Sedative or tranquilizing agents may be indicated, especially if relief is not provided by other agents. Antidepressants can have strong antihistamine and antipruritic effects.[Level of evidence: IV] Diazepam may be useful in some situations to alleviate anxiety and promote rest.
Sequestrant agents may be effective in relieving pruritus associated with renal or hepatic disease through binding and removing pruritogenic substances in the gut and reducing bile salt concentration. Cholestyramine is not always effective and produces gastric side effects.
Aspirin seems to have reduced pruritus in some individuals while increasing pruritus in others. Thrombocytopenic cancer patients should be cautioned against using aspirin. Cimetidine alone or in combination with aspirin has been used with some effectiveness for pruritus associated with Hodgkin lymphoma and polycythemia vera.[Level of evidence: III]
Alternatives to scratching for the relief of pruritus can help the patient interrupt the itch-scratch-itch cycle. Application of a cool washcloth or ice over the site may be useful. Firm pressure at the site of itching, at a site contralateral to the site of itching, and at acupressure points may break the neural pathway. Rubbing, pressure, and vibration can be used to relieve itching.[Level of evidence: IV]
There are anecdotal reports of the use of transcutaneous electronic nerve stimulators (TENS) and acupuncture in the management of pruritus. Ultraviolet phototherapy has been used with limited success for pruritus related to uremia.
- Bernhard JD: Clinical aspects of pruritus. In: Fitzpatrick TB, Eisen AZ, Wolff K, et al., eds.: Dermatology in General Medicine. 3rd ed. New York, NY: McGraw-Hill, 1987, Chapter 7, pp 78-90.
- Dangel RB: Pruritus and cancer. Oncol Nurs Forum 13 (1): 17-21, 1986 Jan-Feb.
- Klein L: Maintenance of healthy skin. J Enterostomal Ther 15 (6): 227-31, 1988 Nov-Dec.
- Lydon J, Purl S, Goodman M: Integumentary and mucous membrane alterations. In: Groenwald SL, Frogge MH, Goodman M, et al., eds.: Cancer Nursing: Principles and Practice. 2nd ed. Boston, Mass: Jones and Bartlett, 1990, pp 594-635.
- Pace KB, Bord MA, McCray N, et al.: Pruritus. In: McNally JC, Stair JC, Somerville ET, eds.: Guidelines for Cancer Nursing Practice. Orlando, Fla: Grune and Stratton, Inc., 1985, pp 85-88.
- Blank L: Factors which influence the water content of the stratum corneum. J Invest Dermatol 18(2): 133-139, 1952.
- Hilderley L: Skin care in radiation therapy. A review of the literature. Oncol Nurs Forum 10 (1): 51-6, 1983 Winter.
- De Conno F, Ventafridda V, Saita L: Skin problems in advanced and terminal cancer patients. J Pain Symptom Manage 6 (4): 247-56, 1991.
- Hassey KM: Skin care for patients receiving radiation therapy for rectal cancer. J Enterostomal Ther 14 (5): 197-200, 1987 Sep-Oct.
- Maienza J: Alternatives to cornstarch for itchiness. Oncol Nurs Forum 15 (2): 199-200, 1988 Mar-Apr.
- Hassey KM, Rose CM: Altered skin integrity in patients receiving radiation therapy. Oncol Nurs Forum 9 (4): 44-50, 1982 Fall.
- Yasko JM, Hogan CM: Pruritus. In: Yasko J, ed.: Guidelines for Cancer Care: Symptom Management. Reston, Va: Reston Publishing Company, Inc., 1983, pp 125-129.
- Geltman RL, Paige RL: Symptom management in hospice care. Am J Nurs 83 (1): 78-85, 1983.
- Levy M: Symptom control manual. In: Cassileth BR, Cassileth PA, eds.: Clinical Care of the Terminal Cancer Patient. Philadelphia, Pa: Lea and Febiger, 1982, pp 214-262.
- Winkelmann RK: Pharmacologic control of pruritus. Med Clin North Am 66 (5): 1119-33, 1982.
- Supportive Care. In: Casciato DA, Lowitz BB: Manual of Bedside Oncology. Boston, Mass: Little & Brown, 1983, pp 59-95.
- Abel EA, Farber EM: Malignant cutaneous tumors. In: Rubenstein E, Federman DD, eds.: Scientific American Medicine. New York: Scientific American, Inc, Chapter 2: Dermatology, Section XII, 1-20, 1992.
- Daly BM, Shuster S: Effect of aspirin on pruritus. Br Med J (Clin Res Ed) 293 (6552): 907, 1986.