Table 3.

Therapeutic options for nocturnal pruritus with respective level of evidence and grade of recommendation

Treatment	Level of evidence*	Grade of recommendation
Nonpharmacologic
Emollients and wet-wrap therapy (González-López et al., 2017; Pereira and Ständer, 2017) Coolants (Kuhn et al., 2017b) Address bathing habits (Haghayegh et al., 2019) Sleep hygiene (Chang and Chiang, 2016) Psychotherapeutic interventions (Bae et al., 2012; Jafferany and Davari, 2019; Schut et al., 2016)	2b 2b 1a 2b 2b	B B A B B
Pharmacologic-topical (Kontochristopoulos et al., 2016; Pereira and Ständer, 2017; Kuhn et al., 2017b)
Anesthetics Corticosteroids Calcineurin inhibitors Miscellaneous agents (naltrexone, polidocanol, aprepitant)	1b 1b 4 5	A A C D
Pharmacologic – systemic
H1 antihistamines (Lavery et al., 2016; Yamanaka et al, 2015)Antidepressants (Khanna et al., 2019; Kuhn et al., 2017b; Lavery et al., 2016; Savin et al., 1979; Yosipovitch and Samuel, 2008) ○Mirtazapine ○Doxepine Gamma-aminobutyric acid agonists (Lavery et al., 2016; Pereira and Ständer, 2017)Opioid receptor modulators (Kozono et al., 2018; Dawn and Yosipovitch, 2006)Benzodiazepines (Ebata et al.,1998; Roux and Kryger, 2010)Melatonin (Chang et al., 2016)Biologics (dupilumab, adalimumab, etanercept; Cork et al., 2020; Fargnoli et al., 2019; Mrowietz et al., 2015; Strober et al., 2012; Tsianakas et al., 2018)Phototherapy (Becker et al., 2011; Kuhn et al., 2017b; Yosipovitch and Bernhard, 2013)	1a 1b 2b 1b 1b 4 5 2b 2b	A A B A A C D B B

^⁎Level of evidence and grade of recommendation were assigned according to validated scale developed by Oxford Centre for Evidence-based Medicine (Burns et al., 2011).