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Pruritus (PDQ�)

Introduction

This patient summary on pruritus is adapted from a summary written for health professionals by cancer experts. This and other credible information about cancer treatment, screening, prevention, supportive care, and ongoing clinical trials is available from the National Cancer Institute. Pruritus (itching) is a side effect of some cancer therapies and may be a symptom of some types of cancers. This brief summary describes pruritus, its causes and treatment.

This summary is about pruritus in adults with cancer.

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 sarcoma, Hodgkin 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. Topicalsteroid 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 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.

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Changes to This Summary (08/03/2011)

The PDQcancer 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.

Editorial changes were made to this summary.

Questions or Comments About This Summary

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About PDQ

PDQ is a comprehensive cancer database available on NCI's Web site.

PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

PDQ contains cancer information summaries.

The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.

Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.

PDQ also contains information on clinical trials.

A clinical trial is a study to answer a scientific question, such as whether one method of treating symptoms is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. Some patients have symptoms caused by cancer treatment or by the cancer itself. During supportive care clinical trials, information is collected about how well new ways to treat symptoms of cancer work. The trials also study side effects of treatment and problems that come up during or after treatment. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients who have symptoms related to cancer treatment may want to think about taking part in a clinical trial.

Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237).