skin patches. Eczema can flare up from time to time and can happen with seasonal allergies.     

The best thing you can do to prevent an allergic rash is to avoid contact with the allergen or irritant that causes the skin irritation. So if you think you will be exposed to something that will cause an allergic skin rash, wear protective clothing or gloves. If you do come into contact with the allergen or irritant, wash your skin immediately with warm water and mild, fragrance and dye-free soap. Pat the area dry and use a cool, wet compress to calm the area.  

It is also best to avoid scratching the irritated, red skin as it can lead to a possible open wound that can get dirty and infected. You can use fragrance-free moisturizers or anti-itch creams like hydrocortisone or calamine to soothe your skin.

During an allergic reaction, your body’s immune system releases natural chemicals called histamines that cause itchy red, inflamed skin. Although it will take time for your body to naturally heal, antihistamines can help relieve the itching associated with skin rashes like hives and eczema. Try your best to avoid scratching the allergic skin rash, because if you open a wound, it can lead to an infection and even longer healing process. Use antihistamines, fragrance-free moisturizers, or anti-itch creams like hydrocortisone or calamine to relieve the itchiness and soothe the irritated skin.  

Typically an allergic skin rash will appear within minutes or hours after your contact with an irritant and the itching symptoms will go away within two to four weeks. An allergic skin rash is limited to the area of skin in contact with the trigger. Use of antihistamines may not reduce the amount of time it takes for the skin rash to go away, but antihistamines will help reduce the itching while you have the rash. If the allergic skin rash does not resolve within a couple weeks or if it worsens over time, you should contact your healthcare provider for evaluation. 

The best antihistamine to take during the day to help with allergic skin rashes is Curist Allergy Relief (levocetirizine) or another antihistamine like fexofenadine or loratadine, which can provide 24-hour symptom relief without making you feel sleepy. For better symptom relief at night, you may use a first-generation antihistamine like benadryl, which can reduce your itchiness and help you sleep. These antihistamines can help you relieve the discomfort and itchiness of the allergic skin rash while your body heals the skin.    

The good news is that an oral antihistamine tablet like levocetirizine (brand Curist) can help relieve the itchiness and discomfort from a rash; however, you will need to let your body heal the rash with time. In addition to an oral antihistamine, an anti-itch cream or moisturizer on your skin can help soothe any red, irritated skin and help you avoid the urge to itch. Scratching the rash could open the wound, allow it to get dirty, and lead to an infection, which will take additional time to heal and possibly require additional medications. 

If you think you will be exposed to something that will cause an allergic skin rash and it cannot be avoided, you can take antihistamines (levocetirizine, fexofenadine, or loratadine) beforehand to help prevent symptoms. For instance, taking antihistamines before visiting your friend who has a cat or dog, can reduce the itching and rash from hives produced from contact with the pet’s dander.

Best Antihistamines for Hives (Urticaria) – Curist

By Deni Hui, The University of Texas at Austin College of Pharmacy

Curist delivers FDA-approved allergy medicines to your door at half the price of traditional brands. We hope everyone stays safe and healthy during this time.

Have you ever broken out in hives and felt the itchy red bumps on your skin? For most people, hives are usually more than just a temporary nuisance. Read along to learn more about what hives are and what you need to know about them!

Hives (also known as urticaria) are a common skin reaction to an allergen (a substance that causes allergies). About 20% of people will develop hives at least once in their lifetime. Though uncomfortable, It is a harmless skin condition marked by spots on the skin that are itchy, red, and raised. Hives are usually a temporary condition, and there are two different types of hives, acute hives (acute urticaria) and chronic hives (chronic urticaria).

• Acute Hives (Urticaria): Short term, most likely allergy-related rash that fades in 2-3 hours but could hold on for as long as six weeks.
• Chronic Hives (Urticaria): Long term, auto-immune related rash that lasts longer than six weeks.

Hives are the classic sign of an allergic reaction, although hives can erupt for other reasons including:

• Allergens (contact urticaria) like pollen, ragweed, mold spores or pet dander
• Insect stings or bites
• Poisonous plants (e.g. poison ivy, poison oak)
• Foods (e.g. milk, peanuts, eggs, fish or shellfish)
• Chemicals
• Medications (e.g. NSAIDs like ibuprofen, aspirin; codeine, blood pressure medicine)
• Infections (e.g. Strep throat or urinary tract infections)
• Emotional stress
• Autoimmune disorders
• Physical causes (physical urticaria) such as cold (cold urticaria), sweating (cholinergic urticaria), water, or sun exposure.

Hives can appear anywhere on your body and can vary in appearance depending on the person and the situation, but the main sign of hives is the hallmark red raised welts. The welts from hives can:

• have a pale center (turns white when pressed)
• appear in clusters
• change shape and location in a matter of hours
• be tiny or as big as a dinner plate
• itch, sting, or cause a burning sensation
• swelling (or angioedema) around eyes, lips, feet or throat

It is important to note that rarely, a person with hives and angioedema can also get anaphylactic shock which include signs of trouble breathing, a drop in blood pressure, or a loss of consciousness. If this situation ever occurs, make sure to seek medical attention immediately.

The main differences between acute and chronic hives (urticaria) are how long the symptoms last and what their respective triggers are. Acute hives are short-term; they can last for less than a day or up to six weeks. They can be triggered by coming into contact with an allergen such as food, animal dander, insect bite, latex or pollen. Acute hives can also occur from non-allergic causes such as heat, exercise or stress. Being able to identify and avoid these triggers can help prevent this allergic reaction from occurring.

Chronic hives, on the other hand, can stick around for a longer period of time (more than 6 weeks). Most chronic hives are idiopathic, meaning that the exact cause is unknown. Only a small percentage of chronic hives are due to an allergic reaction.

Regardless of whether you have acute or chronic hives (acute or chronic urticaria), antihistamines will be your mainstay of treatment options to help relieve symptoms.

Hives (urticaria) are a particular type of skin rash. They are raised, itchy red bumps that can be large or small in size. Skin rash, on the other hand, can take many other forms often characterized by changes in color or texture of the skin. They can cause your skin to feel rough and look scaly or cracked. Unlike hives, rashes don’t always itch. Sometimes, they hurt or make your skin feel irritated, scratchy or uncomfortable.

Hives are often a temporary skin reaction that can go away in 2 to 3 hours without treatment. However, in some people, hives can persist for weeks or months.

Even though hives typically resolve in a couple of hours, over-the-counter (OTC) antihistamines are recommended as treatment options because they provide the quickest route to symptom relief. Anti-itch lotions, creams as well as topical anesthetics can provide instant relief from the pain and itchiness of hives, but they will not relieve the swelling or redness. Thus, antihistamines are best recommended for quick overall symptom relief.

For acute cases of hives (acute urticaria), some of the best antihistamines are well-known over-the-counter antihistamines such as Curist Allergy Relief (levocetirizine), (fexofenadine (brand Allegra), diphenhydramine (brand Benadryl), loratadine (brand Claritin), and cetirizine (brand Zyrtec) can help reduce swelling, redness, itching, and other problems such as wheezing or difficulty breathing. Chronic hives (chronic urticaria) are usually treated with a three to six month regimen of antihistamines. For chronic hives, it’s recommended to use a newer antihistamine like levocetirizine which does not have the same sedating side effects like Benadryl.

If none of the antihistamines work, consult your doctor or pharmacist as they may also add a different type of antihistamine called an histamine-2-receptor blocker, such as ranitidine or cimetidine. These medications are usually used to treat acid reflux but can also help with reducing hives.

Yes, there are non drowsy antihistamines for treating hives, for instance Curist Allergy Relief (levocetirizine) which is minimally drowsy! Fexofenadine (brand Allegra), loratadine (brand Claritin) and cetirizine) (brand Zyrtec) are all considered newer antihistamines because they were designed to be safer than first generation antihistamines like Benadryl (diphenhydramine) as they do not cause drowsiness, or have very limited drowsiness. These newer antihistamines are non drowsy and can provide ample symptomatic relief for as long as 24 hours.

There is not a single best antihistamine for hives, it depends on which antihistamine works for you. Commonly, people often try Benadryl for hives and while it is effective, it has a significant tradeoff – Benadryl is very sedating. So Benadryl may be effective for acute hives, Benadryl is not appropriate for chronic hives. Instead, a newer antihistamine with less sedating side effects like Curist Allergy Relief (levocetirizine), would be better antihistamine for treating hives.  

The most common side effect of antihistamines is drowsiness, but this is less of a problem with the non-sedating antihistamines used to treat hives. Other possible side effects may include headache, mood changes, nausea or dry mouth. If you are concerned about the drug interactions caused by hives medications with the other medicines you are currently taking, make sure to consult your doctor or pharmacist first.

Hives generally go away in a few hours, but some people may live with chronic hives or regular episodes. Here are a few proven home remedies that can help soothe your itchy skin:

• Use a cold compress: Apply an ice pack or washcloth soaked in cold water to your skin for 10 minutes to provide rapid relief from pain and itchiness. You may repeat it several times throughout the day until symptoms subside.
• Use anti-itch cream: Calamine lotion, menthol, capsaicin or hydrocortisone creams are the most effective in quickly relieving skin discomfort. Other topical anesthetics such as lidocaine cream can provide relief against long term itching or pain.
• Take a cool bath: Heat can make itching worse; while cool water can soothe the skin.
• Avoid triggers: If you are repeatedly experiencing episodes of hives, keep a symptom diary to help you identify foods, allergens (pollen or pet dander), chemicals, activities or medications that might be provoking allergic reactions. Avoid any triggers that you discover in your diary.

Lastly, to learn more about itchy skin and hives, read Curist team member Waverly’s story about her experiences diagnosing chronic hives and treating itchy skin.

things to think about uMEDp

The article deals with the pathogenesis of pruritus, possible psycho-emotional problems and somatic triggers of pruritus. The advantages of second-generation antihistamines, in particular cetirizine, are described: in addition to blockade of h2-histamine receptors, the drug inhibits the migration of eosinophils in the focus of inflammation, suppresses the skin response to platelet-activating factor. The results of our own studies showing the effectiveness of cetirizine in dermatological diseases are presented. Namely: the maximum reduction in the intensity of itching already three hours after application during the first five days of therapy.

Fig. 1. Algorithm for diagnosing pruritus

Fig. 2. Distribution of patients by nosology

Fig. 3. The average subjective assessment of the intensity of itching after the use of the drug

Fig. 4. Dynamics of clinical manifestations

The skin makes up about 15% of the total human body weight and is the largest organ. Its most important function is protective.

The condition of the skin has a significant impact on a person’s self-esteem and the formation of interpersonal relationships.

Skin itching is an unpleasant subjective sensation that causes a desire to scratch. This symptom in the vast majority of cases causes discomfort, psycho-emotional stress and exhaustion. In addition, as a result of combing, the integrity of the skin is violated.

It should be noted that, despite the high prevalence of the symptom, it has not been sufficiently studied due to the difficulties of its adequate assessment and the lack of models for research.

Somatic triggers of pruritus

Generalized itching that occurs without concomitant manifestations on the skin can be due to various reasons – from skin xerosis to endocrinological pathologies or carcinoma. That is why in clinical practice one should not neglect the assessment of this important prognostic symptom.

Relatively benign etiological factors include drug allergic reactions, dry skin, scabies, and primary dermatological diseases. Most often, pruritus is observed with dry skin. In older patients, it occurs in 10–50% of cases [1]. Generalized pruritus occurs in 13% of patients with chronic renal failure and in 70–90% on hemodialysis [2]. Liver diseases accompanied by cholestasis (primary biliary cirrhosis of the liver, cholestasis caused by oral contraceptives, intrahepatic cholestasis during pregnancy, etc.) also often cause pruritus [2].

Among the hematological diseases that cause itching are polycythemia, iron deficiency anemia, endocrine diseases – thyrotoxicosis and diabetes mellitus [3].

Pruritus is a common clinical manifestation of AIDS and associated Kaposi’s sarcoma, opportunistic infections. Thus, itching with or without skin rashes is observed in 84% of AIDS patients, in 35. 5% of patients with Kaposi’s sarcoma, which developed against the background of AIDS. AIDS-associated opportunistic infections are accompanied by itching in 100% of cases [4].

It has been established that pruritus can appear in malignant diseases. For example, with Hodgkin’s lymphoma, itching occurs in 10-25% of patients, is characterized by high intensity and limited localization, more often in the lower part of the legs. In some cases, this symptom precedes the diagnosis of lymphoma and may serve as an indicator of a less favorable disease prognosis than fever or weight loss [4]. Adenocarcinomas and squamous cell carcinoma of various organs (stomach, pancreas, lungs, colon, brain, breast, prostate) are accompanied by itching on larger areas of the skin: on the legs, upper body and extensor surfaces of the arms. At the same time, there is a direct relationship between the presence of itching and the activity/recurrence of cancer [4].

Secondary skin itching is usually associated with taking drugs such as opium derivatives (cocaine, morphine, butorphanol), phenothiazines, tolbutamide, erythromycin, anabolic hormones, estrogens, progestins, testosterone, aspirin, quinidine and other antimalarial drugs, biologics ( monoclonal antibodies), vitamin B. In addition, it is known that itching can be a subclinical manifestation of hypersensitivity to any drug [5].

Since itching is observed not only in dermatological pathologies, it is advisable to conduct a thorough examination of patients (Fig. 1) and treat them taking into account the identified pathology.

Mechanisms of development and relief of pruritus

Hypotheses of the mechanisms of itch development were formulated on the basis of a study of the pathophysiology of pain, since pain and itch combine common molecular and neurophysiological mechanisms.

The sensation of itching and pain is the result of the activation of a network of free nerve endings in the dermal-epidermal zone. The trigger mechanism is the influence of internal or external thermal, mechanical, chemical stimuli or electrical stimulation. Skin nerve irritation can be mediated by several biological agents, including histamine, vasoactive peptides, enkephalins, substance P, prostaglandins.

It is believed that other, non-anatomical factors, such as psycho-emotional stress, individual subjective perception, the presence and intensity of other sensations and / or distractions, have a significant impact on the degree of itch sensitivity in different areas of the skin.

The nerve impulse that causes the sensation of itching, which has arisen under the influence of any of the listed factors, is transmitted along the same neural connection as pain impulses: from peripheral nerve endings to the dorsal horns of the spinal cord, through the anterior commissure, along the spinothalamic tract to the contralateral laminar nucleus of the thalamus. It is suggested that the thalamocortical tract of tertiary neurons acts as a “relay” for impulse transmission through the integration of the reticular activating system of the thalamus in several areas of the brain. In response, there is a desire to comb the skin, which is formed in the corticothalamic center and is realized in the form of a spinal reflex. After scratching, itching reappears after 15–25 minutes. However, in some cases, especially in patients with chronic dermatoses, the sensation of itching after scratching does not stop, which leads to excoriation.

Despite the fact that many etiological and pathogenetic factors contributing to the occurrence of itching are currently known, their study continues and new mechanisms are being discovered.

The mechanism by which itching is relieved by scratching has not been reliably established. Perhaps, during scratching, sensory impulses are formed that interrupt the neural arc responsible for the occurrence of sensation.

In addition to scratching, vibrations, injections into the itchy area, exposure to heat, cold, and ultraviolet radiation help to reduce itching [3].

Treatment

Therapeutic methods should be aimed primarily at eliminating pathogenetic factors.

Patients are shown sedatives (especially for intense chronic itching), emollients (to reduce skin dryness, which is both a cause and a consequence of itching), topical distractions (cold lotions, menthol-containing products, etc. ), antihistamines, which in the vast majority of cases are first-line drugs.

There are two generations of antihistamines: sedatives (Suprastin, Tavegil, Diazolin, Diphenhydramine, Phencarol, Fenistil) and non-sedative/mildly sedatives (cetirizine, levocetirizine, loratadine, desloratadine, fexofenadine, ebastine, rupatadine).

It is important to note that, despite the need to take sedatives, it is better not to use first-generation antihistamines (which have a sedative effect in addition to the antihistamine). Firstly, sleep during their use is non-physiological (drugs inhibit the phase of REM sleep). Secondly, the multiple side effects characteristic of this group of drugs limit the possibility of their use in patients with comorbidities.

Therefore, it is better to use tranquilizers as sedatives, and when choosing antihistamines, preference should be given to second-generation blockers.

Cetirizine occupies a special place among them.

Cetirizine

Cetirizine inhibits the histamine-mediated early phase of the allergic reaction, prevents various physiological and pathophysiological effects of histamine, such as dilation and increased capillary permeability (development of edema, urticaria, redness), stimulation of sensitive nerve endings (itching, pain) and contraction of the smooth muscles of the respiratory and gastrointestinal tract.

In the late stage of an allergic reaction, cetirizine not only inhibits the release of histamine, but also the migration of eosinophils and other cells, thus attenuating the late allergic reaction. Reduces expression of adhesion molecules such as Intercellular Adhesion Molecule 1 (ICAM-1) and Vascular Cellular Adhesion Molecule 1 (VCAM-1), which are markers of allergic inflammation .

In addition, unlike other drugs used for skin manifestations of allergies, cetirizine not only blocks H ₁ -histamine receptors, but also suppresses the skin response to platelet-activating factor [6, 7]. This is confirmed by the results of numerous clinical comparative studies: due to the ability to accumulate in the skin, the drug relieves itching and hyperemia more effectively than such drugs as ebastine, epinastine, terfenadine, fexofenadine and loratadine [8–10].

Compared to other antihistamines, cetirizine has a low volume of distribution of 0.5 l/kg. This provides higher concentrations of the substance in the extracellular space, where the H ₁ histamine receptors are located. Thus, their full employment and the highest antihistamine effect are ensured [11]. Another feature of the drug is its high ability to penetrate the skin. 24 hours after taking a single dose of cetirizine, the concentration in the skin is equal to or even slightly higher than the concentration in the blood. The advantage of cetirizine is the steroid-sparing effect: with the simultaneous administration of cetirizine and inhaled glucocorticosteroids in patients with bronchial asthma, the dose of the latter may be reduced or not increased, despite contact with the allergen.

Among cetirizines, Cetrin occupies a special place. In the study by E.E. Nekrasov et al. in patients with chronic urticaria, Cetrin showed the highest efficacy among other cetirizine generics and the best results in terms of pharmacoeconomics [12].

Application experience

We observed 75 patients aged 18 to 76 years (34 men and 41 women) with diagnoses of “atopic dermatitis”, “allergic dermatitis”, “chronic eczema in the acute stage”, “lichen planus”, “toxidermia” ( Fig. 2).

All patients received topical and systemic therapy, which included the antihistamine drug Cetrin (cetirizine) at a dose of 10 mg once a day at night. The duration of therapy is from 14 to 21 days, depending on the diagnosis.

Patients assessed the effectiveness of itching relief according to a point system: 0 points – no itching, 1 point – mild itching (present, but does not bother), 2 points – moderate (it bothers, but does not interfere with daily activity and / or sleep), 3 points – severe / intense itching (disturbs and interferes with daily activity and / or sleep).

The maximum decrease in the intensity of itching was observed already three hours after taking the drug in the first five days (Fig. 3).

Subsequently, a decrease in itching or its absence was noted by the tenth day of therapy with a simultaneous decrease in the clinical manifestations of diseases (Fig. 4).

The results obtained demonstrate the high efficiency of Cetrin (cetirizine) in the treatment of chronic and acute dermatoses. Cetrin (cetirizine) has a pronounced antipruritic effect, and also reduces other clinical manifestations of allergic dermatosis (infiltration, erythema). In addition, as a symptomatic therapy, the drug can also be used for somatic diseases.

The best remedies for itchy skin for 2023

This material is not an advertisement, it is informational in nature and reflects the estimated opinion of the author. All ranking positions are selected based on the developed selection criteria. Before making a purchase, you need to consult a specialist.

One of the most common reasons for seeking medical advice is itchy skin. It is very irritating, reduces the ability to work, creates discomfort, sleep disturbances. Itching occurs most often due to fungal infections or an allergic reaction. The TOP of the most effective remedies for skin itching will help solve this unpleasant problem.

Contents

• 1 Skin itching: what it is, causes
• 2 Symptoms
• 3 Drug therapy
• 4 The best remedies for itching
  9 0120 4. 1 Second generation antihistamines
  • 4.1.1
    Fenistil

  • 4.1.2
    Loratadine

  • 4.1.3
    Erius

  • 4.1.4
    Allegra

  • 4.1.5
    Zodak-Express

  • 4.2 Topical preparations
    • 4.2.1
      Losterin, zinc-naphthalan paste

    • 4.2.2
      Ichthyol ointment, paste, cream (ichthammol)

    • 4.2.3
      Lorinden-A-Elfa

    • 4.2.4
      Menovazin

Skin itching: what is it, causes of occurrence

Skin itching can simultaneously act on the nerves and irritate, but if you manage to satisfy this annoying need even for a minute, a feeling of pleasure appears. Let’s see what characteristics medicine and physiology will give to skin itching.

A strong desire to scratch the skin is due to the fact that the blood rushes to the receptors in the upper layer of the skin. Irritation of receptors can be facilitated by acids, toxins or hormones contained in the blood. Excess release of any compounds is usually a response to a disease or an event. Depending on this, groups of factors that can cause itching are distinguished.

Signs of itching can occur in anyone, regardless of gender or age. Its occurrence can be a wide range of different factors that are associated or not associated with the course of the disease.

Itching of the skin is a symptom that can be accompanied by a huge number of external signs indicating various types of pathologies. To determine the etiological factor from which such a sign follows, and to give an accurate diagnosis, it is necessary to conduct an instrumental laboratory examination.

The cause of pruritus determines the tactics of therapy, but for most cases conservative methods are sufficient.

Symptoms

Itching of the skin is mainly caused by the course of various diseases, therefore, in addition to the main symptoms, other signs of skin lesions can be observed. These specific clinical manifestations include:

1. The appearance of red spots on the skin, often with a clear border. They are often blistered and protrude above the surface of the skin. In certain diseases, several zones of redness can merge into one.
2. The skin is flaky and the flaking scales cause severe discomfort.
3. Burning sensation.
4. Due to constant scratching, wounds and scratches appear in problem areas, as well as characteristic rashes.
5. Crusts form at the sites of burst vesicles or ulcers.

These clinical manifestations are often symptoms of liver disease. But there are other signs that indicate problems with the liver:

1. Strong gas formation.
2. Disorders of defecation, expressed in diarrhea or constipation. There may be an alternation of both.
3. Urine becomes dark in color, and feces, on the contrary, become discolored.
4. Skin and mucous membranes stain yellow.

Often itching occurs without any rash. In such cases, you can pay attention to the bitterness in the mouth, as well as general malaise.

If physiological causes, such as pregnancy, have contributed to the problem, the list of additional symptoms can be supplemented with the following:

1. Sleep disturbance or lack thereof.
2. A state of irritability.
3. Depression.
4. Feeling of emotional and physical discomfort.

It should be noted that all the above factors are only the main signs that accompany the appearance of itching of the skin. All symptoms are strictly individual. There are exceptions when, in addition to the main symptom, no signs are noted. This happens with diseases of the hematopoietic system or mental disorders.

Drug therapy

If drugs are needed, antihistamines become the basis of treatment, as the main means of regulating the irritability of nerve endings by reducing the amount of free histamine. Antihistamines are considered type 1 histamine receptor blockers, and there are several classes of them.

Everyone knows the first one very well. This class includes drugs such as Tavegil, Diazolin, Suprastin, Diphenhydramine. Their action in modern conditions is considered rough, and the drugs themselves are outdated, because they have side effects: sedation, drowsiness. But, oddly enough, these side effects for those suffering from chronic pruritus can even be useful, since the drugs have an effect on muscarinic cholinergic receptors.

For patients with pronounced neurosis, insomnia and severe irritability, who are exhausted from itching, such side effects can be a salvation, as they will bring relief by helping to calm down and make it easier to fall asleep.

I would like to remind you that each drug is first given an international non-proprietary name or INN. The following lists the most popular commercial names, the first of which is the name of the original medicinal product under which it was marketed.

The best remedies for itching

The inclusion or non-inclusion of individual drugs in the rating, as well as the sequence of presentation of information, is not intended to create advertising or anti-advertising, due to current clinical recommendations. The sequence in which drugs are listed on popular pharmaceutical sites is also taken into account.

Second generation antihistamines

Second generation antihistamines, which do not have a sedative effect, are the basis for the treatment of severe chronic itching, since they do not have the ability to penetrate the structures of the nervous system.

Fenistil

A highly popular drug. It can be prescribed in various dosage forms and for internal use – in the form of tablets and drops, and for external use – in the form of a gel. The use of this drug is allowed even for infants.

Recommended for use in eczema, pruritic dermatoses, urticaria, insect bites and mild burns. It has antipruritic and antiallergic effects. Since the gel does not contain hormones, its use does not cause side effects at all.

The drug is applied to problem areas 2-4 times a day. Its effect is felt within a few minutes, the maximum efficiency is reached after 1-4 hours.

Important! With severe itching, the drug is recommended to be used only as directed by a doctor.

Fenistil

Advantages:

• adults need to use the drug for no longer than 30 days;
• is highly efficient;
• pleasant neutral smell, fragrance-free;
• is easy to apply;
• quick relief;
• is allowed to prescribe to infants from the second month of life.

Disadvantages:

• causes dry mouth;
• pupils dilate;
• increases the heart rate.
• other anticholinergic side effects.

Loratadine

A popular antihistamine for allergy control. It is included in the Russian list of drugs necessary for life, approved by the Government of the Russian Federation. Loratadine relieves the course of seasonal exacerbations and reduces the symptoms of allergic reactions.

The drug is available in two forms – syrup and tablets, the main active ingredient of which is loratadine.

In addition to loratadine, the tablets contain sodium croscarmellose, calcium stearate, lactose, polyvinylpyrrolidone and potato starch. Tablets of different pharmaceutical companies differ in composition, shape and color, as well as in the type of packaging. Both regular tablets and effervescent tablets are available, which dissolve in water.

The syrup contains, in addition to loratadine, citric acid, purified water, sorbitol and flavors. Its packaging and composition also varies from manufacturer to manufacturer.

The drug is produced by several domestic pharmaceutical companies, so the rules for its storage may vary. You can buy it at any pharmacy without a prescription. After purchasing Loratadine, you must carefully read the instructions for use to learn how to properly store the drug.

Loratadin

Advantages:

• low price;
• is of high European quality, as it is included in the list of essential medicines.

Faults:

• headaches.

Erius

Erius can rightly be considered a safe modern drug, which is approved for use in children from the age of six months. It belongs to the group of drugs that block receptors, so it does not have a hypnotic or sedative effect. Erius significantly alleviates the condition not only with skin itching, but also with all kinds of allergic edema, and the effect after its use has a long duration. The drug has proven itself in the treatment of classic allergic diseases – Quincke’s edema, conjunctivitis, urticaria or allergic rhinitis.

Erius is produced in two forms – syrup and tablets.
Taking this drug at strict adherence to the indicated dosage does not affect the decrease in attention while driving a car or working with moving mechanisms. The maximum allowable daily dose is one tablet.

Erius

Advantages:

• good efficiency;
• high quality;
• causes very few side effects.

Weaknesses:

• if the dosage is exceeded, dry mouth, feeling very tired and headaches;
• is contraindicated for pregnant and lactating women.

Allegra

A French-made medicinal product from the well-known company Sanofi-Aventis. Allegra is a new generation antihistamine drug with a complete absence of side effects observed during the use of earlier drugs and alpha-blockers. A positive effect is noticeable after an hour, and its duration after a single dose lasts 24 hours. The drug is not addictive and does not require an increase in dosage, no matter how long it takes. Allegra is prescribed for chronic itching of various forms, chronic urticaria, allergic rhinitis.

When prescribing the drug, care must be taken in people with hepatic or renal insufficiency or pathologies of the cardiovascular system. Allegra is considered to be effective in relieving both symptomatic prurigo and prurigo.

Allegra

Advantages:

• few contraindications;
• fast acting;
• convenient regimen – one tablet per day;
• long acting.

Disadvantages:

• has side effects: nausea, diarrhea, headaches, dizziness, drowsiness, muscle pain, cough;
• is contraindicated in children under 12 years of age, pregnant and lactating mothers, people with high sensitivity to the main components.

Zodak Express

The drug is produced by the Czech company Zentiva, the package contains 7 tablets of 5 mg. Zodak is used for both acute and chronic pruritus, it can be prescribed for almost any allergic disease – from Quincke’s edema to urticaria. Does not cause side effects – dry mouth, drowsiness, changes in pupil size, urinary retention.

The usual regimen is one tablet once a day. For the treatment of a small child, it is possible to prescribe the drug in the form of drops.

Zodak-Express

Advantages:

• the ability to selectively block histamine receptors without causing undesirable side effects;
• convenient regimen – once a day;
• long-term effect of a single dose;
• is ideal for compliance.

Disadvantages:

• slight increase in appetite;
• headaches;
• increased fatigue.

Topical preparations

The use of topical preparations will give a positive effect only in the presence of pruritic dermatosis with an altered condition of the skin – the formation of papules or tubercles, blisters, vesicles or vesicles filled with transparent contents that cause severe itching. These elements are considered primary.

Secondary morphological elements, different from the primary ones, are traces of scratching, crusts, wounds with suppuration, etc. They occur as a result of scratching on the skin, which remains practically unchanged, thus violating the integrity of the skin and threatening to attach a secondary infection. The main objectives of the use of external agents for severe chronic itching are to reduce the intensity of itching, drying, antibacterial and disinfectant action. We offer to consider the most famous drugs.

Losterin, zinc naphthalan paste

A cream preparation that is perfect for daily care of problematic skin. It is based on a natural oil compound – deresined naftalan, and contains urea, salicylic acid, zinc oxide and additional components. Due to the presence of urea, Losterin is able to penetrate deep into the epidermis and produce a stronger exfoliating effect. Also, the drug has a long-term analgesic, antimicrobial, anti-inflammatory, vasodilating effect.

Salicylic acid does not allow the development of microorganisms, and the panthenol, vitamin E and a complex of fatty acids present in the composition regulate the water and lipid balance, providing a trophic effect. The drug is approved for long-term use, taken 2-3 times a day. No toxicity;

Disadvantages:

• individual reaction to naftalan or fragrance composition. When the skin smells of oil, others are not very comfortable.

Ichthyol ointment, paste, cream (ichthammol)

Ichthyol ointment is very popular in dermatology. The drug is available in the form of an ointment, paste or cream, the most effective concentration is 10% or 20%. Provides effective assistance in the fight against itching – reduces skin sensitivity, gives antimicrobial, antistreptococcal and antistaphylococcal effects. The drug has been successfully used to treat neuralgia and various forms of arthritis, in addition to the problem of itchy skin.

The product is applied, without rubbing, on the surface of the skin in a thin layer 2-3 times a day. At night, it is allowed to close the treated area of ​​​​skin with a bandage.

Ichthyol ointment, paste, cream (ichthammol)

Benefits:

• allowed for pregnant and lactating mothers;
• Ichthyol is generally well tolerated;
• the drug is highly effective;
• cheap.

Faults:

• peculiar smell;
• is contraindicated in case of personal intolerance.

Lorinden-A-Elfa

An ointment successfully used to combat itchy skin. Lorinden is very effective for dandruff, dermatitis and seborrhea. The drug is hormonal, in connection with which there are a lot of contraindications, and is released strictly according to the prescription, so a consultation with a dermatologist is necessary. The volume of the tube is 15 mg, the ointment is very economically consumed, practically odorless.

The ointment is applied in a thin layer to the affected areas of the skin 1-2 times a day. The drug does not affect the condition of the hair. After the disappearance of itching, it is recommended to continue using the ointment for 3-4 days. The course of treatment should not exceed 21 days.

Lorinden-A-Elfa

Advantages:

• rapid disappearance of itching;
• combined compound;
• the ability to regulate the work of the sebaceous glands.

Weaknesses:

• dry skin, burning sensation may occur.

Menovazin

Liquid alcoholic topical product with a pleasant minty aroma due to the cooling properties of peppermint oil. The composition of Menovazin, in addition to mint oil, includes two components – procaine and benzocaine, which act as a local anesthetic. When applied to the skin, such a composition acts in a complex way. Menthol pleasantly cools, has an effect on the nerve endings, has a distracting effect, reduces the sensation of itching.

Anesthetics act as pain relievers, penetrate the skin shallowly and affect the transmission of nerve impulses. But at the same time, Menovazin is not absorbed into the blood.

Menovazin

Advantages:

• low price;
• pleasant smell;
• good pain relief;
• absorbs quickly;
• helps with itching, bites, scratches, neuralgia, arthritis.

Disadvantages:

• there are contraindications: hypersensitivity, violation of the integrity of the skin, inflammatory skin diseases at the site of the proposed application;
• not a very convenient bottle;
• with frequent use, side effects such as slight dizziness and lowering blood pressure may occur;
• pregnant and lactating mothers to use with caution.