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Pruritus (PDQ®): Supportive care - Patient Information [NCI]

Pruritus (PDQ®): Supportive care - Patient Information [NCI]

This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http://cancer.gov or call 1-800-4-CANCER.

Pruritus

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.
  • Leukemias.
  • Adenocarcinomas.
  • 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:

Chemotherapy

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:

  • Doxorubicin.
  • Daunorubicin.
  • Cytarabine.
  • L-asparaginase.
  • Paclitaxel.
  • Cisplatin.

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 therapy

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.

Biologic therapy

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.
  • Corticosteroids.
  • Antibiotics.
  • Drugs for nausea and vomiting.
  • Hormones.

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

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.

Drugs

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.

About This PDQ Summary

About PDQ

Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. 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 come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.

PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government's center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.

Purpose of This Summary

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.

Reviewers and Updates

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.

The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Supportive and Palliative Care Editorial Board.

Clinical Trial Information

A clinical trial is a study to answer a scientific question, such as whether one treatment 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. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Clinical trials are listed in PDQ and can be found online at NCI's Web site. 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).

Permission to Use This Summary

PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as "NCI's PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary]."

The best way to cite this PDQ summary is:

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>.

Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online. Visuals Online is a collection of more than 2,000 scientific images.

Disclaimer

The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the Coping with Cancer: Financial, Insurance, and Legal Information page.

Contact Us

More information about contacting us or receiving help with the Cancer.gov Web site can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the Web site's Contact Form.

Questions or Comments About This Summary

If you have questions or comments about this summary, please send them to Cancer.gov through the Web site's Contact Form. We can respond only to email messages written in English.

Get More Information From NCI

Call 1-800-4-CANCER

For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 8:00 a.m. to 8:00 p.m., Eastern Time. A trained Cancer Information Specialist is available to answer your questions.

Chat online

The NCI's LiveHelp® online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 8:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.

Write to us

For more information from the NCI, please write to this address:

NCI Public Inquiries Office
9609 Medical Center Dr.
Room 2E532 MSC 9760
Bethesda, MD 20892-9760

Search the NCI Web site

The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. For a quick search, use the search box in the upper right corner of each Web page. The results for a wide range of search terms will include a list of "Best Bets," editorially chosen Web pages that are most closely related to the search term entered.

There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.

Find Publications

The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237).

Last Revised: 2014-02-05


If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.


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