Pruritus in cancer patients as a polyetiological symptom

Cover Page

Cite item

Full Text

Abstract

Pruritus is one of the subjective sensations that significantly reduces the quality of life of patients. In patients with malignancies, itch can be caused by different universal or specific pathophysiological factors. This article discusses disorders that cause pruritus in cancer patients: the tumor growth on it’s own; pathophysiological changes associated with a number of malignancies, paraneoplastic itch, anticancer therapy, concomitant dermatoses, systemic diseases, psychosomatic disorders. Known or proposed mechanisms of the development of pruritus are presented for each of the mentioned provoking factors, and methods of treatment are described, according to the etiological factor. At the end of the article, universal methods for the correction of itching are presented, applicable in cancer patients, regardless of the pruritogenic factor. Special attention is paid to the correction of xerosis as a universal cause of itching in oncological patients.

About the authors

Anna V. Michenko

Central State Medical Academy of the Administrative Department of the President of the Russian Federation; Medical Research and Educational Center of Lomonosov Moscow State University

Author for correspondence.
Email: amichenko@mail.ru
ORCID iD: 0000-0002-2985-5729

Cand. Sci. (Med.)

Russian Federation, Moscow; Moscow

Andrey N. Lvov

Central State Medical Academy of the Administrative Department of the President of the Russian Federation; Medical Research and Educational Center of Lomonosov Moscow State University

Email: amichenko@mail.ru
ORCID iD: 0000-0002-3875-4030

D. Sci. (Med.), Prof.

Russian Federation, Moscow; Moscow

Larisa S. Kruglova

Central State Medical Academy of the Administrative Department of the President of the Russian Federation

Email: kruglovals@mail.ru
ORCID iD: 0000-0002-5044-5265

D. Sci. (Med.), Prof.

Russian Federation, Moscow

Dmitry V. Romanov

3Sechenov First Moscow State Medical University (Sechenov University); Mental Health Research Center

Email: newt777@mail.ru
ORCID iD: 0000-0002-1822-8973

D. Sci. (Med.)

Russian Federation, Moscow; Moscow

Ekaterina A. Kuzma

Central State Medical Academy of the Administrative Department of the President of the Russian Federation

Email: miss.fedulina1998@yandex.ru
ORCID iD: 0000-0002-8079-8002

Medical Resident

Russian Federation, Moscow

References

  1. Dickison P, Swain G, Peek JJ, Smith SD. Itching for answers: Prevalence and severity of pruritus in psoriasis. Australas J Dermatol. 2018;59(3):206-9. doi: 10.1111/ajd.12747
  2. Pavlis J, Yosipovitch G. Management of Itch in Atopic Dermatitis. Am J Clin Dermatol. 2018;19(3):319-32. doi: 10.1007/s40257-017-0335-4
  3. Lim YL, Chan YH, Yosipovitch G, Greaves MW. Pruritus is a common and significant symptom of acne. J Eur Acad Dermatol Venereol. 2008;22(11):1332-6. doi: 10.1111/j.1468-3083.2008.02828.x
  4. Rowe B, Yosipovitch G. Malignancy-associated pruritus. Eur J Pain. 2016;20(1):19-23. doi: 10.1002/ejp.760
  5. Ahern K, Gilmore ES, Poligone B. Pruritus in cutaneous T-cell lymphoma: a review. J Am Acad Dermatol. 2012;67(4):760-8. doi: 10.1016/j.jaad.2011.12.021
  6. Mills KC, Kwatra SG, Feneran AN, et al. Itch and pain in nonmelanoma skin cancer: pain as an important feature of cutaneous squamous cell carcinoma. Arch Dermatol. 2012;148(12):1422-3. doi: 10.1001/archdermatol.2012.3104
  7. Chiang HC, Huang V, Cornelius LA. Cancer and itch. Semin Cutan Med Surg. 2011;30(2):107-12. doi: 10.1016/j.sder.2011.05.003
  8. Lacouture ME (ed.). Dermatologic Principles and Practice in Oncology. 2014.
  9. Миченко А.В., Круглова Л.С., Шатохина Е.А., и др. Дерматологическая токсичность ингибиторов EGFR: патогенетическое обоснование и алгоритм коррекции акнеподобной сыпи. Онкогематология. 2021;16(4):50-8 [Michenko AV, Kruglova LS, Shatokhina EA, et al. Dermatologicheskaia toksichnost' ingibitorov EGFR: patogeneticheskoe obosnovanie i algoritm korrektsii aknepodobnoi sypi. Onkogematologiia. 2021;16(4):50-8 (in Russian)]. doi: 10.17650/1818-8346-2021-16-4-50-58
  10. Yosipovitch G. Chronic pruritus: A paraneoplastic sign. Dermatol Ther. 2010;23:590-6.
  11. Jones EA, Bergasa NV. Why do cholestatic patients itch? Gut. 1996;38:644-5.
  12. Wang H, Yosipovitch G. New insights into the pathophysiology and treatment of chronic itch in patients with end-stage renal disease, chronic liver disease, and lymphoma. Int J Dermatol. 2010;49:1-11.
  13. Naser AY, Hameed AN, Mustafa N, et al. Depression and Anxiety in Patients With Cancer: A Cross-Sectional Study. Front Psychol. 2021;12:585534. doi: 10.3389/fpsyg.2021.585534
  14. Smith HR. Depression in cancer patients: Pathogenesis, implications and treatment (Review). Oncol Lett. 2015;9(4):1509-14. doi: 10.3892/ol.2015.2944
  15. Schmelz M, Schmidt R, Weidner C, et al. Chemical response pattern of different classes of C-nociceptors to pruritogens and algogens. J Neurophysiol. 2003;89:2441-8.
  16. Steinhoff M, Bienenstock J, Schmelz M, et al. Neurophysiological, neuroimmunological, and neuroendocrine basis of pruritus. J Invest Dermatol. 2006;126:1705-18.
  17. Parker F. Structure and function of skin. In: Goldma L, Bennett JC (ed.). Cecil Textbook of Medicine. 21st ed. Philadelphia: Saunders, 2000; p. 2266.
  18. Mir A, Agim NG, Kane AA, et al. Giant Congenital Melanocytic Nevus Treated With Trametinib. Pediatrics. 2019;143(3):e20182469. doi: 10.1542/peds.2018-2469
  19. Yuan T, Lu XH, Tang B Mr, et al. Differences in clinical characteristics and lesion proteomics between inflammatory linear verrucous epidermal nevus and local verrucous epidermal nevus. J Proteomics. 2022;260:104554. doi: 10.1016/j.jprot.2022.104554
  20. Veraldi S, Bocor M, Gianotti R, Gasparini G. Multiple eruptive dermatofibromas localized exclusively to the buttock. Int J Dermatol. 1991;30(7):507-8. doi: 10.1111/j.1365-4362.1991.tb04875.x
  21. Husain Z, Ho JK, Hantash BM. Sign and pseudo-sign of Leser-Trélat: case reports and a review of the literature. J Drugs Dermatol. 2013;12(5):e79-87. PMID: 23652964.
  22. Saini KS, Patnaik MM, Tefferi A. Polycythemia vera-associated pruritus and its management. Eur J Clin Invest. 2010;40(9):828-34. doi: 10.1111/j.1365-2362.2010.02334.x
  23. Villafranca JJ, Siles MG, Casanova M, et al. Paraneoplastic pruritus presenting with Hodgkin’s lymphoma: a case report. J Med Case Rep. 2014;8:300. doi: 10.1186/1752-1947-8-300
  24. Meyer N, Paul C, Misery L. Pruritus in Cutaneous T-cell Lymphomas: Frequent, Often Severe and Difficult to Treat. Acta Derm Venereol. 2010;90:12-7. doi: 10.2340/00015555-0789
  25. Dummer R, Heald PW, Nestle FO, et al. Sezary syndrome T-cells clones display T-helper2 cytokines and express the accessory factor-1 (interferon gamma receptor beta-chain). Blood. 1996;88:1383-9.
  26. Yamamoto T, Katayama I, Nishioka N. Role of mast cell and stem cell factor in hyperpigmented mycosis fungoides. Blood. 1997;90:1338-40.
  27. Vermeer MH, Willemze R. Is Mycosis Fungoides exacerbated by fluoxetine? J Am Acad Dermatol. 1996;35:635-6.
  28. Brandes LJ, La Bella FS, Warrington FC. Increased therapeutic index of antineoplastic drugs in combination with intracellular histamine antagonist. J Natl Cancer Inst. 1991;83:1329-36.
  29. Yosipovitch G, Szolar C, Hui XY, Maibach H. High-potency topical corticosteroid rapidly decrease histamine-induced itch but not thermal sensation and pain in human beings. J Am Acad Dermatol. 1996;35:118-20.
  30. Bingham LG, Noble JW, Davis MD. Wet dressing used with topical corticosteroids for pruritic dermatoses: a retrospective study. J Am Acad Dermatol. 2009;60:792-800.
  31. Phan NQ, Bernhard JD, Luger TA, et al. Antipruritic treatment with systemic mu-opioid receptor antagonists: A review. J Am Acad Dermatol. 2009;63:680-8.
  32. Lidstone V, Thorns A. Pruritus in cancer patients. Cancer Treat Rev. 2001;27:305-12.
  33. Barrios DM, Phillips GS, Geisler AN, et al. IgE blockade with omalizumab reduces pruritus related to immune checkpoint inhibitors and anti-HER2 therapies. Ann Oncol. 2021;32(6):736-45.
  34. Askling J, Linet M, Gridley G, et al. Cancer incidence in a population based cohort of individuals hospitalized with celiac disease or dermatitis herpetiformis. Gastroenterology. 2002;123:1428-35.
  35. Pacheco M, Ferreira H, Silva C, et al. Antinuclear Antibody (ANA) and Anti-Mi-2-Alpha Positive Dermatomyositis Hinting a Cancer Diagnosis. Cureus. 2022;14(2):e21844. doi: 10.7759/cureus.21844
  36. Sanders KM, Akiyama T. The vicious cycle of itch and anxiety. Neurosci Biobehav Rev. 2018;87:17-26.
  37. Reich A, Trybucka K, Tracinska A, et al. Acne Itch: Do Acne Patients Suffer From Itching? Acta Derm Venereol. 2008;88(1):38-42.
  38. Seité S, Moyal D. Using an emollient lotion to improve objective and subjective symptoms in atopic patients. 24th World Congress of dermatology. Abstract book. Milan, 2022.
  39. Wohlrab J, Bangemann N, Kleine-Tebbe A, et al. Barrier protective use of skin care to prevent chemotherapy-induced cutaneous symptoms and to maintain quality of life in patients with breast cancer. Breast Cancer (Dove Med Press). 2014;6:115-22. doi: 10.2147/BCTT.S61699

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1

Download (155KB)
Indexing metadata
3. Fig. 2

Download (81KB)
Indexing metadata
4. Fig. 3

Download (167KB)
Indexing metadata

Copyright (c) 2022 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies