Article previously published in the Cutaneous Lymphoma Foundation's Forum Winter 2011 newsletter.
Cutaneous T-cell lymphoma (CTCL), including mycosis fungoides and Sézary syndrome forms, is a complex disease that can cause affected patients to suffer multiple annoying symptoms. Patients and providers alike know that a comprehensive treatment plan must also include a discussion on how to manage the associated aggravating skin symptoms like itch, burning, redness, and scaling.
The degree to which a patient experiences these problems can vary from day to day – and sometimes even from hour to hour. Herein are some suggestions on skin care to help patients stay as comfortable as possible while disease-specific treatments are being tried. We share with you these tips that we have gathered from our experience treating CTCL patients, and also from listening to our patients with CTCL.
CTCL, as well as some of the treatments for CTCL, can make skin dry, itchy and scaly. Adequate moisturizing is a key part of keeping skin healthy, by improving the barrier function, as well as keeping it comfortable. If the dryness can be decreased, then often much of the itching can also be alleviated. A simple and effective way to decrease skin dry - ness is frequent application of moisturizers (also known as emollients). With so many different moisturizers on the market today, it may be difficult to decide which ones to use. Here are some tips to follow when making a trip to the drug store:
BATHING / SHOWERING
Excessively hot water can temporarily relieve itch, but it is not recommended because it may aggravate the skin and actually worsen itch in the long run. Hot water can be irritating and may remove natural oils from your skin that help to keep it well hydrated. We suggest using lukewarm water for bathing and showing. Keep baths and showers brief, no longer than 15 minutes. Use mild, fragrance-free soaps or cleansers.
The best time to apply emollients to the skin is after a bath or shower, while the skin is still slightly moist. Applying a moisturizer (or a topical medication in an emollient) on damp skin will help seal the hydration into outer layers of your skin. To achieve this, gently dry your skin with a towel, making sure to leave skin slightly damp. Then, while the skin is still slightly damp, apply the emollient.
CONTROLLING THE ITCH
The medical term for itching is ‘pruritus.’ The body’s natural response to an itch is to scratch it. Scratching an itch can feed the ‘itch-scratch cycle’ – an itch demands a scratch, and the scratch further irritates the skin and stimulates more itching. An itch can be a minor annoyance that goes away with a few scratches, or it can be an overwhelming and all-consuming sensation that does not respond to scratching. Scratching can worsen the irritation and prolonged scratching worsens the itch in the long run. Therefore, minimizing the scratching can help minimize the itching in patients with CTCL. (But, of course, this is easier said than done!)
Doctors will often prescribe medications to try to help patients control their itch. In addition, there are several strategies to try when a patient just cannot seem to stop scratching. Patients can try over-the-counter moisturizers that contain antipruritics such as menthol, chamomile, oatmeal, and capsaicin. (Some of these can be irritating for certain patients, so check with your doctor first.) Try soaking for 15 minutes in an oatmeal bath. Applying a cold compress to a particularly itchy area can calm irritation and reduce the urge to itch. ‘Open-wet dressings’ (OWD) are a simple, safe, and very effective way to help alleviate itch, as well as decrease redness, burning and weeping of skin lesions. To perform an OWD, use a single thickness of thin white cotton material, such as a twin-sized flat sheet, pillow case, or light weight pajamas. Place the material under warm tap water. Squeeze out excess water, but do not completely wring dry. Unravel material and cover the affected areas with a single layer of dressing. Do not wrap the material around the area; simply lay it loosely over the involved skin. Allow the material to remain on the skin for 10 to 15 minutes. Remove the material and apply moisturizer (or topical medication, if your doctor recommends it). Perform the above routine two to four times a day as needed for itching.
Other tips to follow for keeping skin comfortable include: wearing loose-fitting, comfortable fabrics that ‘breathe.’ Cotton fabrics are best. Avoid rough, scratchy fabrics like wool. Avoid clothing that fits too tightly. Do not scrub the skin or rub harshly. Keep fingernails short to prevent infection and skin damage. Avoid getting over-heated. Sweating can worsen the itch. Find ways to manage stress as stress can trigger flare-ups in CTCL and cause itching to increase. We hope you find one or more of these suggestions helpful. Please keep in mind that different strategies work well for different skin types and different patients.
Michael Girardi, MD, Associate Professor of Dermatology, Director, Residency Program, Yale University School of Medicine