is a rare but distressing symptom. Intense itch is a form of
Itching is made worse by anxiety or boredom.
Eczema or skin allergies can still occur in terminally ill
patients, and respond to topical steroids. There is usually a
Candidiasis causes soreness as well as itch. Damp
macerated skin (in groin, gluteal cleft, under breasts) can
become infected with candida because maceration (excessive
water in the keratin layer of the skin) breaks the protective
barrier of keratin and allows infection to enter. Treat with
an antifungal lotion, miconazole nitrate 2%, to allow
evaporation and drying of the skin.
reactions are usually obvious, with rash or urticaria.
Some drugs (chlorpromazine, for example) cause cholestasis.
Epidural morphine can cause itching which can respond to
Cholestasis causes itching due to bile-salt retention in
the skin. In the early stages jaundice may not be obvious.
Management options include:
Cholestyramine 4g every 6 to 8 hours
hydroxide 1.5ml every 6 hours
stent (see Jaundice)
Radiotherapy to nodes at the porta hepatis
steroids to relieve biliary pressure
Cholestyramine binds to bile-salts and reduces absorption. It
is unpleasant to take. Aluminum hydroxide also reduces bile-salt absorption but is less effective. Antihistamines will
reduce bile-salt itching in some patients. The non-specific
measures discussed below can also help.
Malignant skin infiltration around a breast cancer
sometimes causes pricking pain and itch which can respond to
an anti-prostaglandin such as naproxen 250mg to 500mg 2 times
6. Non-specific itch may be reduced by one or more of the
Overheating increases itching. Avoid hot baths and use
cotton clothes to reduce sweating.
can contribute to all forms of itching. Skin hydration often
reduces itch. In normal skin a layer of grease (from the
sebaceous glands) keeps the keratin layer hydrated and firm.
With dry skin, keratin flakes off and exposes deeper layers
causing inflammation and itch. Generous use of aqueous cream
as a soap substitute and bland bath oils can restore skin
lotion is soothing. It cools by evaporation and leaves a
fine coating of powder.
crotamiton cream has an anti-pruritic action, but avoid
Antihistamines can reduce all forms of itch. They are
successful for some patients but not for others. Terfenadine
60mg 2 times a day is useful because it is not sedating. A
sedative antihistamine (oral promethazine 75mg, for example)
can be useful at bedtime.
Methyltestosterone 25mg 3 times a day occasionally reduces
severe itching, despite its known tendency to cause
cholestasis. The mode of action is unknown. It takes 7 to 10
days for maximum effect. It is contraindicated in cancers of
the prostate or male breasts.
steroid cream may be necessary if there is secondary
inflammation from scratching.
exchange has been used as a last resort to relieve intense
The author and publisher have taken
precautions to ensure that the information in this book is
error-free. However, readers must be guided by their own
personal and professional standards of good practice in
evaluating and applying recommendations made herein. The
contents of this book represent the views and experience of
the author, and not necessarily those of the publisher.