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.
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Condition
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Associated Tumors
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aquagenic pruritus
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polycythemia vera, malignant lymphoma, myelodysplasia
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erythroderma
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malignant lymphoma, leukemia
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transient acantholytic dermatosis (Grover's disease)
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malignant lymphoma, leukemia
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dermatomyositis
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carcinoma
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acrokeratosis paraneoplatica (Bazex syndrome)
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carcinoma of the head and neck
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malignant acanthosis nigricans
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adenocarcinoma of the GI tract
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generalized granuloma annular
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malignant lymphoma, leukemia
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freckles or seborrheic keratoses (sign of Leser-Trelat)
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adenocarcinoma of the GI tract, malignant lymphoma, leukemia
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paraneoplastic pemphigus
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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
