Pruritus is an itchy feeling that makes you want to scratch your skin. It may occur without a rash or skin lesions. Pruritus sometimes feels like pain because the signals for itching and pain travel along the same nerve pathways. 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.
The way pruritus feels and how long it lasts is not the same in everyone.
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.
Certain conditions, cancers, and blood disorders may cause pruritus.
Pruritus is a symptom of a certain condition, blood disorder, or a disease. These include:
The cause of pruritus is not always known.
Certain cancer treatments may cause pruritus.
Cancer treatments that may cause pruritus include chemotherapy, radiation therapy, and immunotherapy (biologic therapy).
Skin can become thin and dry because many of these therapies make your skin less able to make new cells and heal. Long-term dry skin may occur when hair and sweat gland function does not return to normal right after cancer treatment.
Drugs may be used for supportive care.
Some of the drugs used to prevent or treat cancer symptoms may cause pruritus, including the following:
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, blood tests, and a chest x-ray are done to assess pruritus.
The following tests and procedures may be done to find the problem that is causing the itching:
A history of your health habits, past illnesses, and treatments will also be taken. You may be asked about the following:
Depending on the results, further tests, such as a skin biopsy, may be done to diagnose the problem and decide on treatment.
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.
Good nutrition is very important for healthy skin. A good diet includes a balance of proteins, carbohydrates, fats, vitamins, minerals, and fluids. Eating a balanced diet and drinking plenty of fluids helps your skin stay healthy. It is best to drink at least 3 liters (about 100 ounces) of fluid each day, but this may not be possible for everyone.
Washing the skin every day or every two days is important to help remove dirt and keep the skin healthy.
Different types of treatment are used to help treat pruritus.
Self-care includes avoiding pruritus triggers and taking good care of your skin.
Pruritus triggers include:
Ways to help lessen itching include:
Some over-the-counter treatments (medicines that can be bought without a prescription) help prevent or relieve pruritus. However, you should read labels carefully to look for ingredients that may trigger skin reactions, including alcohol, topical antibiotics, and topical anesthetics.
Cornstarch and talc
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.
For itching not related to radiation therapy, talc-based treatments may be better than cornstarch-based treatments, especially where two skin surfaces touch or rub together (such as the underarm or between fingers or toes).
Creams and lotions
If pruritus is related to dry skin, emollient creams or lotions may be used. Emollients help soothe and soften the skin and increase moisture levels in the skin. It is important to know the ingredients in these creams and lotions because some may cause skin reactions. Such ingredients include:
Other ingredients added to emollients, such as thickeners, preservatives, fragrances, and colorings, may also cause allergic skin reactions.
Emollient creams or lotions are applied at least two or three times a day and after bathing. Gels with a local anesthetic (0.5%–5% lidocaine) can be used on some small areas as often as every 2 hours if you aren't sensitive to alcohol ingredients.
To soothe or cool areas of severe pruritus, over-the-counter products containing menthol, camphor, pramoxine, or capsaicin can be used. These products soothe, cool, and decrease the urge to scratch. Capsaicin-based therapies may work best in pruritus related to nerve signals.
Prescription drugs applied to the skin
Your doctor may prescribe topical steroids (steroids applied to the skin) to reduce itching, but they cause thinning of the skin and make it more sensitive. They should be used only for pruritus related to inflammation. Topical steroids should not be used on skin being treated with radiation therapy, but may be used to relieve inflamed skin after radiation treatment ends.
For xerosis (abnormally dry skin) or keratoderma (a horn-like skin condition), moisturizer creams may be used to seal in moisture and peel off scaly layers of skin. Humectants with ingredients like salicylic acid, ammonium lactate, or urea may improve skin smoothness but can cause stinging if applied to broken skin.
Systemic therapies travel through the bloodstream and reach and affect cells all over the body. They may help treat the condition causing your pruritus or help control your symptoms.
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. A larger dose may sometimes be used at bedtime to help you sleep.
Other drug therapies
If other drug treatments do not work to control pruritus, sedatives and antidepressants are sometimes used.
Aspirin may relieve pruritus in some patients with polycythemia vera but may increase pruritus in others. Cimetidine alone or combined with aspirin may help control pruritus in patients with Hodgkin lymphoma and polycythemia vera.
Other steps may be taken to help you keep from scratching and stop the itch-scratch-itch cycle. These may include:
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PDQ® Supportive and Palliative Care Editorial Board. PDQ Pruritus. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/about-cancer/treatment/side-effects/skin-nail-changes/pruritus-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389398]
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Last Revised: 2016-06-15
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