Itching and cancer

What is an itch?

An itch or itching is a sensation on the skin that can be uncomfortable and irritating. This sensation causes the urge to scratch. The medical name for itching is pruritus.

Diagnosing the cause of your itch

There are a number of reasons why you may itch. It could be a side effect of a new drug or because you 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, liver and thyroid 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.

Some of the main causes of itching include:

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 yellow discolouration of the body tissues. It happens when there is a build up of a substance called bilirubin in the bloodstream and body tissues. The build up happens when a blockage is somewhere in the bile system. Bile contains yellow pigments that make your skin and the whites of your eyes appear 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 gallbladder disease, including bile duct cancer

• cancer of the head of the pancreas - the tumour can block the bile duct

Allergy

Itching can be a sign of an allergy. Talk to your doctor or nurse if you feel itchy after starting a new treatment. It may be that you 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 even, though rare, the third dose.

Infections

Some infections can make you itchy. These include 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. This includes cancers such as:

• lymphoma (particularly Hodgkin lymphoma)

• myeloma

• leukaemia

• neuroendocrine (carcinoid) tumour involving the stomach

We don’t fully understand why some cancers cause itching. Doctors think it may be due to substances released by the cancer or by the body reacting to the cancer. 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 immunotherapy, hormone or targeted therapy, can cause an itchy skin rash. This doesn’t necessarily mean that you are allergic to the treatment.

Treating the cause of the 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 cancer can be relieved by treating the cancer

• itching from infection will be helped by treating the infection, this might be with antibiotics, antiviral 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.

Moisturisers

Moisturisers that contain emollients help soften, soothe and make the skin smooth.

There are many different types of moisturisers available, and they come in different forms. The one you use depends on what suits your skin.

Moisturisers also protect your skin from the environment and can help to reduce inflammation.

You use emollients at least once a day. You might need it more than once a day depending on how dry your skin is. You can also use most emollients as a soap to wash with, as most soaps dry your skin. Ask your pharmacist more about this.

Some moisturisers have a cooling effect as they contain menthol. Cooling the skin can help relieve and soothe itching.

You can get moisturisers without a prescription, but for some people they might need something stronger. Your healthcare team can assess your skin and prescribe the right treatment for you.

Antihistamines

Our immune system produces histamine to protect us from illness. Sometimes the body produces too much histamine, causing itching, redness and swelling. Antihistamines block the action of histamine in the body. They can help to reduce itching to give you some relief, but don't work for everyone. For example, they might not work so well for itching caused by lymphoma or due to jaundice caused by a blocked bile duct.

You can get most antihistamines over the counter at the pharmacy, but some may need a prescription. There are many different types and they come in different forms. Some antihistamines can make you feel sleepy. It’s important not to drive or operate machinery when taking this type of antihistamine.

Colestyramine

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

Anti-depressants medicines

Some types of anti-depressant 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. Anti-depressants used for itching include amitriptyline, mirtazapine and paroxetine.

Steroids

Steroids can help. They come as:

• creams you put on your skin in the affected area

• tablets or a liquid you take by mouth

• drops you put in your eyes (eye drops)

• an injection into your bloodstream (intravenous)

You can buy low dose steroid cream over the counter from the pharmacy. But your doctor needs to prescribe higher doses of steroids. You can only have intravenous steroids by a trained health professional.

You usually only have steroids for a short time because they can cause side effects if you take them for too long.

Read about the side effects of steroids

Complementary therapies

Some people find that complementary therapies can help to distract them from the itching. It includes therapies such as:

• music therapy

• gentle massage

• relaxation exercises

• guided visualisation

Read more about complementary therapies

Tips to cope with itching

Washing and drying

• Limit the number of baths you take, use lukewarm water.

• Avoid soaking in the bath for long periods as warm water may remove the skin’s natural oils.

• Instead of soap, use a moisturising liquid (emollient), such as Oilatum or Diprobase.

• Pat your skin dry with a towel rather than rubbing.

• Dry the skin thoroughly after bathing. This reduces the chance of chaffing and fungal infection.

Creams, lotions and moisturisers

• Avoid perfumed, scented and lanolin based lotions and moisturisers as these can cause allergies in the skin and more itching.

• Use odourless and colourless moisturiser, such as epaderm and hydromol. Apply the moisturiser regularly.

• Moisturise your skin straight after you bath. Apply the moisturiser in the same direction as your hair grows. Do not rub them into the skin as this can make itching worse.

• Keep your moisturiser in the fridge. Moisturiser cooled in a refrigerator can soothe the skin.

• Some moisturisers come in a tub. To help keep out bacteria, do not put your hands in. Instead use a clean spoon to take the amount of moisturiser you need out.

What to wear

• Wear cotton, linen or silk, rather than wool or man-made materials, which can irritate the skin.

• Keep your bed clothes light.

• Wear cotton gloves at night to avoid scratching in your sleep.

Other tips

• Use an electric razor rather than wet shaving.

• Drink plenty, preferably water (2 to 3 litres a day).

• Keep your nails short to reduce the risk of scratching your skin.

• Avoid highly perfumed washing products.

• Try to keep an even, cool temperature in your room, as getting hot can make itching worse.

• Try to distract yourself by watching a film or reading a book.

• If you’re hot and itchy during the day, use a fan to cool you down.

• Practise mindfulness. It can help to break the cycle of itch and scratching.

What to do instead of scratching

• gently pinch an area of skin close to the itch

• pat, tap or press the area gently

• put a cool pack on the skin

• gently apply more moisturiser

When to contact your healthcare team

Contact your healthcare team 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