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).
Topical Skin Care
If pruritus is thought to be primarily related to dry skin, interventions to improve skin hydration can be employed. The main source of hydration for skin is moisture from the vasculature of underlying tissues. Water, not lipid, regulates the pliability of the epidermis, providing the rationale for use of emollients. Emollients reduce evaporation by forming occlusive and semiocclusive films over the skin surface, encouraging the production of moisture in the layer of epidermis beneath the film (hence, the term moisturizer).[Level of evidence: IV]
Knowledge of the ingredients of skin care products is essential, since many ingredients may enhance skin reactions. Three main ingredients of emollients are petrolatum, lanolin, and mineral oil. Both petrolatum and lanolin may cause allergic sensitization in some individuals.[Level of evidence: IV]
Petrolatum is poorly absorbed by irradiated skin and is not easily removed. A thick layer could produce an undesired bolus effect when applied within a radiation treatment field.[Level of evidence: IV] Mineral oil is used in combination with petrolatum and lanolin to create creams and lotions and may be an active ingredient in bath oils. Other ingredients added to these products, such as thickeners, opacifiers, preservatives, fragrances, and colorings, may cause allergic skin reactions.