Lymphoma is a type of blood cancer that develops in the lymphatic system. The lymph nodes, spleen, and other lymphatic tissue become abnormal. There are two main types of lymphoma – Hodgkin lymphoma and non-Hodgkin lymphoma. Lymphoma can cause many different symptoms depending on where it is located in the body. One common symptom of lymphoma is itchy skin, also known as pruritus.
What causes itching with lymphoma?
The exact cause of itching with lymphoma is not fully understood. It is thought to be related to the release of cytokines, which are small proteins involved in immune responses. The increase in cytokines may irritate nerve endings in the skin, triggering sensations of itching. The accumulation of lymphoma cells in lymph nodes and other organs can also cause swelling and pressure on nerves that influence itchiness.
Where does the itching occur?
Lymphoma-related itching can occur all over the body, but there are some areas that are more commonly affected:
- Arms and legs – Especially the lower legs and forearms
- Torso – Including chest, back, and abdomen
- Head and neck – Scalp, face, and neck
In some cases, the itching is generalized and occurs all over. But often it starts more focused in certain zones like the legs or arms before becoming widespread if the lymphoma progresses.
Itching patterns with lymphoma
The itching associated with lymphoma tends to follow some general patterns:
- Bilateral – Occurs on both sides of the body symmetrically
- Intense – Severe sensation, not just a mild itch
- No rash – Usually no visible skin changes like a rash
- Worse at night – Tends to be more bothersome at night
The itching can be very bothersome, causing difficulty sleeping and quality of life issues. Scratching can provide temporary relief but also damage the skin.
What types of lymphoma cause itching?
Both Hodgkin lymphoma and non-Hodgkin lymphoma can cause itching, but it is more common with:
- Hodgkin lymphoma – Estimated 60% of patients have itching
- Non-Hodgkin lymphomas:
- Peripheral T-cell lymphomas
- Cutaneous T-cell lymphomas (mycosis fungoides)
In general, lymphomas that involve increased cytokine production and spread through the skin-associated lymph nodes tend to be associated with more itching.
Why does lymphoma cause itching?
There are a few proposed reasons why lymphoma can lead to severe itching:
- Cytokine release – Lymphoma cells produce excess cytokines like interleukin-2 and interleukin-6 that can over-activate nerve fibers involved in itch sensation.
- Infiltration of skin – Certain lymphomas like cutaneous T-cell lymphoma infiltrate the skin itself, directly activating itch receptors.
- Enlarged lymph nodes – Swelling of lymph nodes from lymphoma infiltration may compress nearby nerve fibers that influence itch.
Research indicates that interleukin-31 in particular may play an important role in lymphoma itching. Drugs that target this cytokine are being studied as treatments.
Does the itching go away if lymphoma is treated?
For many patients, successfully treating the lymphoma can eliminate or significantly reduce the itching. However, it may take some time for the itching to fully subside after starting lymphoma treatment.
Some key points about resolution of lymphoma itching:
- May begin improving within 1-2 weeks of starting chemotherapy
- Can take 1-2 months to fully resolve
- Typically resolves faster if lymphoma responds well to initial treatment
- May persist or worsen if lymphoma is resistant to treatment
Controlling the itching during lymphoma treatment is important for quality of life. Anti-itch medications, topical creams, and other symptom management strategies can help.
What if the itching persists after lymphoma treatment?
In some cases, severe itching related to lymphoma continues even after the cancer is in remission following treatment. This is often termed post-lymphoma itch and can be very frustrating for patients.
Reasons itching may persist after successful lymphoma treatment:
- Residual cytokine production still affecting nerves
- Ongoing nerve damage from chronic itching
- Scarring where lymph nodes were enlarged
- Development of neuropathy from chemotherapy
For persistent post-lymphoma itching, medications targeting itch mediators, nerve block injections, phototherapy, and psychotherapy may help provide relief.
When to see a doctor for lymphoma itching
It’s important to consult a doctor promptly for evaluation of severe, persistent itching. This is particularly crucial if you have any signs or risk factors for lymphoma such as:
- Unexplained lymph node swelling
- Unintentional weight loss
- Drenching night sweats
- Persistent fever
- Fatigue
A doctor can help determine if lymphoma or another condition may be causing your symptoms. Catching and treating lymphoma early is critical.
Diagnosing the cause of itching
To help diagnose the cause of itching, doctors may:
- Perform lymph node exam to feel for enlargement
- Order blood tests to look for signs of inflammation or abnormal cells
- Do imaging tests like CT scan to visualize lymph nodes and organs
- Do a lymph node biopsy to analyze cells
These tests can detect if lymphoma or another condition is responsible for severe itching.
Lymphoma itching treatments
The main way to treat itching caused by lymphoma is to treat the cancer itself with chemotherapy, radiation, immunotherapy, or other cancer treatments. Itching often improves as the lymphoma responds to these treatments.
In addition, a number of strategies may help provide relief from lymphoma itching:
- Antihistamines – Block histamine’s role in itching
- Corticosteroids – Reduce inflammation
- Antidepressants – Interfere with itch transmission
- Nerve block injections – Inhibit itch signals
- Phototherapy – Can reduce cytokine activity
- Moisturizing creams – Soothe irritated skin
Finding the right combination of non-medication strategies like cool compresses, skin moisturizing, and wearing light clothing can also help supplement medical itch relief approaches.
Coping with lymphoma itching
Severe itching can be exhausting and detrimental to your quality of life. Some tips for coping with lymphoma-related itching include:
- Avoid scrubbing or scratching, which can damage skin
- Apply cold compresses to itchy areas for relief
- Keep your environment cool; heat can exacerbate itching
- Wear soft, loose fitting clothing
- Use unscented moisturizing lotions after bathing
- Engage in relaxing activities to distract your mind from the itch
- Join a support group to connect with others experiencing lymphoma itching
Coping strategies along with medical treatments can help manage itching from lymphoma. Discuss all your symptom relief options with your healthcare team.
Outlook for lymphoma itching
The outlook for lymphoma itching depends on the individual situation:
- Often improves substantially or resolves when lymphoma responds well to treatment
- May take weeks to months to fully resolve even with treatment response
- Can potentially persist long-term, requiring ongoing symptom management
- Tends to worsen or become intolerable if lymphoma progresses
Close collaboration with your medical providers and promptly reporting any worsening of the itch are important to ensure the best outlook.
Staying positive and utilizing all available treatments to reduce your lymphoma itching can help support you through this challenging symptom.
When to seek emergency lymphoma itch treatment
Most of the time, lymphoma-related itching can be managed with outpatient treatments and lifestyle measures. However, emergency care is warranted if you experience:
- Itching so severe it prevents sleeping for multiple nights
- Bleeding, infection, or ulceration from extensive scratching
- Difficulty breathing or swallowing due to swollen lymph nodes
- Sudden onset of severely swollen lymph nodes
- Rapid worsening of itching not relieved by medications
Seek prompt medical attention if you have any signs of a complication from lymphoma or an allergic reaction to a medication. Getting emergency care for dangerous levels of itching can prevent further health issues.
Conclusion
Itching is a problematic but common symptom of certain lymphomas like Hodgkin lymphoma and cutaneous T-cell lymphoma. While the exact cause is unclear, excess cytokine production is likely involved. Treatments aimed at the lymphoma itself and medications to reduce itching can provide relief in most cases. Working closely with your healthcare providers and using self-care strategies allows most patients to manage lymphoma-related itching successfully. Promptly reporting any concerning changes in the itch remains important.