Itch

The sensation of itch can have a significant impact on quality of life, affecting day to day comfort as well as interrupting sleep. Whilst itch may be histamine related (allergies) in palliative care it is often unrelated.

Causes

• Metabolite build up - bile salts in hepatic disease, uraemia
• Opioid induced
• Lymphoma
• Paraneoplastic
• Secondary to immunotherapy
• Infestations - scabies, fleas, bedbugs
• Iron deficiency
• Skin diseases - eczema, psoriasis

Non-drug measures

• Breaking the itch-scratch cycle
• Keep nails short or wear cotton gloves
• Mindfulness and relaxation techniques for distraction
• Avoid soap and bubble baths
• Emollients especially with added menthol

Drug treatment

• Targeted treatment of specific cause may be possible e.g. cholestyramine for biliary salt absorption
• Antihistamine medications e.g. loratadine 10 mg once a day
• Sertraline 25mg once a day
• Low dose corticosteroids
• Gabapentin may be helpful in some resistant cases