Unbearably itchy skin is a very common eczema symptom. Nonetheless, scratching only makes the skin condition worse and invites infection, according to Harvard Health Publishing. When itching is very troublesome, eczema treatment often includes oral antihistamines (along with other medications). Antihistamines are drugs used to stop the itch-scratch cycle of eczema that can bother you in the day and even keep you up at night.
“While antihistamines won’t stop the eczema flare-ups from happening, they will help to relieve some of the itchiness, and itchiness is the No. 1 complaint I hear from my patients with eczema,” says Debra Wattenberg, MD, a dermatologist in private practice in New York City.
Atopic eczema, also known as atopic dermatitis, is the most common type of eczema, according to the National Eczema Association, and is considered similar to an allergic condition.
In the case of allergies, the body mistakes harmless substances like pollen or dust mites as a threat and releases histamine, an immune system protein that helps protect cells from infection, to fight them off, according to the Mayo Clinic. Allergic symptoms like itchy eyes and skin can result.
Antihistamine drugs are often used to treat allergic conditions. They block the effects of histamine to provide relief, per the Cleveland Clinic. Some individuals are sensitive to the sedative effects of first-generation antihistamines and prefer second-generation antihistamines.
Antihistamines “are the only oral medications we have to treat itching,” says Suephy Chen, MD, a dermatologist and the chair of the department of dermatology at Duke University School of Medicine in Durham, North Carolina. But, she explains, they work differently when used as an eczema treatment.
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Antihistamines as a Treatment for Eczema
“Eczema is not really a histamine problem, but antihistamines do seem to have some effect. The sedating effect is helpful because scratching always makes eczema worse. So if the medications keep people from scratching, indirectly they can help eczema,” Dr. Chen says, adding that antihistamines are still not as effective as we would like in treating the itch of eczema.
In general, there are two types of oral antihistamines on the market: first-generation antihistamines and second-generation antihistamines. First-generation drugs, such as diphenhydramine (Benadryl) and chlorpheniramine (Chlor-Trimeton), affect the brain and can cause side effects like drowsiness, according to the Cleveland Clinic.
These sedating antihistamines are most beneficial as a treatment for eczema, especially if the eczema symptom of itchy skin is keeping you from sleeping, says Dr. Wattenberg. And getting a good night’s sleep promotes healing and is beneficial for the immune system, according to the nonprofit Allergy & Asthma Network. When taken as directed, first-generation antihistamines are safe, even for children, according to the American Academy of Dermatology Association, though it’s important to talk to your child’s doctor first.
One note about first-generation antihistamines: long-term use, particularly among senior citizens, may increase the risk of dementia, according to one study. However, further studies are needed. If you are concerned about dementia, second-generation antihistamines (those that do not cross into the brain) are safe, according to Harvard Health Publishing.
Because second-generation antihistamines don’t have an effect on the brain, they also won’t make you sleepy. So, Chen says, as a treatment for eczema, second-generation drugs are “even less likely to work because of the nonsedating properties.” Second-generation antihistamines include loratadine (Claritin) and cetirizine (Zyrtec), the Cleveland Clinic notes.
Whether you’re taking a first- or second-generation variety, just don’t get your hopes up too high. When it comes to using antihistamines to help with eczema, they aren’t a cure-all. “Antihistamines won’t prevent flare-ups because they don’t target the actual root of the disease, but they do help with the itch, which could allow your flare-up to heal faster,” says Wattenberg.
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Side Effects of Antihistamines as Treatment for Eczema
Because first-generation drugs are sedating, here are some side effects you need to watch out for, according to the NHS in the United Kingdom, especially if you’re taking them at times besides before bed:
- Your ability to drive or operate machinery may be impaired.
- You might not be able to think clearly, so work or school may be difficult.
- Mixing antihistamines with other sedatives, muscle relaxers, or sleeping pills can increase the sedation.
Common side effects also include dry mouth, dizziness, and decreased appetite, according to MedlinePlus. First-generation antihistamines may not be right for you. Talk to your doctor if you have any of these medical conditions:
Many first-generation antihistamines are available without a prescription at your local drugstore, says Wattenberg. Prices vary, but at one nationwide drugstore chain, a box of 24 Benadryl Allergy Liqui-Gels cost less than $8. Store brands with the same active ingredients are generally less expensive. Ask your doctor about what would be best for you, suggests Wattenberg.
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Taking Care of Your Eczema
Stopping itchy eczema symptoms as soon as possible is essential to managing the condition. Sticking to your medications is very important.
“I recommend taking antihistamines in conjunction with topical steroids to improve the skin health,” says Wattenberg; she also advises against topical antihistamines, which she says may actually irritate your eczema. Your doctor might suggest a corticosteroid cream, which is a topical steroid that’s often a go-to treatment for eczema, according to the National Eczema Society, and helps fight inflammation.
Also, you’ll want to steer clear of irritants or allergens. One study found that for some people with eczema, acute itching may be caused by environmental allergens like animals, dust, and mold. Also, researchers found that for those with eczema, taking antihistamines may not always help with these hyper-acute flare-ups (caused by environmental allergens) because the itch-signals are carried along different brain pathways.
And of course, don’t forget to keep your skin hydrated by using plenty of moisturizer. According to the American Academy of Allergy, Asthma & Immunology, moisturizers help improve the skin barrier.
Additional reporting by Regina Boyle Wheeler.