Pruritus may occur as a paraneoplastic phenomenon.


Features of paraneoplastic pruritus:

(1) The onset may precede recognition of the underlying tumor by weeks or months.

(2) Successful treatment of the underlying tumor usually is associated with disappeareance of the pruritus.

(3) The pruritus may accompany other paraneoplastic skin lesions, or chronic excoriation can result in traumatic skin lesions.

(4) Nocturnal pruritus can result in chronic lack of sleep.



Associated Tumors

aquagenic pruritus

polycythemia vera, malignant lymphoma, myelodysplasia


malignant lymphoma, leukemia

transient acantholytic dermatosis (Grover's disease)

malignant lymphoma, leukemia



acrokeratosis paraneoplatica (Bazex syndrome)

carcinoma of the head and neck

malignant acanthosis nigricans

adenocarcinoma of the GI tract

generalized granuloma annular

malignant lymphoma, leukemia

freckles or seborrheic keratoses (sign of Leser-Trelat)

adenocarcinoma of the GI tract, malignant lymphoma, leukemia

paraneoplastic pemphigus



Drugs used to treat paraneoplastic pruritus may include:

(1) selective serotonin reuptake inhibitors (SSRI): paroxetine, sertaline

(2) tricyclic antidepressants: doxepin

(3) H1-antihistamines: hydroxyzine

(4) mu-opioid antagonists: naltrexone, butorphanol

(5) neuroleptics that inhibit the itch pathway: gabapentin, pregabalin

(6) neurokinin-1 inhibitor: aprepitant

(7) thalidomide

(8) selective alpha-2 adrenerigc receptor antagonist (SNRI): mirtazapine

(9) ultraviolet light therapy

(10) prednisone


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