American Journal of Clinical Dermatology

, Volume 17, Issue 6, pp 681–690 | Cite as

Itch in the General Internal Medicine Setting: A Cross-Sectional Study of Prevalence and Quality-of-Life Effects

  • Jonathan I. Silverberg
  • Keiki Hinami
  • William E. Trick
  • David Cella
Original Research Article



Itch is a well-established symptom in cutaneous disease. However, little is known about the burden of itch outside the dermatology setting.


To determine the prevalence and impact of itch on quality of life (QOL) in the general internal medicine setting.


We performed a cross-sectional study of 2076 adults from an outpatient general internal medicine clinic, using an audio computer-assisted self-administered interview. A history of itch (acute or chronic) and other physical symptoms in the past week, Patient-Reported Outcomes Measurement Information System (PROMIS) 10-item Global Health Questionnaire scores, and Patient Health Questionnaire-2 scores were assessed.


The prevalence of itch was 39.9 % and increased with age from 33.1 % at age 19–39 years to 45.9 % at age ≥80 years. In multivariable models controlled for socio-demographics, even feeling “a little” or “some” distress from itch was significantly associated with lower PROMIS global physical and mental health T-scores and estimated health utility scores (P ≤ 0.01). Further, feeling “quite a lot” of distress or “very much” distress from itch was associated with higher adjusted odds ratios for depressed mood (4.91 [95 % confidence interval (CI) 3.36–7.18]) and anhedonia (4.46 [95 % CI 3.07–6.47]). The patient burden of itch was similar to those of pain, constipation, sexual dysfunction, cough, and weight loss.


Itch occurs commonly in the primary care setting and is associated with poor QOL. Physicians should inquire about itch and its associations during review of systems. Future studies are needed to distinguish between the effects of acute and chronic itch.


Sexual Dysfunction General Internal Medicine National Ambulatory Medical Care Survey HRQOL Impairment Chronic Itch 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Author contributions

Study concept and design: Keiki Hinami, William Trick, and Jonathan Silverberg. Acquisition of data: Keiki Hinami, William Trick, and Jonathan Silverberg. Analysis and interpretation of data: Jonathan Silverberg, Keiki Hinami, and David Cella. Drafting of the manuscript: Jonathan Silverberg, David Cella, and Keiki Hinami. Critical revision of the manuscript for important intellectual content: Jonathan Silverberg, David Cella, William Trick, and Keiki Hinami. Statistical analysis: Jonathan Silverberg. Obtaining funding: Jonathan Silverberg, William Trick, and David Cella.

Compliance with Ethical Standards


This publication was made possible with support from the Dermatology Foundation and the Agency for Healthcare Research and Quality (AHRQ) Grant Numbers K12HS023011 and R24 HS19481-01 to support technology implementation.

Conflict of interest

Jonathan Silverberg, David Cella, William Trick, and Keiki Hinami have no conflicts of interest to declare.

Ethical approval/informed consent

This study was approved by the CCHHS institutional review board (protocol #14-096). All participants provided written informed consent for study participation.

Supplementary material

40257_2016_215_MOESM1_ESM.pdf (45 kb)
Supplementary material 1 (PDF 44 kb)


  1. 1.
    Silverberg JI, Garg NK, Paller AS, Fishbein AB, Zee PC. Sleep disturbances in adults with eczema are associated with impaired overall health: a US population-based study. J Invest Dermatol. 2015;135(1):56–66.CrossRefPubMedGoogle Scholar
  2. 2.
    Garg N, Silverberg JI. Association between childhood allergic disease, psychological comorbidity, and injury requiring medical attention. Ann Allergy Asthma Immunol. 2014;112(6):525–32.CrossRefPubMedGoogle Scholar
  3. 3.
    Garg N, Silverberg JI. Association between eczema and increased fracture and bone or joint injury in adults: a US population-based study. JAMA Dermatol. 2015;151(1):33–41.CrossRefPubMedGoogle Scholar
  4. 4.
    Valdes-Rodriguez R, Mollanazar NK, Gonzalez-Muro J, Nattkemper L, Torres-Alvarez B, Lopez-Esqueda FJ, et al. Itch prevalence and characteristics in a Hispanic geriatric population: a comprehensive study using a standardized itch questionnaire. Acta Derm Venereol. 2015;95(4):417–21.CrossRefPubMedGoogle Scholar
  5. 5.
    Gotthardt DN, Rupp C, Bruhin M, Schellberg D, Weiss KH, Stefan R, et al. Pruritus is associated with severely impaired quality of life in patients with primary sclerosing cholangitis. Eur J Gastroenterol Hepatol. 2014;26(12):1374–9.PubMedGoogle Scholar
  6. 6.
    Susel J, Batycka-Baran A, Reich A, Szepietowski JC. Uraemic pruritus markedly affects the quality of life and depressive symptoms in haemodialysis patients with end-stage renal disease. Acta Derm Venereol. 2014;94(3):276–81.CrossRefPubMedGoogle Scholar
  7. 7.
    Hinami K, Smith J, Deamant CD, Kee R, Garcia D, Trick WE. Health perceptions and symptom burden in primary care: measuring health using audio computer-assisted self-interviews. Qual Life Res. 2015;24(7):1575–83.CrossRefPubMedGoogle Scholar
  8. 8.
    Hays RD, Bjorner JB, Revicki DA, Spritzer KL, Cella D. Development of physical and mental health summary scores from the Patient-Reported Outcomes Measurement Information System (PROMIS) global items. Qual Life Res. 2009;18(7):873–80.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Revicki DA, Kawata AK, Harnam N, Chen WH, Hays RD, Cella D. Predicting EuroQol (EQ-5D) scores from the Patient-Reported Outcomes Measurement Information System (PROMIS) global items and domain item banks in a United States sample. Qual Life Res. 2009;18(6):783–91.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Schut C, Mollanazar NK, Kupfer J, Gieler U, Yosipovitch G. Psychological interventions in the treatment of chronic itch. Acta Derm Venereol. 2016;96(2):157–61.CrossRefPubMedGoogle Scholar
  11. 11.
    Shive M, Linos E, Berger T, Wehner M, Chren MM. Itch as a patient-reported symptom in ambulatory care visits in the United States. J Am Acad Dermatol. 2013;69(4):550–6.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Britt H, Pan Y, Miller GC, Valenti L, Charles J, Knox S, et al. Presentations of ‘itch’ in Australian general practice. Aust Fam Physician. 2004;33(7):488.PubMedGoogle Scholar
  13. 13.
    Verhoeven EW, Kraaimaat FW, van de Kerkhof PC, van Weel C, Duller P, van der Valk PG, et al. Prevalence of physical symptoms of itch, pain and fatigue in patients with skin diseases in general practice. Br J Dermatol. 2007;156(6):1346–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Jonathan I. Silverberg
    • 1
    • 2
  • Keiki Hinami
    • 3
  • William E. Trick
    • 3
  • David Cella
    • 4
  1. 1.Departments of Dermatology, Medical Social Sciences and Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoUSA
  2. 2.Northwestern Medicine Multidisciplinary Eczema CenterChicagoUSA
  3. 3.Collaborative Research Unit, Department of MedicineCook County Health and Hospitals SystemChicagoUSA
  4. 4.Department of Medical Social SciencesNorthwestern University Feinberg School of MedicineChicagoUSA

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