The U.S. National Cancer Institute does not currently endorse any
foreign translations of PDQ® and no such endorsement should be inferred
for the following translation.
Pruritus: Supportive care
Last Modified : 2005-10-06
Overview
Pruritus is an itching sensation that triggers the desire to scratch. It is a
distressing symptom that can cause discomfort. Scratching may cause breaks in
the skin that may result in infection. Pruritus can be related to anything
from dry skin to undiagnosed cancer. It can occur in people who have cancer or
in those who have received cancer treatment.
Risk Factors
Pruritus may occur in some people with cancer but not in others. However, the
following persons with cancer may be at a higher risk for developing pruritus:
- Persons with various malignant diseases that are known to produce
symptoms of pruritus, including, but not limited to AIDS-related
Kaposi's sarcoma, Hodgkin's lymphoma and other lymphomas, leukemias,
adenocarcinomas, and cancer of the stomach, pancreas, lung, colon,
brain, breast, and prostate. Pruritus tends to disappear when cancer
is cured or in remission. It may reappear when the disease recurs.
- Persons who have had chemotherapy. Usually the itching subsides within
30-90 minutes and does not require treatment. The development of
pruritus may be a sign that the patient is especially sensitive to the
chemotherapy drug.
- Persons who have had radiation therapy. Radiation can kill skin cells
and cause burning and itching. As the skin peels off, scratching can
damage it further, which creates the potential for infection.
Treatment may need to be interrupted to allow the skin time to heal.
- Persons who have had radiation therapy plus chemotherapy. The combined
effects of these drugs can cause an increased skin reaction.
- Persons who have had biological response modifier therapy (a treatment
to try to improve the body's natural immune response to disease).
- Persons who have had bone marrow transplantation. Patients may
experience changes in skin condition that include dryness, itching, and
rashes.
Drugs given at any time during cancer treatment may cause pruritus. Itching
may be caused by sensitivity to the drug, or the drug may interfere with normal
nerve function.
Pruritus can be a symptom of infection. The infection may or may not be
related to cancer treatment. Infections involving itching may be caused by a
tumor, fungus, discharge from a wound, or drainage after surgery.
Pruritus is a symptom, not a diagnosis or disease. If you feel itching, let
your doctor know. The doctor will ask for your medical history and give you a
thorough physical examination. This assessment will enable the doctor to
discover the problem that is causing the itching and find the best treatment
for it.
Treatment
Maintaining healthy skin may relieve pruritus. Good skin care includes
adequate nutrition and daily fluid intake, protection from the environment, and
cleansing practices that don't dry the skin.
Some specific factors that may relieve itching are the following:
-
Moisturizing creams and lotions. These water-containing products form
films over the skin surface and encourage the production of moisture
beneath the film. This prevents dryness, which can cause itching.
These products should be carefully chosen for each person's needs.
Some ingredients, such as petrolatum, lanolin, and mineral oil can
cause allergic reactions in some people.
-
Powders, bubble baths, and cornstarch. These products should be used
with caution because they can irritate the skin and cause itching.
Cornstarch is an effective treatment for itching that is associated
with dry skin due to radiation therapy but should not be applied to
moist surfaces, to areas with hair, sweat glands, skin folds, or to
areas close to mucosal surfaces, such as the vagina or rectum. When
cornstarch becomes moist, it can promote fungal growth. Some powders
such as those that contain talcum and aluminum can cause skin
irritation during radiation therapy and should be avoided when you are
receiving radiation treatment. Alcohol or menthol, which are found in
some creams and over-the-counter lotions, may also produce skin
reactions. Topical steroid creams may reduce itching but may cause
thinning of the skin and can make it more prone to injury.
-
Tepid baths. Baths that are moderately warm and last no longer than
one half hour every day or every two days can help relieve itching.
Frequent bathing can aggravate dry skin, and hot baths can promote
itching.
-
Mild soaps. Mild 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.
-
A cool humid environment. Heat can cause itching. Your skin loses
moisture when the humidity is low. A cool, humid environment may
prevent your skin from itching.
-
Removal of detergent residue. Residue left on clothing by detergent
and fabric softeners may aggravate pruritus. The irritation 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 sold for
washing baby clothes.
-
Cotton clothing and bed sheets. Body heat, wool, and some synthetic
fabrics can aggravate itching. It may be helpful to wear
loose-fitting, lightweight cotton clothing and to use cotton bed sheets.
In addition to the skin-care factors, medications applied to the skin or taken
by mouth may be necessary to treat pruritus. Antibiotics may relieve itching
caused by infection. Antihistamines may be useful in some cases of pruritus.
Sedatives, tranquilizers, and antidepressants may be useful treatments.
Aspirin seems to have reduced itching in some patients but increases it for
others. Aspirin combined with cimetidine may be effective for patients with
Hodgkin's lymphoma or polycythemia vera.
Interrupting the itch-scratch-itch cycle, an increase in itching that can
result from the process of scratching, may also help to alleviate pruritus.
The cycle may be broken by applying a cool washcloth or ice over the affected
area. Rubbing the skin and applying pressure or vibration to the skin may also
help. Other methods that may be useful in relieving symptoms include
distraction, music therapy, relaxation, and imagery techniques.