Itching in palliative care

Itchiness is a sensation on your skin that makes you want to scratch or rub the area. 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. 

Many things can contribute to itching if you have a terminal illness.

It can be caused by the terminal illness you're 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.

Your healthcare team 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 they think 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 for you 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 bath 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 patting your skin instead of scratching when you feel itchy.
• Avoid food and drink such as caffeine, alcohol, spices and hot water as these can make itching worse.

Apps reviewed by Healthify

You may find it useful to look at some skin care (dermatology) apps, Long-term condition apps, and pain management apps.