Paraneoplastic Itch: An Expert Position Statement from the Special Interest Group (SIG) of the International Forum on the Study of Itch (IFSI)

Abstract

In clinical practice, the term "paraneoplastic itch" is used to describe itch in patients with cancer. Patients with hematological or solid tumor malignancies can be affected. In general, paraneoplastic itch is considered a rare disorder. However, paraneoplastic itch in hematological malignancies such as polycythemia vera and lymphoma are relatively frequent while other forms of paraneoplastic itch are in fact extremely rare. The true frequency of this symptom is unclear, epidemiological data in this field are limited. Itch in malignant disease may additionally impair patients' quality of life. A population-based cohort study showed that chronic itch without concomitant skin changes is a risk factor for having undiagnosed hematologic and bile duct malignancies. Paraneoplastic itch is rather resistant to treatment. In 2012, an interdisciplinary interest group of physicians and researchers was founded, aiming to generate a clear definition of paraneoplastic itch. In this paper we briefly review the current knowledge and aim to define what can be summarized under the term "paraneoplastic itch".

Chronic Pruritus in the Elderly: Pathophysiology, Diagnosis and Management

“…This agent was found to be efficacious in a crossover, double-blind, randomized, controlled trial [155]. It has also been mentioned as a potential treatment for paraneoplastic itch [89].…”

“…Itch related to cancer is known as paraneoplastic itch and was recently defined as ''the sensation of itch as a systemic reaction to the presence of a tumor or a hematological malignancy neither induced by the local presence of cancer cells nor by tumor therapy. It usually disappears with remission of the tumor and can return with its relapse'' [89]. Multiple case reports and some clinical studies have reported generalized itch as an important skin symptom in cancer patients [78,90].…”

“…The initial workup for diagnosis should include a thorough history and physical examination, including lymph node assessment. Laboratory tests, including a complete blood cell count and liver function tests, should be considered, as well as imaging studies in some cases [89]. The diagnostic workup should be directed by the clinical evaluation and the index of suspicion.…”

Management von paraneoplastischem Pruritus

“…Wenn eine direkte neoplastische Invasion oder Kompression durch einen Tumor die Ursache für Juckreiz ist, gilt dies nicht als paraneoplastischer Pruritus. 2015 definierte die Special Interest Group des «International Forum on the Study of Itch» den paraneoplastischen Pruritus wie folgt: ‹Juckreiz als systemische (nicht lokale) Reaktion auf das Vorliegen eines Tumors oder einer malignen hämatologischen Erkrankung, der weder durch lokal vorhandene Tumorzellen noch durch die Tumortherapie hervorgerufen wird› [2]. …”

Paraneoplastic Syndromes in Children with Hodgkin Lymphoma

“…27,33 The symptom precedes the diagnosis or occurs early in the clinical course of the malignancy. Patients may present with secondary skin findings as a result of scratching, including excoriations, hyper-and hypopigmented lesions, lichenification, prurigo nodules, and scars.…”