Pruritus (PDQ®): Supportive care - Patient Information [NCI]
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General Information About Pruritus
Pruritus is an itchy feeling that makes you want to scratch your skin. It may occur without a rash or skin lesions. It's a symptom of a condition or disease. Pruritus can be caused by cancer, cancer treatments, and conditions related to cancer. It also may be caused by an infection, dry skin, reaction to a drug, or a disease or condition that is not cancer.
The skin is the largest organ of the body. The most important job of skin is to protect against heat, sunlight, injury, and infection. The skin is also important to self-image and your ability to touch and be touched.
Pruritus can be very uncomfortable and scratching may cause breaks in the skin, bleeding, and infection. If your skin feels itchy, let your doctor know so it can be treated and relieved.
Causes of Pruritus in Cancer Patients
Certain cancers and blood disorders are likely to cause pruritus.
These include the following:
- Polycythemia vera.
- AIDS -related Kaposi sarcoma and AIDS-related infections.
- Hodgkin lymphoma and other lymphomas.
- Stomach cancer.
- Pancreatic cancer.
- Lung cancer.
- Colon cancer.
- Brain cancer.
- Breast cancer.
- Prostate cancer.
Certain cancer treatments may cause pruritus.
Cancer treatments that may cause pruritus include the following:
When chemotherapy causes pruritus, it may be a sign that you are sensitive to the drugs being used. Anticancer drugs that commonly cause itching include the following:
The way you react depends on the drug, the dose, and whether you are allergic to it. Itching caused when drugs are given by infusion usually occurs only near the place where the needle was inserted and often stops on its own 30 to 90 minutes after the infusion ends. It's important to report itching caused by chemotherapy to your doctor because your reactions can get worse each time the same drug is used.
Radiation can kill skin cells and cause dryness, burning, and itching as the skin peels off. Broken skin may become infected by scratching. If your skin is severely damaged, radiation treatments may have to be stopped for a while to give your skin time to heal. This can affect how well your cancer treatment works. Your doctor will try to keep your skin healthy so you can continue treatment. Some types of radiation cause fewer side effects than others.
Radiation therapy and chemotherapy together
The side effects of radiation therapy and chemotherapy given together can be more severe than the side effects when each is given alone.
Several biologic therapy drugs may cause itching. This is most common with drugs called interferons.
Bone marrow transplant
Graft-versus-host disease (GVHD) can occur after a bone marrow transplant. In some patients, GVHD may cause dry skin and an itchy rash. In severe cases, it can progress to scleroderma, which is a hardening and thickening of the skin. Muscles and tendons can also harden and make joints stiff. This complication of scleroderma is called contracture.
Drugs for supportive care
Some of the drugs used to prevent or treat cancer symptoms may cause pruritus, including the following:
- Pain medicine.
- Drugs for nausea and vomiting.
Pruritus can be a symptom of infection.
Itching around the anus or vulva might be caused by infections with Trichomonas or fungi, nearby tumors, hemorrhoids, tears in the anus, or fluids draining from wounds.
Assessment of Pruritus
Finding the cause of the itching is the first step in relieving pruritus.
Since pruritus is a symptom of a disease or condition, finding and treating the cause is the first step in bringing you relief.
A physical exam and a blood test are done to assess pruritus.
The following tests and procedures may be done to find the problem that is causing the itching:
Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. The doctor will check your skin for the following:
- Signs of infection.
- Signs of a drug reaction.
- Redness, dryness, scratches, or lesions.
- Swelling or stiffness.
- Abnormal color, texture, or temperature.
A history of your health habits and past illnesses and treatments will also be taken, including the following information:
- When the pruritus started, how long it lasts, how bad it is, and where on your body it's felt.
- Whether you have had pruritus before.
- What relieves the itching or makes it worse.
- Diseases you have now or had in the past.
- Treatments you are receiving and have received in the past.
- Pain medicines, antibiotics, or other drugs you are taking.
- Whether your diet is healthy and you drink enough fluids.
- How you care for your skin.
Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:
- The number of red blood cells, white blood cells, and platelets.
- The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
- The portion of the blood sample made up of red blood cells.
Treatment of Pruritus
Treatment of pruritus in cancer patients involves learning what the triggers are and taking steps to avoid them.
It is important for you and for caregivers to know what triggers itching, such as dry skin or hot baths, so you can take steps to prevent it. You may need more than one type of treatment to relieve or prevent pruritus, protect your skin, and keep you comfortable.
Self-care, drugs, and comfort measures may all be used to treat pruritus.
Self-care includes avoiding pruritus triggers and taking good care of your skin:
- Keep your home cool and humid. Warm, dry air can cause skin to become dry and itchy. Cool, humid air may prevent itching.
- Eat a healthy diet and drink plenty of fluids. This helps your skin stay moist and healthy.
- Avoid detergent residue on clothing and bed sheets. Traces of laundry detergent and fabric softener may be left behind on fabrics and can make pruritus worse. The residue can be reduced by adding vinegar (one teaspoon per quart of water) to the laundry rinse cycle or by using a mild laundry soap that is used for washing baby clothes.
- Wear cotton clothing and use cotton bed sheets. Body heat, wool, and some man-made fabrics can trigger itching. Wear loose-fitting, lightweight cotton clothing and use cotton bed sheets.
- Control stress. Stress and anxiety can make it harder for you to cope with pruritus. Ways to control stress include relaxation therapy, positive imagery, music therapy, and distracting yourself with activities. Talk with your doctor if stress is a problem for you.
- Use moisturizing creams and lotions. A skin moisturizer prevents dryness, which can cause itching. A moisturizer contains water and forms a film over the skin's surface to keep it moist. Choose a moisturizer that meets your own needs. Some ingredients, such as petrolatum, lanolin, mineral oil, alcohol, and menthol, cause allergic reactions in some people. Topical steroid creams can reduce itching but may cause skin to become thin and easily injured.
- Avoid hot baths. Hot baths can trigger itching. Baths that are just warm and last no longer than one half hour every day or every two days can help relieve itching. Bathing more often can make dry skin worse.
- Use mild soaps. Mild bath soaps contain less soap or detergent that can irritate skin. Oil can be added to the water at the end of a bath or applied to the skin before drying.
Avoid powders, bubble baths, cornstarch, deodorants, and antiperspirants. These products should be used with care because they can irritate the skin and cause itching.
- Cornstarch can help prevent itching of dry skin caused by radiation therapy but should not be used where skin is moist. When cornstarch becomes moist, fungus may grow. Avoid using it on areas close to mucous membranes, such as the vagina or rectum, in skin folds, and on areas that have hair or sweat glands.
- Some powders and antiperspirants, such as those that contain talc and aluminum, cause skin irritation during radiation therapy and should be avoided when you're receiving radiation treatment.
Your doctor may prescribe an antibiotic if your pruritus is caused by an infection. You may also be given an oral antihistamine to relieve itching, with a larger dose at bedtime to help you sleep. For pruritus that is not related to radiation, you may use a mild corticosteroid on your skin, to relieve itching. Corticosteroids should not be used if the cause of pruritus is unknown.
Other drugs that may be used if other treatments do not work to control pruritus include sedatives and antidepressants. Antidepressants can have strong antihistamine and antipruritic effects.
Talk with your doctor about medicines you take that may be causing pruritus, such as opioids, morphine, or antibiotics. Changing to a different drug may stop the itching.
Comfort measures and acupuncture
The following may help relieve itching:
- A cool washcloth or ice held over the itchy area.
- Firm pressure on the itchy area or on the same area on the opposite side of the body.
- Acupressure or acupuncture.
- Rubbing or vibration on the itchy area.
Changes to This Summary (02 / 05 / 2014)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
This summary was completely reformatted and some content was added.
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This PDQ cancer information summary has current information about the causes and treatment of pruritus. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.
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Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change.
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National Cancer Institute: PDQ® Pruritus. Bethesda, MD: National Cancer Institute. Date last modified <MM/DD/YYYY>. Available at: http://cancer.gov/cancertopics/pdq/supportivecare/pruritus/Patient. Accessed <MM/DD/YYYY>.
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Last Revised: 2014-02-05
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