Topical steroids + dermeleve (otc anti-pruritic) cream ILK versus other OTC topicals (capsaicin, Sarna, pramoxine) versus compounded gabapentin, amitriptyline, lidocaine (my main go-to second line) Oral - gabapentin vs doxepin vs desipramine Recalcitrant cases I’ve added dupilumab or phot...

Physical therapy is the first line of treatment if the patient is willing to commit effort. Patients often accept reassurance, which I offer before capsaicin because it requires frequent application. The risk of falls due to gabapentin outweighs the benefits in most patients. Topical strontium (D...