Dealing with itching

Doctors often call itching by its Latin name ‘pruritus’. For some people it is just uncomfortable and irritating. For other people, itching can be unbearable and constant. Uncontrolled itching can cause restlessness, sleeplessness, feeling low and sometimes depression. Scratching can also cause skin soreness and infection.

The main causes of itching when someone has cancer are

• Dry skin
• Jaundice
• Allergy
• Infections
• The cancer itself
• Cancer treatments

Dry skin

Your skin may be dry for several reasons when you have cancer. It could be due to

• Dehydration
• Your treatment
• Your age
• Hormone changes - if you have gone through the menopause your skin may be dry
• The time of year - in the winter your skin is more likely to be dry from cold air outdoors and central heating in buildings.

Jaundice

Jaundice is a build up of bile in the blood stream and body tissues. The build up happens when there is a blockage somewhere in the bile system. Bile contains yellow pigments that make your skin and the whites of your eyes go yellow. It also makes you itch.

A number of things may cause jaundice, including

• Drugs that affect the liver or bile system, including some herbal remedies
• Inflammation of the liver (hepatitis)
• Breakdown of red blood cells
• Liver disease, including cancer
• Gallstones
• Other gall bladder disease, including cancer
• Cancer of the head of the pancreas - the tumour can block the bile duct

Allergy

Itching can be a sign of an allergy. If you start to feel itchy after starting a new treatment, talk to your doctor or nurse. You may need to change treatments. An allergic reaction doesn’t always happen the first time you have a treatment. It can happen with the second or, more rarely, the third.

Infections

Some infections can make you itchy - for example, fungal infections. If you have low immunity, you are more likely to develop fungal infections, such as thrush. If you have an infection, you will need to have treatment for the type of infection you have. You may have antibiotics for bacterial infections, antiviral medicines for viral infections or antifungal medicines for fungal infections.

The cancer itself

Some cancers cause itching. We don’t fully understand why. Doctors think it may be due to substances released by the tumour or by the body reacting to the tumour.

Between 10 and 25 out of 100 people with Hodgkin’s lymphoma (10% to 25%) have itching of the whole body. Non Hodgkin’s lymphomas and leukaemias can cause less severe itching. Itching may also be caused by

• Stomach cancer
• Pancreatic cancer
• Lung cancer
• Bowel cancer
• Brain tumours
• Breast cancer
• Prostate cancer
• Carcinoid tumours

The itching tends to be all over the body but worse on the legs and chest. It usually goes when you have treatment for the cancer.

Cancer treatments

Some cancer treatments cause itching. This may be itching over the whole body (generalised itching) or just in one part of the body. You may also have a rash. Some treatments, such as hormone or biological therapies, can cause an itchy skin rash. This doesn’t necessarily mean that you are allergic to the treatment. Researchers have found that for some types of treatment (for example erlotinib) itching can be a sign that your treatment is working.

To find out about whether itching is a side effect of your treatment, look in our individual cancer drugs section.

For most people with cancer who have itchy skin, the cause may be obvious. If your doctors don’t know the cause, they will try to find out why you itch. It could be because you started taking a new drug or are using something new, such as bubble bath or washing powder. You may need to stop taking the new drug or stop using the new product to see if the itching stops.

You may need to have blood tests to check that your kidneys and liver are working normally. You may also have a test to check the number of different types of cells in your blood. Checking your levels of white blood cells called eosinophils can show whether an allergy is causing the itch.

There are various treatments to help relieve itching. The treatments can either

• Treat the cause of the itching
• Soothe the itching

Treating the cause of itching

If you know what is causing your itching, the best treatment is one that gets rid of the cause. For example

• Itching from jaundice caused by a blocked bile duct can be helped by unblocking the bile duct
• Itching from substances released by tumours can be relieved with treatment to shrink the tumour
• Itching from infection will be helped by treating the infection (antibiotics, antiviral drugs or antifungal drugs)

Treatment to soothe itching

There are some treatments that can help to soothe and relieve itching. Your doctor may need to try a few until you find one that works.

Antihistamines block the action of histamine in the body. Our immune system produces histamine to protect us from illness. Sometimes the body produces too much histamine, causing itching, redness and swelling. Antihistamines can help to reduce itching, but they don’t work for everyone. Your doctor can prescribe antihistamines. There are many different types and they may give you some relief. They tend not to work so well for itching caused by lymphoma or due to jaundice caused by a blocked bile duct.

If you have jaundice, a drug called cholestyramine can reduce itching. This drug binds with bile salts in the body tissues to reduce itching.

Some types of antidepressant medicines can help to reduce itching. They act like an antihistamine and also help you relax. They can work well for itching due to nerve irritation, such as peripheral neuropathy. Antidepressants used for itching include amitriptyline, imipramine and paroxetine.

Steroids can help. They come either as creams you put on to your skin or as tablets. You can buy low dose steroid cream over the counter from the chemist. But your doctor needs to prescribe the higher dose creams and the tablets. You usually only have steroids for a short time because they can cause side effects if you take them for too long. You can find out more about steroids and their side effects in the individual cancer drug section.

Lotions, creams and ointments called emollients reduce itching by helping to 'oil' the skin to keep it supple and moist. Some bath and shower products contain emollients. You can bathe or wash your hair in them to soothe your whole body. Your doctor, nurse or pharmacist can tell you more about them.

Some people find that complementary therapies such as music therapy, gentle foot massage, relaxation exercises or guided visualisation help to distract them from the itching.

• Limit the number of baths you take - use lukewarm water and very little or no soap
• Instead of soap, you can use a moisturising liquid (emollient), such as aqueous cream, Oilatum or Diprobase, prescribed by your doctor or nurse
• Pat your skin dry with a towel rather than rubbing
• Drying the skin thoroughly reduces the chance of chaffing and fungal infection
• Moisturise your skin straight after you bathe - apply the moisturiser in the same direction as your hair grows
• Avoid scented or lanolin based lotions
• Use odourless and colourless moisturiser such as epaderm and hydromol, which you can get from the chemist and apply it 4 times a day
• Wear cotton and linen, rather than wool or man made materials which can irritate the skin
• Keep your bedclothes light
• Try to keep an even, cool temperature in your room, as getting hot can make itching worse
• Use an electric razor rather than wet shaving
• Drink plenty of fluids - preferably water (2 to 3 litres a day)
• Keep your nails short to reduce the risk of scratching your skin

Instead of scratching

• It can sometimes help to gently pinch an area of skin close to the itch
• Rub, tap or press the area
• Put a cool pack on the skin
• Gently apply more moisturiser

Contact your doctor or nurse if you

• Notice the itching gets worse
• See the itchy area getting more red and sore
• See any pus coming from the skin or it smells
• Are unable to sleep because of the itching