What you Need to Know about Itching and Myeloproliferative Neoplasms

If you have been diagnosed with myelofibrosis or polycythemia vera, you may have experienced itching as a side effect. Itching occurs as a result of the activity of cytokines (small proteins involved in cell signaling) associated with myeloproliferative neoplasms (MPNs) and because a certain type of cell called a mast cell may release substances called histamines, which cause itching. (Histamines also cause some of the symptoms associated with allergies).

There are several ways to reduce itching in MPNs. These include MPN treatment, lifestyle changes, and anti-itching medications .

MPN Treatment

Treatment of MPNs can help control symptoms. A Phase III trial reported in the New England Journal of Medicine demonstrated that Jakafi® (ruxolitinib) more effectively controlled symptoms of polycythemia vera than standard therapy with Hydrea® (hydroxyurea). Itching was reduced by 95% in PV patients treated with Jakafi®, compared to only 2% with standard therapy.

Lifestyle Changes                                                                                                                                           

You may need more than one strategy to relieve or prevent itching, protect your skin, and stay comfortable.       

  • Learn what triggers itching and take steps to avoid those triggers.
    • Triggers can include dry skin or hot baths.
  • Change the way you bathe or shower.
    • Use warm or cool water instead of hot water.
    • Avoid bathing too often: bathing more frequently may make dry skin worse.
    • Use baby wash or very mild soaps that don’t make skin too dry.
    • Carefully pat skin dry after bathing and avoid rubbing or excessive toweling.
    • Keep your skin moisturized with lotion.
  • Reduce your skin’s exposure to sweat.
    • Always bathe right away after you exercise.
    • Carry a cloth with you to wipe away sweat during activity.
  • Watch what you eat and drink.
    • Drink plenty of fluids. This helps your skin stay moist and healthy.
    • Avoid eating spicy foods or drinking alcohol.
  • Keep your home cool and humid.
    • Warm, dry air can cause skin to become dry and itchy. Cool, humid air may prevent itching.
  • Wear cotton clothing and use cotton bed sheets.
    • Body heat, wool, and some manmade fabrics can trigger itching. Wear loose-fitting, lightweight cotton clothing and use cotton bed sheets.
  • Control stress.
    • Stress and anxiety can make it harder for you to cope with itching. Stress management strategies include relaxation therapy, positive imagery, music therapy, and distracting yourself with activities. Talk with your doctor if stress is a problem for you.

Anti-Itching Medications

  • Oral antihistamines can be used to relieve itching, and a dose prior to bedtime can help with sleep. These include diphenhydramine, hydroxyzine, doxepin, loratadine, fexofenadine, and cetirizine.
  • Corticosteroid medications applied directly to the skin (creams, foams, gels, lotions, and ointments) can help relieve itching.
  • Antidepressants can have strong antihistamine and anti-itching effects.
  • Ketotifen, a mast cell stabilizer, is available as an eye drop (Zaditor®) in the United States and can help patients who also experience bone pain and/or flushing.
  • Disodium cromolyn is a mast cell stabilizer that is believed to act by decreasing mast cell release of histamines to treat symptoms in some patients.
  • Psoralens and ultraviolet-A (PUVA) can be used to reduce itching.
  • Low-dose aspirin is helpful in some patients. It causes continuous release of histamines from mast cells to prevent extreme peaks of histamine release.

To learn more about strategies to control itching, talk to your doctor about treatment options, lifestyle changes, and anti-itching medications that might be appropriate for you. Have other tips to prevent and manage itching? Join the conversation in the CancerConnect Myeloproliferative Neoplasms Support Group here and share your experience.

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