Dr Sam Hamilton1, Dr Katherine Davis1, Mr Benjamin Hill1, Mr Nanda Kandamany1
1Royal Hobart Hospital, Hobart, Australia
Pruritus remains one of the most common and significant issues for burns patients, with 87-93% of adult patients reporting itch at varying intensities (Nieuwendijk SMP et al, 2018). There is no consensus on pruritus management (Kuipers HC et al, 2015), although individual departments may have their own guidelines. We have reviewed the relevant literature, with the aim to provide a brief guide and update on current itch management in burns patients.
A comprehensive search of Pubmed and Burns was performed using broad search terms.
The ISBI Practice Guidelines Committee (2016) recommends four stages in approaching itch management; assessment, skin hydration, pharmacological and non-pharmacological. Assessment of itch can be performed using several available tools. Skin hydration using moisturisers and emollients has been shown to decrease itch intensity. Following this, there is no clear evidence-based step-wise approach to pharmacological management, although oral anti-histamines are the mainstay of treatment (ISBI Practice Guidelines Committee, 2016), and there is increasing evidence that gabapentin and pregabalin improve pruritus and neuropathic pain when added to antihistamine regimens in all age groups (Kaul I et al, 2018). Non-pharmacological management with compression garments, skin cooling and massage now has an additional repertoire, with recent trials considering use of Pulsed Dye Laser (PDL), low energy extracorporal shock wave therapy and electrocutaneous nerve stimulation devices (Joo SY et al, 2017; Samhan AF & Abdelhalmin NM, 2019; Joo SY et al 2018). Evidence for these is not strong, but emerging.
Pruritus remains an important management challenge in burns patients. A multi-modal approach must be taken, with consideration of pharmacological and non-pharmacological treatment options. There is emerging evidence for novel new non-pharmacological treatments for treatment-resistant itch in burns patients.
Sam is a surgical resident medical officer at the Royal Hobart Hospital, with a keen interest in plastic surgery and burns management.