East Region Formulary

Aqueous calamine cream is available via pharmacy first so patients should be directed there.

Apply 2-3 times daily

Apply 1-2 times a day

Prescribing Notes:

Pruritus may be caused by systemic disease, skin disease or as a side-effect of medication. Where possible the underlying cause should be identified and treated.
Anti-pruritics should be considered when an emollient on its own has been ineffective in relieving symptoms.
1% menthol in aqueous cream is useful for patients with non-specific itch.
Menthol in aqueous cream is an appropriate choice for the elderly. A range of strengths are included as stinging may be associated with the higher strengths.
Topical antihistamines and local anaesthetics are not recommended as they are only marginally effective and can cause sensitisation.
Crotamiton is useful for pruritus persisting after treatment of scabies.
Emollient preparations may be useful for pruritus due to dry skin; sedating oral antihistamines may also be helpful for itch (see Allergy recommendations in the Respiratory chapter of the formulary).
Calamine is useful for itch associated with chickenpox.

History Notes

15/12/2021

East Region Formulary content agreed.

Oral antihistamines can be used in combination with topical treatments.

10mg daily.

Oral antihistamines can be used in combination with topical treatments. Sedating antihistamine can be helpful for troublesome nocturnal itch. Avoid in the elderly, chlorphenamine has strong anticholinergic effects – see prescribing notes

Adult, 4mg every 4–6 hours; maximum 24mg per day.
Elderly, 4mg every 4–6 hours; maximum 12mg per day.

Oral antihistamines can be used in combination with topical treatments. Sedating antihistamine can be helpful for troublesome nocturnal itch. Avoid in the elderly, hydroxyzine has strong anticholinergic effects – see prescribing notes

Adult, initially 25mg daily, dose to be taken at night; increased if necessary to 25mg 3–4 times a day.
Elderly, initially 25mg daily, dose to be taken at night; increased if necessary to 25mg twice daily.

Prescribing Notes:

Pruritus may be caused by systemic disease, skin disease or as a side-effect of medication. Where possible the underlying cause should be identified and treated.
Emollient preparations may be useful for pruritus due to dry skin.
Antihistamines (including non-sedative antihistamines) can cause day time somnolence, and patients should be aware of this potential side-effect, particularly in relation to driving or operating machinery.
If there is troublesome nocturnal itch, consider a short-term trial of a sedating oral antihistamine, such as chlorphenamine or hydroxyzine.
Sedating antihistamines such as chlorphenamine and hydroxyzine have strong anticholinergics effects and should be avoided in the elderly. Medicines with strong anticholinergics effects have long been linked to impaired cognition and falls risk, and more recently have also been linked to increased morbidity and mortality. Further information about anticholinergic load can be read in the Scottish Government Polypharmacy Guidance.

History Notes

05/06/2025

Updates to prescribing information, ERWG July 25

15/12/2021

East Region Formulary content agreed.

Aqueous calamine cream is available via pharmacy first so patients should be directed there.

For dose, refer to product literature.

Crotamiton is useful for pruritus persisting after treatment of scabies.

For dose refer to BNF for children.

Prescribing Notes:

Pruritus may be caused by systemic disease, skin disease or as a side-effect of medication. Where possible the underlying cause should be identified and treated.
Anti-pruritics should be considered when an emollient on its own has been ineffective in relieving symptoms.
1% menthol in aqueous cream is useful for patients with non-specific itch or for symptomatic treatment of hives in urticaria.
Topical antihistamines and local anaesthetics are not recommended as they are only marginally effective and can cause sensitisation.
Emollient preparations may be useful for pruritus due to dry skin; sedating oral antihistamines may also be helpful for itch (see Allergy recommendations in the Respiratory chapter of the formulary).
Calamine is useful for itch associated with chickenpox.

History Notes

31/05/2024

East Region Formulary content agreed.

Prescribing Notes:

Pruritis without an underlying cause is uncommon in children. The underlying cause should be identified and treated, consider diagnosis and seek specialist advice if required. Regular oral antihistamine are rarely indicated.
Emollient preparations may be useful for pruritus due to dry skin.

History Notes

31/05/2024

East Region Formulary content agreed.

Dose according to age and product licence.

Topical corticosteroids. Product supplied depends on indication and age of patient. Refer to Pharmacy First PGD for inflammatory skin conditions.

Dose according to age and product licence when 'over the counter' (OTC) product is supplied. Individuals aged 1 month and over with symptoms of skin inflammation, who are not eligible for treatment with an OTC product (either sold OTC or supplied from NHS PFS Approved List) may be eligible for supply of a Prescription Only Medicine (POM) under the Pharmacy First hydrocortisone PGD for inflammatory skin conditions. Refer to the PGD for information on dose, age, indication, duration and referral criteria.

Dose according to age and product licence when 'over the counter' (OTC) product is supplied. Individuals aged 1 month and over with symptoms of skin inflammation, who are not eligible for treatment with an OTC product (either sold OTC or supplied from NHS PFS Approved Only Medicine (POM) under the Pharmacy First hydrocortisone PGD for inflammatory skin conditions. Refer to the PGD for information on dose, age, indication, duration and referral criteria.

Oral treatment can be used in combination with topical treatments.

Dose according to age and product licence.

Prescribing Notes:

See NICE CKS Itch-widespread for further guidance.
Emollient preparations may be useful for pruritus due to dry skin.
Sedating oral antihistamines may also be helpful for itching in patients over 1 year of age.
Crotamiton is useful for pruritus persisting after treatment of scabies.
Acute urticaria is usually self-limiting and, if mild, treatment is often unnecessary. Sedating oral antihistamines may be particularly helpful if sleep is disturbed.
Topical corticosteroids are not recommended in urticaria, rosacea, acne or undiagnosed, possibly infective, disorders.
Indication and age restrictions apply to 'over the counter' (OTC) products, refer to product information for full details. Individuals aged 1 month and over with symptoms of skin inflammation, who are not eligible for treatment with an 'over the counter' (OTC) product (either sold OTC or supplied from NHS PFS Approved List) may be eligible for supply of a Prescription Only Medicine (POM) under the Pharmacy First hydrocortisone PGD for inflammatory skin conditions. Refer to the PGD for information on dose, age, indication and duration.
To minimise the risk of side effects with topical corticosteroids, the smallest effective amount should be used, reducing strength and frequency of application as the condition settles. The risk of systemic side effects increases with prolonged use on thin, inflamed or raw skin surfaces, use in flexures, or use of more potent corticosteroids.
Topical corticosteroids should not be used on infected skin unless the infection is being treated. Palms and soles may require potent or very potent steroids.

History Notes

18/06/2026

Updated prescribing information, ERWG April 2026.

19/12/2024

Arjun 1% cream removed, content agreed ERFC Dec 2024.

16/06/2022

Menthol formulations updated to reflect the 15th Edition (May 2022) of the NHS Pharmacy First Scotland Approved List of Products.

27/10/2020

Content migrated from ‘East Region Formulary: Pharmacy First - supporting minor ailments’ document.

View all