Why are anti-itch medicines so expensive? (Especially when they don't work very well)

Factual Questions
1

For the last several months I’ve been suffering from an extreme case of eczema, with all the dry skin and constant itching that comes along with it. (Actually it turned out not to be actual eczema, but a symptom of cancer, although for practical purposes there’s no real difference.) Frankly, I’m amazed that there’s so few effective treatments for itching, and the ones that actually work are extraordinarily expensive.

For instance, my dermatologist gave me a script for fluocinolone acetonide body oil (“Derma-Smooth”) which my insurance initially refused due to cost: $185 per bottle!! Even once insurance caved in and paid, my co-pay was close to $65. It worked beautifully, killed the itching dead – for just one day. And then I had to stop because of a severe allergic reaction to it. :smack:

The backup prescription, Triamcinolone topical cream, was also quite expensive ($7.85 with insurance, probably up to $40 without) and while it had some effect against the itching, it wears off very quickly. Plus there are limitations about where you can use it and for how long. I’m also using a cannabinoid-infused skin cream which has limited use against itching, but works when it works – it costs about $45 per bottle (shocking when I first heard about it, until a Google search showed that wasn’t a bad price at all) plus I can use it on those “forbidden areas” contraindicated by Tramcinolone. (Always a scary situation when you spread an unknown substance on your balls for the first time…)

And that’s it. Forget about pills, there are NONE designed solely for itching – antihistamines supposedly work, but all they seem to do for me is sneak up behind the itch and yell “BOO!” And that OTC 1% Cortizone cream is a joke. I’ve had some luck with Cetaphil Restoraderm, which is just a moisturizer with no active ingredients (hence it’s marketed as “Eczema Calming” instead of actually curing anything) but its price is crazy-crazy, up to $20 for a 10oz bottle. Still, it’s the only thing that works reliably.

So here comes the GQ part: WTF??? Why are there so few effective treatments for extreme itchy skin, except the ones that are ridiculously expensive? And why is there no “nuke it from orbit” style pill for itching? There’s very nice pills for pain, nausea, anxiety, and many other conditions, but with itchiness, even in the 21st century, you’re out of luck. Why haven’t science and medicine kept pace?

2

The itch sensation comes from a specific type of cutaneous nerve fiber. It’s really hard to target that kind of thing (as opposed to drugs that target enzymes or cell actions).

3

Hydrocortisone cream has worked well for me, and it’s not expensive.

4

You actually got lucky. A couple of years ago I got ringworm. It’s a fungal infection, and the antifungal was only about $20, but the steroid cream for the itching was nearly $300! I tried cortisone cream OTC, but it didn’t touch the itching, which was driving me insane to the point that I couldn’t sleep.

5

Vicks Vapor Rub works for me.

And it is cheap.

6

I’d you can, get some prescription strength lidocaine patches. They work great on all sorts of itching, and on mild burns ( which I don’t believe you are supposed to use them for, but I’m a big baby when I burn myself and will use any resource available)

7

I have no idea why they haven’t figured it out, all I know is two things work, Hot water (feels good too) and putting on Carmex on the itchy spot after its dried. Works better than hydrocortisone by far. Menthol or Camphor probably have something to do with it being mild analgesics.

8

But it’s 2018, we can detect distant exoplanets from measuring the wobbles of their stars, we’ve got the entire human genome mapped out, we should be able to create a drug that targets one tiny type of nerve fiber.

My dermatologist recommended that I quit hot showers and just bathe in lukewarm water only. That made me feel terrible so I went right back to hot showers. So what if they dry out my skin faster, that’s what moisturizing cream is for. In fact I even found a cite at the Mayo Clinic saying that many patients gain relief from itching via hot showers (and some prefer cold, go figure.)

9

Have you tried a warm oatmeal bath? Lots of people swear by it and it seems to give my dog relief when he has itchy skin.

I too have been desperate for itch relief and found the available products both lacking and expensive. I eventually crushed some OTC antihistamine tablets, mixed that with a little Vaseline and applied it topically. It worked so well I too wondered why such a product didn’t already exist!

Wishing you Good Luck!

10

I use apple cider vinegar for any itches that do not respond to scratching

11

Biology is complicated. Really complicated. You just won’t believe how vastly hugely mindbogglingly complicated it is. I mean you may think that your tax return or your smartphone is complicated, but that’s just peanuts to biology.*

Snark aside, it’s really tricky to target a specific chemical to a specific cell type. It’s possible in principle with methods like antibody-drug conjugates, which are at the state of the art for cancer treatment. But the development and production costs for treatments like that are enormous, so they probably won’t be economically viable for an itch cream any time soon.

*With apologies to Douglas Adams.

12

Some find relief with the electrical stimulation of a TENS unit. Of course in some people the electrodes can result in skin irritation - and itching.

13

It aggravates the skin, causing more irritation, which eventually makes the itching worse. So my dermatologist says anyway. It does feel absolutely orgasmic at the time though—to a frankly bizarre degree for anyone who doesn’t suffer from eczema/psoriasis. Moisturizing helps, a little.

Will your doctor recommend using a topical steroid instead, such as clobetasol? Or is that going to be teratogenic, and therefore contraindicated in your case? It works better than fluocinolone for relieving the severity and pruritus of my flares. And much better than triamcinolone, which is still better than nothing. I am glad that hydrocortisone works for some of you; it doesn’t do much for me.

The delta between insurance and non-insurance pricing for medications is a giant PITA, I agree, and frankly criminal. I get buying in bulk and discount pricing, but the delta for some of these meds can be literally 100x, insurance v non-insurance pricing. There are overseas sources for some of these medications, caveat emptor.

If you’ve lesions along with the itching, I’ve found some relief from UV (B?) light box therapy too. Antihistamines somewhat help, and by antihistamines, 4x benadryl every 4 to 6 hours when I wasn’t receiving topical steroids. It sucked. I take a large dose of claritin every day; it doesn’t seem to be hurting anything…

Best of luck. I hope it gets better for you.

14

Adding that sometimes the insurance co-pay price is higher than what you might pay without insurance. I checked pricing for Triamcinolone at www.goodrx.com and found triamcinolone available for $4 from Wal-Mart pharmacy. Less than $6 from Kroger, Costco, Albertson’s or Target.

Check prices on that site and maybe buy some scripts for cash and not tell them you have prescription insurance. Might require going to a pharmacy you do not normally deal with. I’ve found it helpful to have at least one pharmacy that I only do cash purchases at.

15

Maybe because itching is so annoying that people will pay anything to get relief?

16

A year so ago my scalp started itching like crazy. I went to a dermatologist and he prescribed Ketoconazole Shampoo 2%, and it worked! I know your situation is different, but I know itching can really ruin one’s quality of life.

17

Having recently acquired one helluva poison ivy rash - and spreading it all over myself before I figured out what happened - I’ve got buckets of sympathy for you. Concur that there’s not much in the way of effective relief for weapons-grade itchiness.

I don’t know if it works for your symptoms, OP, but mosquito bites in particular respond well if I smartly slap myself right over the itch. The sting seems to briefly overwhelm the “itch” nerves (I guess pain gets priority) without the damage inflicted by fingernails.

Again, my sympathies.

18

Several years ago, I developed severe hives related to lupus. I would rather have had an equivalent amount of pain. You can take painkillers for pain. I couldn’t even sit or lie on anything upholstered. Hot showers made it much worse. And I got all the recommendations you’ve gotten: oatmeal baths, hydrocortisone cream, etc., etc. I already had Triamcinilone and another Rx topical steroid cream, Clobetasol, which is somewhat stronger–and also pricey. Neither can be used for more than two weeks because they cause thinning of the skin.

It’s not much help, but I took warm showers, then baths as cool as I could stand them. Cold water numbed the itching better than anything else.

You’re not the only one who’s noticed the hefty price tags. A 2016 study of 19 dermatological topical meds found that 7 of them quadrupled in price between 2009 and 2015. Topical steroids increased by 290%. Why? According to this article in the Dermatology Times:

  1. One drug company. “Drugs produced by Canadian drug firm Valeant Pharmaceuticals International saw the most significant increase in cost. While we cannot accuse Valeant of being the culprit behind rising costs, there is a strong correlation between one pharmaceutical company increasing [its] prices (or charging more for a new drug) and competing pharmaceutical companies following suit. With only a select number of drug manufacturers, a company can theoretically charge a higher price. It becomes a supply and demand game where the patient always loses."

  2. Pharmaceutical companies can charge what they want.

  3. Insurance companies. “In the payer world, PBMs (Pharmacy Benefit Managers) are those who assist and represent the carriers in coverage determinations and paying for medications. They look at dermatological conditions as non-life-threatening and, therefore, they feel justified in either increasing the copays significantly or not covering the medications at all.”

There’s more in the article.

One tip: During the Hives of Hades experience, I found cool baths helpful. They seemed to calm the itching for up to 30 minutes after I got out of the tub. A rather Spartan solution, but hey, it was cheap.

19

Interesting stuff. Thanks for sharing this!

“Hives from Hades” is awesome btw. :slight_smile:

20

Hydrocortisone bought over the counter didn’t help me at all, but a cream with Clobetasol propionate, a much stronger corticosteroid prescribed by a doctor, worked wonders with severe itching.

A small amount seems to work quickly and effectively, and I still keep some to use on the occasional itchy rash.