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Pruritus (itching)
INTRODUCTION
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.
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 an 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 may
not occur 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 disease
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. 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 disease 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. |
