Table 1.

Studies of interventions for burns pruritus in adult patients depicting agent/author of study, CRD level of evidence, salient design details, outcomes, reported side-effects/contraindications, cost (1 month treatment for maximum oral dose or a 5% injury for topical agents) and median GRADE score

Author/agent	CRD level of evidence	Patient sample	Study design	Outcome	Side-effects/comments	Cost	Median grade score
Vitale et al.[2]/antihistamines	Prospective cross-over observational study (4)	N = 40; average age: 35.9 ± 12.8 y	3 agents changed monthly in random order (hydroxyzine, chlorpheniramine, diphenhydramine); lubricants prn	20% pts reported complete relief, 60% partial, 20% of pts had no relief; no differences in agents tested; 61% pts preferred hydroxyzine, 26% chlorpheniramine, 13% diphenhydramine	C: 35 pts analysed (5 abandoned study due to itch cessation); 37% of respondents developed tolerance and dose increase restored response in 85% pts	£3.36.48	-2
Choiniere et al.[18]/capsaicin	Experimental study (1)	N = 30; mean age: 37.4 ± 11.9 y	0.025% caps vs. placebo fourtimes/ day for 6 weeks	No significant difference between the 2 groups	S/E: transient burning at application site	£184.80	-1
Hettrick et al.[19]/transcutaneous electrical nerve stimulation (TENS)	Experimental study (1)	N = 30	Control: pressure garments, skin lubrication, soft tissue mobilisation, PT/OT, antiitch medication; TENS group: 1 h/ day for 3 weeks over pruritic area (<150 μs, >180 Hz, low– comfortable level)	Change between pre- and post-TENS itch VAS significant (P = 0.086)	C/I: electrical injuries, pregnancy, epilepsy history, pacemaker in situ; C: 20 pts completed study; 10 withdrew/did not comply with study	£34, but nondisposable parts can be used sequentially by many patients	+1
Field et al.[20]/ massage therapy	Experimental study (1)	N = 20; average age = 38.2 y	Massage group: 30 min cocoa butter over a moderatesized area (trained therapists) twice/week for 5 weeks; control group: medical care, PT/OT cocoa butter application	Immediate reduction in itch following first and last sessions (P < 0.001; P < 0.005), improved pain, anxiety/mood ratings with massage		£120	+2
Whitaker[21]/ TENS	Case report (4)	N = 1 (19 y)	TENS over itchy area, 5–8 mA for 5 days before and 2 weeks after discharge	TENS stopped after 2 weeks, since patient’s symptoms improved significantly		£34, but disposable parts can be used sequentially by many patients	+2
Gaida et al.[22]/ low-lever laser	Case– control (3a)	N = 19; average age = 38 ± 13.97, range = 18–77 y	400 mW 670 nm Softlaser twice/week for 8 weeks, control area on each pt	Relief of itch in all pts (VAS drop from 4.36 ± 3.26 to 1.31 ± 1.88)		£50 (once laser equipment is available in the medical setting)	+2
Roh et al.[23]/skin rehabilitation massage	Pre test–post test study (3b)	N = 35; mean age = 39.1 ± 8.2 y	Massage group: 30 min/week by certified nurses + 10 min/day by caregiver for 3 months	Significant decrease in pruritus with massage than control (t =−2.942, P = 0.006)		£120	+2
Demling et al.[25]/Doxepin	Case–control study (3b)	N = 41	Doxepin group: cream qds + skin moisturiser 20 min later; control group: skin moisturiser + diphenhydramine + hydroxyzine (3-month study)	Significant reduction in itch and erythema for study length period; itch stopped in 55% pts before the end of the 3-month period vs. 10% in the oral medication group (response seen within 15 min of application)	S/E: mild and transient somnolence (15% doxepin vs. 80% standard care group), localised skin reaction in 1 patient (removed from the study)	£218.40	-1
Bauling et al.[26]/ dapsone	Observational study (4)	N = 8	Gel topically up to qds for 14 days	5 pts had significant relief, 2 moderate and 1 patient reported no symptomatic relief	C: No toxic serum dapsone levels recorded	£256.15	-2
LaSalle et al.[27]/ naltre-xone	Observational (4)	N = 13; average age = 43.3 ± 16.9 y, range = 19–78 y	50 mg/day naltrexone, antihistamines and hydrating lotion in addition to traditional therapy (1 pt required 100 mg naltrexone/ day)	72% satisfied with itch relief, 69% were able to reduce/ stop taking other medications to control itch, 85% recommended to other burn pts, 62% reported improved quality of life	C/I: abnormal LFT, opioid taking; C: 2 dropouts – 1 intolerable dizziness, 1 allergic reaction to dye in pills	£23.80	-2
So et al.[28]/ silicone sheeting	Experimental study (1)	N = 28	CEG group: routine product instructions (verbal and handout); EEG group: as above and additionally a 5-page handout and 26 min videotape	EEG group: steady and progressive decline in itching severity over 6 months of follow-up compared to the CEG group (P = 0.01)	C/I: inability to communicate in English, cognitive impairment, use of alternative scar treatments, open/ unstable wounds, facial scars; C: 3 pts lost to follow-up	£49.92	-2

N, number of patients; M, months; Y, years; prn, as required; pts, patients; C, comments; S/E, side–effects; PT, physiotherapy; OT, occupational therapy; C/I, contraindications; VAS, visual analogue scale; CEG, conventional education group; EEG, enhanced education group