Itch, also called pruritis, can be an uncomfortable and frustrating symptom when you have a terminal illness. But there are things that can help, including treatments that your health and social care team can support you with. On this page we explain possible causes of itch and ways to manage it.
This information is written for people living with a terminal illness. But it may also be helpful for carers, family, friends, and health and social care professionals.
What is itch?
Itch makes you want to scratch, which can cause more damage to skin and more itching. This is called the itch-scratch-itch cycle.
Scratching may cause the skin to break or bleed. It may also lead to an infection. Itch can also make it harder to sleep. These things could make your quality of life worse.
It’s important to tell people close to you, including your health and social care team, if you have itch. People do not always mention it themselves, so itch can be underdiagnosed and undertreated.
What causes itch?
There are many causes of itch. A person may feel itchy because of more than one reason. Sometimes, itch has no obvious cause.
Skin issues that can cause itch
- Dry skin.
- Infection – for example, thrush (candidiasis) or fungal infection.
- Eczema (atopic dermatitis).
- Allergic skin reaction (contact dermatitis).
- Psoriasis.
- Insect infestation – for example, scabies, lice, bed bugs and fleas.
- Lots of moisture caused by sweating or incontinence.
- Skin being in contact with pee (urine), poo (faeces), or both for a long time.
Causes of itch from other areas of the body
- Anaemia and having low levels of iron (iron deficiency).
- High or low levels of thyroid hormone (hyperthyroidism or hypothyroidism).
- Diabetes.
- Blocked bile duct (cholestasis).
- Liver disease – for example, cholestatic jaundice, hepatitis, liver cancer or primary biliary cirrhosis.
- High concentration of red blood cells (polycythaemia).
- Chronic kidney disease or kidney (renal) failure.
- Leukaemia or lymphoma.
It’s important to be aware of the serious causes of itch, such as liver and kidney disease, and get urgent help from your healthcare team if you have symptoms or are worried about them.
Medicines that can cause itch
- Opioids, particularly morphine and diamorphine.
- Aspirin.
- Antibiotics.
- Hormone treatments.
- Selective serotonin re-uptake inhibitors antidepressants (SSRIs) – such as citalopram, fluoxetine, paroxetine and mirtazapine.
- ACE inhibitors, such as enalapril and ramipril. These are usually prescribed to people after a heart attack. They are also used to treat heart failure and high blood pressure.
- Statins, such as atorvastatin, simvastatin and pravastatin.
- Chemotherapy drugs.
- Immunotherapy (monoclonal antibodies).
Psychological causes of itch
- Anxiety.
- Depression.
- Hallucinations related to phobias or psychosis.
How is itch assessed?
Although there are some simple steps you can try to ease itching, it’s important for your healthcare team to find the cause, so you can have the most appropriate treatment.
Your doctor, nurse or another member of your healthcare team may ask you these questions to help find the cause for the itch:
- When did it start? They may ask this because your itch could be because of a change in treatment.
- Did it start gradually or come on quickly? They may ask this because itch coming on suddenly is more likely to have been caused by a drug, an allergic reaction to an irritant, or an infestation.
- Is it new or have you had it before?
- If you’ve had it before, has anything helped or made it worse?
- Did you change anything recently, such as your soap or washing powder?
- Is the itch in a particular area of the body (localised), or all over? They may ask this because itch in a particular area of the body is more likely to be caused by an irritant or allergy.
- Is anyone else in the house affected? They may ask this to understand whether the itch may be caused by an insect infestation.
- Are there pets in the house? They may ask this because having pets could increase the chance of an insect infestation (see Ways to ease and manage itch below).
- Are you allergic to any animals? If you do have pets, you may have an allergy that could be causing itch.
The person asking the questions will note down your answers. They should then look at the most appropriate treatment, or speak with the member of your healthcare team who’ll be able to suggest the right treatment (see Treating itch below).
Sometimes you may need blood tests or other tests to find out the cause of itch. But this is not always needed. It depends on your individual situation.
You may also find it helpful to keep a symptom diary. If you have a carer, family member or friend who sees you often, they may be able to help with this. This may help to:
- identify the cause of the itching
- show when symptoms are worse
- show whether anything helps with the itching.
Ways to ease and manage itch
Whatever the cause of itch, there are things you can do to help care for your skin and make it feel less itchy.
Skin care
- Check your skin for signs of damage, bleeding and infection.
- Apply moisturising lotions and creams (emollients) often. This helps to keep the skin supple and moist.
- Try lotions and creams with anti-itch or cooling ingredients, such as menthol.
- Check with your GP or pharmacist if there are other lotions or creams that may help. They might be able to prescribe you something, such as a corticosteroid creams, to use for a short time.
Eating and drinking
- Try to drink water or suck on ice cubes to stay hydrated.
- Avoid or cut down on anything that can cause dilation of the blood vessels in the skin (vasodilation). This includes caffeine, alcohol, spices and heat.
Bathing
- If you have a bath, use warm, not hot, water.
- Add sodium bicarbonate or oatmeal to the bath water.
- Avoid soaps, shower gels and bubble baths. These can dry skin out by washing away natural oils. Use an emollient soap substitute instead.
- Pat yourself dry, rather than rubbing, after bathing.
Clothing and environment
- Avoid irritating fabrics for clothes and bed sheets. Some people find cotton and silk can be cooler and less irritating than synthetic fabrics.
- Keep your room at a comfortable temperature and make sure you’re not too warm at night. Consider using a fan.
Managing scratching and itching
- Remember that scratching can make the itch worse and create a cycle.
- You could wear gloves at night, as this can reduce damage done to the skin by scratching.
- Try to keep your nails short.
- If the itch is worse at night and stopping you from sleeping, speak with your doctor or nurse. They may suggest ways to help, such as a short-term trial of a sedating oral antihistamine.
- Pressing, tapping or drumming the skin, rather than scratching, can help.
- Try distraction techniques, such as music, relaxation or positive imagery. These may help to break the itch-scratch-itch cycle.
- If itch is caused by anxiety, try to get emotional support and reassurance.
Treating itch
The best treatment will depend on the cause of the itching. Treatment might include:
- topical steroid creams
- anaesthetic cream (topical lignocaine) to numb the nerves in the skin and reduce the sensation of itch
- antidepressants, such as paroxetine or mirtazapine
- antihistamine tablets
- ultraviolent B (UVB) light therapy
- acupuncture.
Treating itch caused by an insect infestation
Sometimes itch is caused by an insect infestation, such as scabies, lice, bed bugs or fleas. In this case, your home or place of care will need to be treated. You or your health and social care team can contact your local council or trust for information about pest control services.
You usually need to leave the place that is being treated. Your health and social care team can talk to you about options and support you through this.
Getting more support with itch
Speak to your person’s GP, specialist nurse or district nurse if you are concerned about what’s causing the itch. They can try to work out the underlying cause, or causes, and give the appropriate treatment. They will review your medicines and change any that might be contributing to the itch.
It’s also important to seek help if you think you have a skin infection. Your health and social care team are the best people to speak to about this.
If you, or someone supporting you, would like some emotional support, you can call our free Support Line on 0800 090 2309 or email support@mariecurie.org.uk.
