Pruritus Associated With Skin Conditions Increases Burden on Patients’ Quality of Life

Pruritus is highly prevalent across several chronic dermatoses, and increased intensity of this symptom greatly affects impairment in many areas of patients’ daily functioning, according to study findings published in the Journal of the American Academy of Dermatology.

A total of 800 adult patients with active chronic skin diseases were recruited into this study from a dermatology department in Germany. Pruritus intensity was assessed on a 10 cm visual analogue scale (VAS). In addition, localization of pruritus was also assessed. Validated self-reported questionnaires were used to assess patients’ quality of life, work productivity, activity impairment, depression, anxiety, and sleep quality.

Dermatoses across all patients included chronic spontaneous urticaria (n=143), psoriasis (n=138), atopic dermatitis (AD; n=129), chronic inducible urticaria (n=76), chronic prurigo (n=75), primary cutaneous T-cell lymphoma (n=68), mastocytosis (n=54), chronic pruritus on primary unaltered skin (n=30), parapsoriasis en plaque (n=29), primary cutaneous B-cell lymphoma (n=26), bullous pemphigoid (n=15), lichen planus (n=11), and urticarial vasculitis (n=6).

About 89.4% – or 1 in 10 patients – said they experienced pruritus throughout their skin disease. Approximately 73% of patients indicated that they experienced pruritus in the past 7 days. Women reported significantly more intense pruritus (median VAS, 6.1 vs 5.2; P =.001) and more maximal pruritus (median VAS, 7.5 vs 6.8; P =.004).

Generalized pruritus that involved the entire body was reported by 45.2% of patients with AD and 37.8% of patients with CSU. More impairments to sleep quality and work productivity were reported by patients with moderate to severe pruritus. Also, compared with a control population, patients with pruritus more often had depression and experienced anxiety.

Approximately 13% of patients with strong pruritus and 18% of patients with very strong pruritus reported they had suicidal ideations due to pruritus in the past. Patients with past suicidal ideations due to their pruritus reported significantly higher levels of depression compared with patients without past suicidal ideations (P <.001). In addition, patients with suicidal ideations more frequently reported anxiety compared with patients without suicidal ideations (P <.001).

Limitations of this study were the inclusion of only patients from a tertiary dermatologic clinic as well as the variation in numbers of patients across the different skin condition groups.

The investigators noted that patients with skin conditions and concomitant pruritus should “be adequately monitored and managed using a multidisciplinary approach to treat the primary underlying cause of the disease alongside the dermatologic, emotional, and physical aspects.”

Disclosure: This clinical trial was supported by Novartis and Leo Pharma. Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Hawro T, Przybyłowicz K, Spindler M, et al. The characteristics and impact of pruritus in adult dermatologic patients: A prospective, cross-sectional study. J Am Acad Dermatol. Published online August 13, 2020. doi:10.1016/j.jaad.2020.08.035