Itching in palliative care

There are many causes that can contribute to itching if you have a terminal illness.

It can be caused by the terminal illness you are living with, eg, liver cancer, or other medical conditions that happen at the same time. It can also be caused by a combination of things. Sometimes, it's not possible to find out an exact cause. 

Common causes of itching in patients living with a terminal illness include:

• cancer such as liver cancer, lymphoma or multiple myeloma
• a skin condition such as dry skin, eczema, allergic reaction, psoriasis, parasitic or fungal skin infections – these are usually accompanied by a skin rash
• a general medical condition such as anaemia, liver disease, chronic kidney disease or thyroid disorders
• the side effect of medicines, eg, opioids, lamotrigine, antibiotics or chemotherapy drugs
• psychological conditions such as anxiety or depression.

The feeling of the itch is very unpleasant and uncomfortable. You can feel the sensation of itching in one area of your body or your whole body, depending on what is causing your itchiness.

In severe cases, itching can cause sleep disturbance, anxiety and depression. 

Your doctor will ask you some questions related to your itching, including whether you have any other symptoms and any allergies. Your doctor will also examine you and, in particular, your skin if you have a rash. Some tests may be done, depending on what your doctor thinks is causing your itching. These include:

• blood tests such as full blood count, renal function tests or liver function tests
• imaging tests such as a chest x-ray or abdominal ultrasound
• a skin swab or biopsy.

In palliative care, treatment aims to relieve your symptom of itching and make you feel better. You may have many health professionals such as doctors, nurses, a dermatologist, a palliative care specialist or a cancer specialist involved in your care, as it may require treatment from a multidisciplinary team. 

If you have a medical condition or any obvious causes of your itching are found, treatment will focus on the condition or cause. Treatment that may be prescribed by your doctor includes:

• moisturisers or emollients to keep your skin moist 
• topical corticosteroids or oral steroids
• antihistamines 
• amitriptyline
• gabapentin
• benzodiazepines
• cholestyramine
• rifampicin
• phototherapy
• cognitive behavioural therapy (CBT) to break the itch–scratch cycle. 

There are some self-care measures that you can do to help relieve the symptom of itching.

• If you have dry skin, apply moisturisers or emollients often. Using surface cooling agents such as menthol creams can be soothing. 
• Avoid skin irritants such as soaps or foaming body washes.
• Don't bathe in hot water for long periods – shower or bathe quickly in cool or tepid water not more than once a day. 
• Keep yourself cool and don't sleep in wool or rough clothing.
• Try not to scratch your skin when you feel itchy and avoid situations that can trigger the desire to scratch. 
• Keep your nails clean and short, wear cotton gloves or apply paste bandages to reduce the skin damage caused by scratching.
• Try to pat your skin instead of scratch when you feel itchy.
• Avoid food and drink such as caffeine, alcohol, spices and hot water as these can worsen itching. 

Living with itching and other symptoms of terminal illness can be frustrating. It can also make it challenging to do things physically. Talk through your feelings with your family/whānau and friends to get the support you need. 

If you need extra help in daily activities such as washing, dressing or cooking, your doctor may be able to arrange this for you. 

Below are some support services and information for people affected by cancer and their family/whānau:

Emotions and cancer(external link) Cancer Society, NZ
How we can help(external link) Cancer Society, NZ
NZ cancer services - find a hospital/service near you(external link) Healthpoint, NZ
More cancer support groups