The Hodgkin's Lymphoma Itch - Incidence and Treatments

Treatment of Hodgkin Disease and Paraneoplastic Pruritis (Itching)

Dermatology Consultation. Credit: Media for Medical / Contributor / Getty Images

What is the Hodgkin itch?  How common is it, and how can it be treated?

The "Hodgkin Itch"

Itching is one of the peculiar symptoms of Hodgkin lymphoma. About 10-25% of individuals suffering from Hodgkin disease suffer from an intense itch. In some, the itching starts before the diagnosis of lymphoma is made. It is often felt as a burning sensation occurring on a particular area of skin, frequently on the lower legs.

Causes of the Itch

The cause of this itch is not definitely known. It is believed that some blood cells release chemicals near the nerves of the skin and irritates these nerves. We feel this as an itch.

Does an itch mean that the cancer is in your skin?  Non-specific skin symptoms or other skin involvement in Hodgkin lymphoma are reported to occur in 15 to 50 percent of people with the disease. Of these, a small minority may actually have Hodgkin lymphoma of the skin, or cutaneous Hodgkin lymphoma. It's possible there are multiple sources of itchiness in people with Hodgkin lymphoma pruritis. Several theories have been developed, but the precise cause is still unknown.

Paraneoplastic Pruritis (Itching) and Blood Cancers

Hodgkin itch is known medically as “paraneoplastic pruritus,” and it occurs in other blood cancers as well, but Hodgkin lymphoma seems to produce this symptom in a greater percentage of patients and itchiness has been recognized as a symptom for some time.

Hodgkin itch can develop weeks and even months before other clinical signs of lymphoma. Itching can be extremely severe and has a negative impact on a person’s quality of life.

Importance

Itching in Hodgkin disease has more importance than just being an uncommon symptom. It may be an indicator of a less favorable prognosis when associated with significant fever or weight loss, the so-called B symptoms of lymphoma.

How is the Hodgkin's Itch Treated?

There have not been an abundance of large studies to investigate which treatments might be effective for this particular kind of itching in Hodgkin lymphoma, but there are some data to help guide therapeutic decision making. According to an article in the 2014 “Journal of Medical Case Reports,” one drug that appears to be effective is Emend (aprepitant,) a neurokinin-1 receptor antagonist, however future controlled trials would help to clarify the role of this drug as an anti-pruritic for lymphoma.  Emend is most often used to help prevent nausea and vomiting due to chemotherapy.

A variety of different medications and interventions have been proposed as potentially useful; some have been found to be effective for itchiness in certain types of lymphoma, but not others. These include drugs from the antidepressant family, sedating antihistamines, oral steroids, light therapy for cutaneous T-cell lymphoma, thalidomide and others. 

Support

While there have not been any controlled studies done to date, mind/body therapies that are used in an integrative way to help people cope with the symptoms of cancer treatment (such as massage therapy, meditation, or acupuncture) may be of some benefit.

  Talk with your oncologist to find out what has worked for other people with Hodgkin disease.  It may be helpful to join an online support community of other people who are similarly coping with the Hodgkin itch for ideas, as well as to feel the support that can come from knowing you aren't alone in your experience.  But first, check out these tips on safe social media for cancer patients, as well as these thoughts on coping with lymphoma.

For Caregivers and Loved Ones

Last but definitely not least, if it is your loved one coping with the Hodgkin itch, realize that the itch is real, and can be severe.  Worse for the one living with the cancer itch than itching, is finding that others don't believe what they are experiencing, or don't understand how annoying it can be.  Be patient when your loved one is itching.  Most of us are not as kind -- and can be nasty - when we aren't feeling well, and can say things we otherwise wouldn't.  Try to step back and picture it as the itch talking, and not your loved one.  Social media is also a good place for caregivers to connect with other caregivers who are going through the same issues.

Sources:

Vrotsos E, Dosal J, Zaiac M, Alexis J. Pityriasis rosea-like cutaneous eruption as the presenting symptom of Hodgkin lymphoma. Case report and review of the literature. Journal of Dermatological Case Reports. 2015;9(3):81-84.

Yosipovitch G. Chronic pruritus: a paraneoplastic sign. Dermatol Ther. 2010;23:590–596.

Wang H, Yosipovitch G. New Insights into the pathophysiology of chronic itch in patients with end stage renal failure, chronic liver disease and lymphoma. Int J Dermatol. 2010;49:1–12.

Arenas 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.

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