Introduction
Overview
Risk Factors
Treatment
Get More Information From NCI
Changes to This Summary (07/16/2007)
Questions or Comments About This Summary
About PDQ

Introduction

This patient summary on pruritus is adapted from a summary written for health professionals by cancer experts. This and other credible information about cancer treatment, screening, prevention, supportive care, and ongoing clinical trials is available from the National Cancer Institute. Pruritus (itching) is a side effect of some cancer therapies and may be a symptom of some types of cancers. This brief summary describes pruritus, its causes and treatment.

Overview

Pruritus is an itching sensation that triggers the desire to scratch. It is a distressing symptom that can cause discomfort. Scratching may cause breaks in the skin that may result in infection. Pruritus can be related to anything from dry skin to undiagnosed cancer. It can occur in people who have cancer or in those who have received cancer treatment.

Risk Factors

Pruritus may occur in some people with cancer but not in others. However, the following persons with cancer may be at a higher risk for developing pruritus:

• Persons with various malignant diseases that are known to produce symptoms of pruritus, including, but not limited to AIDS -related Kaposi sarcoma, Hodgkin lymphoma and other lymphomas, leukemias, adenocarcinomas, and cancer of the stomach, pancreas, lung, colon, brain, breast, and prostate. Pruritus tends to disappear when cancer is cured or in remission. It may reappear when the disease recurs.



• Persons who have had chemotherapy . Usually the itching subsides within 30-90 minutes and does not require treatment. The development of pruritus may be a sign that the patient is especially sensitive to the chemotherapy drug.



• Persons who have had radiation therapy . Radiation can kill skin cells and cause burning and itching. As the skin peels off, scratching can damage it further, which creates the potential for infection. Treatment may need to be interrupted to allow the skin time to heal.



• Persons who have had radiation therapy plus chemotherapy. The combined effects of these drugs can cause an increased skin reaction.



• Persons who have had biological response modifier therapy (a treatment to try to improve the body's natural immune response to disease).



• Persons who have had bone marrow transplantation . Patients may experience changes in skin condition that include dryness, itching, and rashes.

Drugs given at any time during cancer treatment may cause pruritus. Itching may be caused by sensitivity to the drug, or the drug may interfere with normal nerve function.

Pruritus can be a symptom of infection. The infection may or may not be related to cancer treatment. Infections involving itching may be caused by a tumor, fungus, discharge from a wound, or drainage after surgery.

Pruritus is a symptom, not a diagnosis or disease. If you feel itching, let your doctor know. The doctor will ask for your medical history and give you a thorough physical examination. This assessment will enable the doctor to discover the problem that is causing the itching and find the best treatment for it.

Treatment

Maintaining healthy skin may relieve pruritus. Good skin care includes adequate nutrition and daily fluid intake, protection from the environment, and cleansing practices that don't dry the skin.

Some specific factors that may relieve itching are the following:

• Moisturizing creams and lotions. These water-containing products form films over the skin surface and encourage the production of moisture beneath the film. This prevents dryness, which can cause itching. These products should be carefully chosen for each person's needs. Some ingredients, such as petrolatum, lanolin, and mineral oil can cause allergic reactions in some people.



• Powders, bubble baths, and cornstarch. These products should be used with caution because they can irritate the skin and cause itching. Cornstarch is an effective treatment for itching that is associated with dry skin due to radiation therapy but should not be applied to moist surfaces, to areas with hair, sweat glands, skin folds, or to areas close to mucosal surfaces, such as the vagina or rectum. When cornstarch becomes moist, it can promote fungal growth. Some powders such as those that contain talcum and aluminum can cause skin irritation during radiation therapy and should be avoided when you are receiving radiation treatment. Alcohol or menthol, which are found in some creams and over-the-counter lotions, may also produce skin reactions. Topical steroid creams may reduce itching but may cause thinning of the skin and can make it more prone to injury.



• Tepid baths. Baths that are moderately warm and last no longer than one half hour every day or every two days can help relieve itching. Frequent bathing can aggravate dry skin, and hot baths can promote itching.



• Mild soaps. Mild 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.



• A cool humid environment. Heat can cause itching. Your skin loses moisture when the humidity is low. A cool, humid environment may prevent your skin from itching.



• Removal of detergent residue. Residue left on clothing by detergent and fabric softeners may aggravate pruritus. The irritation 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 sold for washing baby clothes.



• Cotton clothing and bed sheets. Body heat, wool, and some synthetic fabrics can aggravate itching. It may be helpful to wear loose-fitting, lightweight cotton clothing and to use cotton bed sheets.

In addition to the skin-care factors, medications applied to the skin or taken by mouth may be necessary to treat pruritus. Antibiotics may relieve itching caused by infection. Antihistamines may be useful in some cases of pruritus. Sedatives, tranquilizers, and antidepressants may be useful treatments. Aspirin seems to have reduced itching in some patients but increases it for others. Aspirin combined with cimetidine may be effective for patients with Hodgkin lymphoma or polycythemia vera.

Interrupting the itch-scratch-itch cycle, an increase in itching that can result from the process of scratching, may also help to alleviate pruritus. The cycle may be broken by applying a cool washcloth or ice over the affected area. Rubbing the skin and applying pressure or vibration to the skin may also help. Other methods that may be useful in relieving symptoms include distraction, music therapy, relaxation, and imagery techniques.

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 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.

Chat online

The NCI's LiveHelp® ¹ online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 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

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Search the NCI Web site

The NCI Web site ² 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 our “Best Bets” search box in the upper right hand corner of each Web page. The results that are most closely related to your search term will be listed as Best Bets at the top of the list of search results.

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 ³. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

Changes to This Summary (07/16/2007)

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.

Editorial changes were made to this summary.

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 ⁴. We can respond only to email messages written in English.

About PDQ

PDQ is a comprehensive cancer database available on NCI's Web site.

PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site ². PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

PDQ contains cancer information summaries.

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 are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.

Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.

PDQ also contains information on clinical trials.

A clinical trial is a study to answer a scientific question, such as whether one method of treating symptoms 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. Some patients have symptoms caused by cancer treatment or by the cancer itself. During supportive care clinical trials, information is collected about how well new ways to treat symptoms of cancer work. The trials also study side effects of treatment and problems that come up during or after treatment. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients who have symptoms related to cancer treatment may want to think about taking part in a clinical trial.

Listings of clinical trials are included in PDQ and are available online at NCI's Web site ⁵. Descriptions of the trials are available in health professional and patient versions. 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); TTY at 1-800-332-8615.

Glossary Terms

Cancer that begins in cells that line certain internal organs and that have gland-like (secretory) properties.

Acquired immunodeficiency syndrome. A disease caused by the human immunodeficiency virus (HIV). People with AIDS are at an increased risk for developing certain cancers and for infections that usually occur only in individuals with a weak immune system. Also called acquired immunodeficiency syndrome.

A hypersensitive immune reaction to a substance that normally is harmless or would not cause an immune response in most people. An allergic response may cause harmful symptoms such as itching or inflammation or tissue injury.

A drug used to treat infections caused by bacteria and other microorganisms.

A drug used to treat depression.

A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention.

In healthcare, a process used to learn about a patient’s condition. This may include a complete medical history, medical tests, a physical exam, a test of learning skills, tests to find out if the patient is able to carry out the tasks of daily living, a mental health evaluation, and a review of social support and community resources available to the patient.

BRM therapy. Treatment to boost or restore the ability of the immune system to fight cancer, infections, and other diseases. Also used to lessen certain side effects that may be caused by some cancer treatments. Agents used in biological response modifier therapy include monoclonal antibodies, growth factors, and vaccines. These agents may also have a direct antitumor effect. Also called immunotherapy, biological therapy, biotherapy, and BRM therapy.

A procedure to replace bone marrow that has been destroyed by treatment with high doses of anticancer drugs or radiation. Transplantation may be autologous (an individual's own marrow saved before treatment), allogeneic (marrow donated by someone else), or syngeneic (marrow donated by an identical twin).

Glandular organ located on the chest. The breast is made up of connective tissue, fat, and breast tissue that contains the glands that can make milk. Also called mammary gland.

A term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord.

The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.

Treatment with drugs that kill cancer cells.

A drug usually used to treat stomach ulcers and heartburn. It is also commonly used in a regimen to prevent allergic reactions.

A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called a clinical study.

The longest part of the large intestine, which is a tube-like organ connected to the small intestine at one end and the anus at the other. The colon removes water and some nutrients and electrolytes from partially digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus.

To heal or restore health; a treatment to restore health.

The process of identifying a disease, such as cancer, from its signs and symptoms.

In medicine, a fluid that comes out of the body. Discharge can be normal or a sign of disease. Discharge also means release of a patient from care.

In medicine, a pain relief method that takes the patient's attention away from the pain.

In medicine, to remove fluid as it collects; or, a tube or wick-like device used to remove fluid from a body cavity, wound, or infected area.

Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.

Liquid.

A plant-like organism that does not make chlorophyll. Mushrooms, yeasts, and molds are examples. The plural is fungi.

An organ that makes one or more substances, such as hormones, digestive juices, sweat, tears, saliva, or milk. Endocrine glands release the substances directly into the bloodstream. Exocrine glands release the substances into a duct or opening to the inside or outside of the body.

A cancer of the immune system that is marked by the presence of a type of cell called the Reed-Sternberg cell. The two major types of Hodgkin lymphoma are classical Hodgkin lymphoma and nodular lymphocyte-predominant Hodgkin lymphoma. Symptoms include the painless enlargement of lymph nodes, spleen, or other immune tissue. Other symptoms include fever, weight loss, fatigue, or night sweats. Also called Hodgkin disease.

A technique in which the person focuses on positive images in his or her mind.

The activity of the immune system against foreign substances (antigens).

Invasion and multiplication of germs in the body. Infections can occur in any part of the body and can spread throughout the body. The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on where the infection occurs. When the body’s natural defense system is strong, it can often fight the germs and prevent infection. Some cancer treatments can weaken the natural defense system.

A type of cancer characterized by the abnormal growth of blood vessels that develop into skin lesions or occur internally.

Cancer that starts in blood-forming tissue such as the bone marrow and causes large numbers of blood cells to be produced and enter the bloodstream.

One of a pair of organs in the chest that supplies the body with oxygen, and removes carbon dioxide from the body.

Cancer that begins in cells of the immune system. There are two basic categories of lymphomas. One kind is Hodgkin lymphoma, which is marked by the presence of a type of cell called the Reed-Sternberg cell. The other category is non-Hodgkin lymphomas, which includes a large, diverse group of cancers of immune system cells. Non-Hodgkin lymphomas can be further divided into cancers that have an indolent (slow-growing) course and those that have an aggressive (fast-growing) course. These subtypes behave and respond to treatment differently. Both Hodgkin and non-Hodgkin lymphomas can occur in children and adults, and prognosis and treatment depend on the stage and the type of cancer.

Cancerous. Malignant tumors can invade and destroy nearby tissue and spread to other parts of the body.

The moist, inner lining of some organs and body cavities (such as the nose, mouth, lungs, and stomach). Glands in the mucosa make mucus (a thick, slippery fluid). Also called mucous membrane.

The National Cancer Institute, part of the National Institutes of Health of the United States Department of Health and Human Services, is the Federal Government's principal agency for cancer research. The National Cancer Institute conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the National Cancer Institute Web site at http://www.cancer.gov. Also called NCI.

A bundle of fibers that receives and sends messages between the body and the brain. The messages are sent by chemical and electrical changes in the cells that make up the nerves.

The taking in and use of food and other nourishing material by the body. Nutrition is a 3-part process. First, food or drink is consumed. Second, the body breaks down the food or drink into nutrients. Third, the nutrients travel through the bloodstream to different parts of the body where they are used as "fuel" and for many other purposes. To give the body proper nutrition, a person has to eat and drink enough of the foods that contain key nutrients.

A medicine that can be bought without a prescription (doctor's order). Examples include analgesics (pain relievers) such as aspirin and acetaminophen. Also called nonprescription and OTC.

A glandular organ located in the abdomen. It makes pancreatic juices, which contain enzymes that aid in digestion, and it produces several hormones, including insulin. The pancreas is surrounded by the stomach, intestines, and other organs.

PDQ is an online database developed and maintained by the National Cancer Institute. Designed to make the most current, credible, and accurate cancer information available to health professionals and the public, PDQ contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, complementary and alternative medicine, and supportive care; a registry of cancer clinical trials from around the world; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care. Most of this information, and more specific information about PDQ, can be found on the NCI's Web site at http://www.cancer.gov/cancertopics/pdq. Also called Physician Data Query.

An exam of the body to check for general signs of disease.

A disease in which there are too many red blood cells in the bone marrow and blood, causing the blood to thicken. The number of white blood cells and platelets may also increase. The extra blood cells may collect in the spleen and cause it to become enlarged. They may also cause bleeding problems and make clots form in blood vessels.

In medicine, action taken to decrease the chance of getting a disease or condition. For example, cancer prevention includes avoiding risk factors (such as smoking, obesity, lack of exercise, and radiation exposure) and increasing protective factors (such as getting regular physical activity, staying at a healthy weight, and having a healthy diet).

A gland in the male reproductive system. The prostate surrounds the part of the urethra (the tube that empties the bladder) just below the bladder, and produces a fluid that forms part of the semen.

Itching. Severe itching may be a side effect of some cancer treatments and a symptom of some types of cancers.

The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called radiotherapy and irradiation.

The last several inches of the large intestine closest to the anus.

To come back or to return.

A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although cancer still may be in the body.

Checking for disease when there are no symptoms. Since screening may find diseases at an early stage, there may be a better chance of curing the disease. Examples of cancer screening tests are the mammogram (breast), colonoscopy (colon), Pap smear (cervix), and PSA blood level and digital rectal exam (prostate). Screening can also include checking for a person’s risk of developing an inherited disease by doing a genetic test.

A problem that occurs when treatment affects healthy tissues or organs. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.

An organ that is part of the digestive system. The stomach helps digest food by mixing it with digestive juices and churning it into a thin liquid.

Care given to improve the quality of life of patients who have a serious or life-threatening disease. The goal of supportive care is to prevent or treat as early as possible the symptoms of a disease, side effects caused by treatment of a disease, and psychological, social, and spiritual problems related to a disease or its treatment. Also called palliative care, comfort care, and symptom management.

A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.

An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.

Treatment.

On the surface of the body.

An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancerous), or malignant (cancerous). Also called neoplasm.

The muscular canal extending from the uterus to the exterior of the body. Also called birth canal.

A break in the skin or other body tissues caused by injury or surgical incision (cut).