Pruritus (PDQ®): Supportive care - Health Professional Information [NCI] - Interventions
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Management of pruritus associated with neoplastic disease is directed toward effective management of the underlying malignancy, elimination of actual or potential alterations in skin integrity, and promotion of comfort. Given the subjective nature of itching, the extent to which any therapy is effective may be modified by psychological factors. Multiple approaches and combined efforts may be needed to promote comfort and prevent alterations in the integrity of the skin.
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Treatment of pruritus can be grouped into four categories:[1,2][Level of evidence: IV]
Patient education and minimizing or eliminating provocative factors.
Application of topical preparations.
Physical treatment modalities.
Patient Education and Elimination of Provocative Factors
Patients and caregivers must be included in planning care and providing care to the extent possible. Education is an important aspect of symptom control. Skin care regimens incorporate protection from the environment, good cleansing practices, and internal and external hydration.[Level of evidence: IV] The intensity of the regimen and the techniques employed will vary according to etiologic factors and the degree of distress associated with the pruritus.
Affected individuals (either patients or caregivers) should have a good understanding of factors that promote or aggravate itching. Knowledge of factors that alleviate symptoms provides rationale for the development and implementation of effective and reasonable self-care interventions.
Adequate nutrition is essential to the maintenance of healthy skin. An optimal diet should include a balance of proteins, carbohydrates, fats, vitamins, minerals, and fluids. Daily fluid intake of at least 3,000 cc is suggested as a guideline but may not be possible for some individuals.[4,5]
Aggravating factors should be avoided, including the following:
Fluid loss secondary to fever, diarrhea, nausea and vomiting, or decreased fluid intake.
Use of ointments (e.g., petroleum, mineral oil).
Bathing with hot water.
Use of soaps that contain detergents.
Frequent bathing or bathing for longer than ½ hour.
Adding oil early to a bath.
Genital deodorants or bubble baths.
Sheets and clothing laundered with detergent.
Tight restrictive clothing or clothing made of wool, synthetics, or other harsh fabric.
Use of opium alkaloids, morphine, and antibiotics.
Underarm deodorants or antiperspirants.
Alleviating factors should be promoted, as follows:
Basic skin care.
Application of emollient creams or lotions.
Use of mild soaps or soaps made for sensitive skin.
Limiting bathing to ½ hour daily or every other day.
Adding oil at the end of a bath or adding a colloidal oatmeal treatment early to the bath.
Use of cornstarch to areas of irradiated skin following bathing.
Maintenance of a humid environment (e.g., humidifier).
Use of cotton flannel blankets if needed.
Washing of sheets, clothing, and undergarments in mild soaps for infant clothing (e.g., Dreft).
Wearing of loose-fitting clothing and clothing made of cotton or other soft fabrics.
Use of distraction, relaxation, positive imagery, or cutaneous stimulation.
Use of antibiotics if pruritus is secondary to infection.
Use of oral antihistamines, with increased doses at bedtime.
Use of topical mild corticosteroids (except for pruritus secondary to radiation therapy).