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.
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:
- Dehydration caused by fever, diarrhea, nausea and vomiting, or low fluid intake.
- Hot baths or bathing more than once a day, or for longer than 30 minutes.
- Bubble baths or soaps with detergents.
- Reusable scrubbing sponges for the face or loofahs for the body.
- Scents, fragrances, and perfumes.
- Adding oil at the beginning of the bath.
- Dry indoor air.
- Laundry detergent with scents, dyes, or preservatives.
- Fabric softener sheets.
- Tight clothes or clothes made of wool, synthetics, or other harsh/scratchy fabric.
- Underarm deodorants or antiperspirants.
- Skin care or cosmetics with scents, dyes, or preservatives.
- Emotional stress.
Ways to help lessen itching include:
- Using unscented, soothing creams or ointments.
- Bathing in slightly warm water no more than 30 minutes daily or every other day.
- Using mild skin cleansers (non-soap) or soaps made for sensitive skin (such as Cetaphil cleanser, Dove for Sensitive Skin, Oilatum, Basis).
- Adding oil and soap at the end of a bath or adding a colloidal oatmeal treatment early to the bath.
- Using soap only for dirty areas; otherwise water is good enough.
- Gently washing, if needed, with a clean, fresh, soft cotton washcloth.
- Rinsing all soap or other residue from bathing with fresh, slightly warm water.
- Drying off by patting skin instead of rubbing.
- Keeping home air cool and humid (including use of a humidifier).
- Washing sheets, clothes, and underwear in mild soap or baby soap that contains no scents, dyes, or preservatives (such as Dreft, All Free Clear, Tide Free and Gentle). Adding vinegar (one teaspoon per quart of water) to rinse water removes traces of detergent.
- Using liquid fabric softener that gets rinsed out in the wash (such as All Free Clear Fabric Softener) or avoiding fabric softener altogether.
- Using blankets that are soft, such as cotton flannel.
- Wearing loose-fitting clothes and clothes made of cotton or other soft fabrics.
- Using distraction, music therapy, relaxation, or positive imagery.
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:
- Petrolatum, which is not well absorbed in skin treated with radiation therapy and may build up too much or be hard to remove.
- Lanolin, which may cause allergic reactions in some people.
- Mineral oil, which may be combined with petrolatum and lanolin in creams and lotions and may be an ingredient in bath oils.
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:
- Applying emollients to help prevent skin breakdown.
- A cool washcloth or ice held over the itchy area.
- Firm pressure on the itchy area, on the same area on the opposite side of the body, and at acupressure points.
- Rubbing or vibration on the itchy area.
- Transcutaneous electrical nerve stimulation (TENS) or acupuncture.