When Is Itchy Skin a Cancer Symptom?

Both cancer itself and cancer treatments may cause itching (pruritis)

Itchy skin (also called pruritis) can be a symptom of cancer or even the first sign of cancer, though other causes of itching are certainly much more common. Cancers commonly associated with itching include some leukemias and lymphomas, gallbladder cancer, and liver cancer. However, a number of other cancers may be implicated as well.

Itching may occur due to direct irritation of the skin (such as with skin cancer or skin metastases), through the build-up of bile salts, or due to substances secreted by a tumor or by the body in response to a tumor. Though it can be difficult to differentiate itching due to cancer from itching due to benign causes, there are a few clues that should raise suspicion.

What should you know about the link between cancer and itching?

itchy skin during cancer treatment
Illustration by Brianna Gilmartin, Verywell

Incidence

It's uncertain exactly how often itching occurs as a symptom or first symptom of cancer, but it's thought that an underlying systemic (body-wide) disease is present in 10 percent to 25 percent of people who develop generalized itching without a rash.

In one study looking at almost 17,000 people, those who had generalized itching were more likely to have an underlying cancer (5.76 times more likely) than those who did not experience itching. The cancers that were most commonly associated included liver cancer, gallbladder cancer, bile duct cancer, blood-related cancers such as lymphomas and leukemias, and skin cancer.

In this study, black people were more likely to have skin cancer, soft tissue cancers (such as sarcomas), and blood-related cancers as the underlying cause of their itching, whereas white people were more likely to have liver cancer, lung cancer, digestive tract cancers, and cancers of the female reproductive tract such as ovarian cancer.

Among the participants with newly diagnosed with cancer, 30 percent of those with Hodgkin's lymphoma, 15 percent with non-Hodgkin's lymphoma, 5 percent with leukemia, and over 50 percent of those with myeloproliferative disorders had significant itching.

Is Cancer Causing the Itching?

Itching related to cancer is sometimes identical to itching related to skin conditions or other benign causes, but there are some characteristics that may differ.

Characteristics of cancer-related itching may include:

  • itching in response to water (aquagenic pruritis)
  • the absence of a rash or hives (though sometimes a rash occurs due to repeated scratching)
  • the presence of other symptoms such as jaundice (a yellowish discoloration of the skin), and the B symptoms of lymphoma (fever, weight loss, and drenching night sweats)

In addition, itching associated with cancer tends to feel the worst on the lower legs and chest and may be associated with a burning sensation.

How Does Cancer Cause Itching?

There are a number of mechanisms by which cancer can lead to itching. The body contains nerve endings that cause itching (similar to pain receptors). In general, anything that irritates these nerve endings can cause itching.

Direct Inflammation

Cancers that involve the skin or mucous membranes in some way are the most obvious cause of itching. This may include the different types of skin cancer, breast cancers such as inflammatory breast cancer, Paget's disease of the nipple, and certainly any cancer that spreads (metastasizes) to the skin.

Direct inflammation may also give rise to the itch associated with vulvar and anal cancers.

Build-Up of Bile Salts

Obstruction of the bile ducts or the breakdown of red blood cells can both lead to the build-up of bile salts in the skin. This often leads to severe itching. This may occur with leukemias and lymphomas (due to the breakdown of cells), abdominal cancers such as those of the liver and gallbladder, and any cancer that spreads to the liver (such as breast, lung, colon, and more).

Sometimes the build-up of bile salts is associated with jaundice (a yellowish appearance to the skin), though not always.

Secretion of Chemicals

Substances secreted by tumors (which cause paraneoplastic symptoms), or substances released by the body in response to a tumor, may lead to itching. This itching is often most severe in the legs. In some cases, paraneoplastic symptoms such as itching may precede by weeks or months the diagnosis of cancers such as non-small cell lung cancer or lymphomas.

Some of the chemicals that have been implicated in this effect include cytokines (inflammatory chemicals released from immune cells often in response to lymphomas), substance P, neuropeptides, prostaglandins, and more. Some of these chemicals act directly on the nerve endings to cause itching, whereas others may cause the release of histamine by mast cells and other mechanisms.

Itching as a paraneoplastic symptom may occur alone, or may be associated with rashes such as erythroderma, acanthosis nigricans, dermatomyositis, Grover's disease, or eruptive seborrheic keratosis.

Hormonal Changes

Hormonal changes related to cancer or cancer treatments can lead to itching in a few ways. Menopause in women (whether natural, surgical, or medically induced such as with breast cancer) can cause dryness. Hormonal changes may also lead to hot flashes. These hot flashes, often followed by sweats, can easily lead to itching.

Other Mechanisms

There are a number of other ways in which cancer may cause itching. For example, mast cells (which are responsible for allergic reactions and release histamine) may become overactive with some cancers, especially when exposed to hot water, such as during a hot shower. This is most common with blood-related cancers and myeloproliferative disorders.

Cancers That May Cause Itching

As noted earlier, there are some cancers that are more likely to present with symptoms of itching than others. Sometimes the itching is severe, whereas other times it may occur intermittently or only after taking a hot bath or shower.

Leukemias, Lymphomas, and Multiple Myeloma

Any type of blood-related cancer may present with itching, but the most common culprits include Hodgkin's lymphoma, leukemia, and cutaneous T cell lymphoma (such as mycosis fungoides and Sezary syndrome).

With cutaneous T cell lymphomas, the cancer can cause itching both due to direct skin involvement and due to the secretion of inflammatory substances such as interleukin-31.

Myelodysplastic disorders such as polycythemia vera also commonly present with itching.

With both T cell lymphomas and myeloproliferative disorders, itching of the skin due to the exposure to water may even be present for years before the cancer is diagnosed.

Skin Cancer

Skin cancer is the most common type of cancer to cause itching. Itching is more common with basal cell carcinoma and squamous cell carcinoma than with melanoma.

Vulvar Cancer and Anal Cancer

Itching in the vulvar and vaginal region or anal region is more likely due to another cause, but this is still sometimes seen with cancers in these regions.

Breast Cancer

Itching as a symptom of breast cancer isn't common, but it may occur. Unlike the more common types of breast cancer, inflammatory breast cancer often looks like a rash or breast infection (mastitis) initially.

Sometimes, symptoms begin with itching and a small rash that could even be dismissed as a bug bite before it worsens. Paget's disease of the breast may also present with itching that is often associated with a dry, scaly rash of the nipple.

Liver, Bile Duct, Pancreatic, and Gallbladder Cancers

Any cancer that interferes with the bile ducts can lead to obstruction and the consequent build-up of bile salts in the skin. With pancreatic cancer specifically, this is most common with cancers located in the head of the pancreas. Other symptoms may include jaundice, abdominal pain, ascites (the build-up of fluid in the abdomen), and abdominal pain.

Metastatic Cancer

Metastatic cancer to the skin (skin metastases) may present with itching. In women, breast cancer is the most common source of skin metastases; in men, lung cancer is most common. Other cancers may also spread to the skin, such as colon cancer and more.

Liver metastases may also lead to itching, similar to the itching associated with primary liver cancers. The most common cancers to spread to the liver include lung cancer, breast cancer, colon cancer, and melanoma.

Itching and Cancer Treatments

There are many cancer treatments that can lead to itching. The most common include some targeted therapies and some immunotherapy drugs, especially interferon and interleukin-2. Many medications can also cause allergic reactions or inflammation of the liver, which in turn, can lead to itching.

Radiation therapy commonly causes itching, especially later on in treatment when the skin begins to heal.

Diagnosing Itching

Unexplained itching should be evaluated by your doctor. The first step in diagnosis includes a careful history and physical examination looking for any obvious causes of itching.

Laboratory work may include a complete blood count and liver function tests. If leukemia, lymphoma, or a myeloproliferative disorder is suspected, a bone marrow test is often needed to either confirm or rule out a problem.

Imaging tests may be needed as well. Paraneoplastic symptoms are not uncommon with lung cancer, and evaluation may include a chest CT scan (chest X-rays can miss up to 25% of lung cancers). If an abdominal cancer is a possibility, an abdominal CT scan as well as other imaging tests may be needed.

Even if the evaluation is negative, careful follow-up is necessary if a cause is not found. As noted earlier, itching may occur weeks to months before other symptoms with lung cancer, and itching may appear years before the diagnosis of a T cell lymphoma is made.

If an obvious underlying medical cause is not determined (either benign or cancerous), keeping a symptom diary is sometimes helpful, as well as letting your doctor know if any new symptoms arise.

Managing Itching

Managing itching with cancer is very important in improving quality of life, especially when itching is severe such as with liver metastases or T cell lymphomas.

Often times, treatment of the underlying cancer reduces itching.

However, this isn't always possible, for example, with advanced cancers. It can take some time to resolve the itching.

Lifestyle Measures

Simple measures for managing itchy skin due to cancer treatment can include:

  • staying well hydrated
  • using quality lotions and creams (avoiding any scented products)
  • applying baking soda or oatmeal mixtures to the skin
  • using a humidifier if the air is dry in your home
  • avoiding shaving
  • bathing in lukewarm rather than hot water
  • try to limit bathing to every few days rather than daily, and avoid sitting in a tub more than 30 minutes
  • allowing your skin to dry naturally after bathing rather than rubbing your skin with a towel
  • wearing comfortable and loose clothing
  • avoiding clothing that creates friction or rough clothing such as wool; cotton and linen are preferable to synthetic garments
  • keeping the thermostat down or the air conditioning up to decrease sweating (sweating can greatly aggravate itching)
  • using distraction, such as conversations, music, or anything to help you get your mind off of the itching
  • keeping your fingernails short to avoid scratching when you are sleeping
  • using insect spray when spending time outside to avoid additional causes of itching
  • avoiding your personal triggers for itching (sometimes keep a symptom diary can help you determine what makes the itching worse and what helps the most)
  • reducing stress, as emotional stress can make itching more severe

Avoiding scratching, is of course, important, but often easier said than done. To relieve the itch you may try patting the area, massage, gentle pressure, or vibration as alternatives to scratching. Cold compresses are helpful for some people.

Medications

A number of different medications have been used to help relieve itching. Before using any over-the-counter (OTC) preparations, however, make sure to talk to your oncologist. Some medications can interfere with cancer treatments.

For example, Benadryl (diphenhydramine) counteracts the effects of the breast cancer drug tamoxifen. Options include:

  • antihistamines
  • topical or oral steroids
  • the anti-nausea drug Zofran
  • Questran (a bile acid sequestrant that may be helpful for people who have itching due to liver metastases or tumors that are causing bile duct obstruction)
  • serotonin reuptake inhibitors such as Paxil (paroxetine)
  • serotonin-norepinephrine reuptake inhibitors such as Cymbalta (duloxetine)
  • Neurontin (gabapentin), a seizure drug, or Remeron (mirtrazapine), an atypical antidepressant which may be helpful for the severe itching associated with T cell lymphomas
  • Emend (aprepitant), a medication often used to prevent nausea and vomiting associated with chemotherapy. The medication is a substance P antagonist.
  • Tagamet (cimetidine) with or without aspirin may help with itching related to Hodgkin lymphoma

A Word From Verywell

Most often, itching is due to something other than cancer. However, it can be a symptom or even the first sign of several types of cancer in certain cases. If you have itching that is not otherwise explained, it's important to make an appointment to see your doctor to determine the underlying cause. In addition to cancer, there are other medical conditions ranging from liver disease to kidney disease that could be a factor, and treatment of many of these conditions—just as it is with cancer—is often most successful when the condition is discovered earlier rather than later.

Finally, even though it may be considered a "nuisance symptom" by some, itching can seriously reduce your quality of life. Talking to your doctor may help you determine both the underlying cause, and find relief.

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Article Sources

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  1. Larson VA, Tang O, Ständer S, Kang S, Kwatra SG. Association between itch and cancer in 16,925 patients with pruritus: Experience at a tertiary care center. Journal of the American Academy of Dermatology. 2019. 80(4):931-937. doi:10.1016/j.jaad.2018.08.044

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