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Itching

  • Vastgesteld: 16-07-2024
  • Regiehouder: Nederlandse Vereniging van Kindergeneeskunde (NVK)

Diagnostics of itching

 DO
  • Take a history of itching and perform careful physical examination.

 Consider
  • In cases of itching, consider additional laboratory tests if indicated.
  • In cases of itching, consider a consultation with a dermatologist.

Treatment of cause





 
 Consider
  • Consider as treatment of the underlying cause (if possible) of itching:
    • Adjustment of medication. 
    • Treatment of infection. 
    • Treatment of iron deficiency anaemia.
    • Treatment of underlying endocrinological conditions such as diabetes. 
    • Removal of bile duct obstruction, by placing a stent (if life expectancy is longer than a few weeks) or nasobiliary drainage. 
    • Chemotherapy (e.g., in malignant lymphoma). 
    • Radiotherapy (e.g., in Hodgkin's disease).

Non-pharmacological treatment


 DO
  • Take good care of the skin.
  • Prevent skin irritation.
  • Pay attention to mental well-being.


 Consider
  • In children with itching, consider using ointments based on skin condition.  
  • In children with itching, consider complementary therapy, such as hypnosis.

Pharmacological treatment

Local treatment






 
 DO
  • Treat dry skin (see dry skin module).
  • In children with itching due to eczematous skin abnormalities, alternate cream with corticosteroids with a neutral cream. Preferably let cream with corticosteroids soak in for 30 min before applying oily ointment over it.
  • In children with itching due to fungal infections, use topical antimycotics such as miconazole cream (2dd) or terbinafine cream (1dd). 
  • Use in children with itching due to bacterial infections:
    • Antibacterial agents such as chlorhexidine 0.5% in 70% alcohol with 1% glycerine 85% (chlorhexidine spirit FNA). 
    • Disinfectants such as disinfecting soaps or betadine scrub (dissolved and not applied directly to the skin, supplemented if necessary, with fusidic acid ointment 2%). 
    • Hygienic measures (own towel).

Systemic treatment

 
 Consider
  • Consider pharmacological treatment of itching depending on the cause, in accordance with the paediatric formulary.
  • For itching due to cholestasis, consider stent placement for (bile) flow obstruction, naloxone (provided the child is not on opioids), colestyramine or ondansetron (be cautious in use).
  • For itching due to other causes or itching non-responsive to other agents, consider a sedative antihistamine.

Evaluation

 
 DO
  • Evaluate the effect and side effects of the treatment instituted at the appropriate time, and adjust treatment as needed. Involve child and family in this process.