Advertisement

Pruritus pp 97-101 | Cite as

Measurement of Itch: Actigraphy

  • Toshiya EbataEmail author
Chapter

Abstract

Since pruritus is defined as an unpleasant sensation that provokes the desire to scratch, the assessment of scratching can provide indirect but objective data about itch intensity. Unlike scratching during the daytime, nocturnal scratching is expected to be less influenced by psychosocial factors so as to reflect the extent of itch more reliably. It is also less confounded by other body movements, which makes its measurement easier. Several methods have been devised to record nocturnal scratching since 1970s. Among them wrist actigraphy has advantages as being a portable lightweight device easily tolerated by patients, allowing for longitudinal recording at home with a simple method of data collection and analysis. The amount of wrist activity is reported to correlate with the amount of nocturnal scratching measured by video recording, subjective evaluation of itch, scoring of skin lesions of atopic dermatitis and serum levels of certain inflammatory cytokines, which suggest potential of actigraphy as a useful device to measure nocturnal scratching for the evaluation of itch. On the other hand it is challenged by inability of actigraphy to discriminate scratching from other body movements, discrepancy between the subjective score of itch and actigraphy values, and inter-individual variation in scratching.

Keywords

Actigraphy Accelerometer Measurement of itch Scratching Nocturnal scratching Measurement of scratching Atopic dermatitis Objective Wrist activity Sleep Chronic pruritus 

References

  1. 1.
    Stander S, Augustin M, Reich A, Blome C, Ebata T, Phan NQ, Szepietowski JC. Pruritus assessment in clinical trials: consensus recommendations from the International Forum for the Study of Itch (IFSI) Special Interest Group Scoring Itch in Clinical Trials. Acta Derm Venereol. 2013;93(5):509–14.CrossRefPubMedGoogle Scholar
  2. 2.
    Price AP, Cohen DE. Assessment of pruritus in patients with psoriasis and atopic dermatitis: subjective and objective tools. Dermatitis. 2014;25(6):334–44.CrossRefPubMedGoogle Scholar
  3. 3.
    Savin JA, Paterson WD, Oswald I. Scratching during sleep. Lancet. 1973;2:296–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Savin JA, Paterson WD, Oswald I, Adam K. Further studies of scratching during sleep. Br J Dermatol. 1976;94(2):179–89.CrossRefPubMedGoogle Scholar
  5. 5.
    Felix R, Shuster S. A new method for the measurement of itch and the response to treatment. Br J Dermatol. 1975;93(3):303–12.CrossRefPubMedGoogle Scholar
  6. 6.
    Summerfield JA, Welch ME. The measurement of itch with sensitive limb meters. Br J Dermatol. 1980;103(3):275–81.CrossRefPubMedGoogle Scholar
  7. 7.
    Aoki T, Kushimoto H, Hishikawa Y, Savin JA. Nocturnal scratching and its relationship to the disturbed sleep of itchy subjects. Clin Exp Dermatol. 1991;16(4):268–772.CrossRefPubMedGoogle Scholar
  8. 8.
    Endo K, Sumitsuji H, Fukuzumi T, Adachi J, Aoki T. Evaluation of scratch movements by a new scratch-monitor to analyze nocturnal itching in atopic dermatitis. Acta Derm Venereol. 1997;77(6):432–5.PubMedGoogle Scholar
  9. 9.
    Ebata T, Aizawa H, Kamide R. An infrared video camera system to observe nocturnal scratching in atopic dermatitis patients. J Dermatol. 1996;23(3):153–5.CrossRefPubMedGoogle Scholar
  10. 10.
    Ebata T, Aizawa H, Kamide R, Niimura M. The characteristics of nocturnal scratching in adults with atopic dermatitis. Br J Dermatol. 1999;141(1):82–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Talbot TL, Schmitt JM, Bergasa NV, Jones EA, Walker EC. Application of piezo film technology for the quantitative assessment of pruritus. Biomed Instrum Technol. 1991;25(5):400–3.PubMedGoogle Scholar
  12. 12.
    Bergasa NV, Alling DW, Talbot TL, Swain MG, Yurdaydin C, Turner ML, Schmitt JM, Walker EC, Jones EA. Effects of naloxone infusions in patients with the pruritus of cholestasis. A double-blind, randomized, controlled trial. Ann Intern Med. 1995;123(3):161–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Molenaar HA, Oosting J, Jones EA. Improved device for measuring scratching activity in patients with pruritus. Med Biol Eng Comput. 1998;36(2):220–4.CrossRefPubMedGoogle Scholar
  14. 14.
    Bijak M, Mayr W, Rafolt D, Tanew A, Unger E. Pruritometer 2: portable recording system for the quantification of scratching as objective criterion for the pruritus. Biomed Tech. 2001;46(5):137–41.CrossRefGoogle Scholar
  15. 15.
    Cole RJ, Kripke DF, Gruen W, Mullaney DJ, Gillin JC. Automatic sleep/wake identification from wrist activity. Sleep. 1992;15(5):461–9.PubMedGoogle Scholar
  16. 16.
    Ebata T, Iwasaki S, Kamide R, Niimura M. Use of a wrist activity monitor for the measurement of nocturnal scratching in patients with atopic dermatitis. Br J Dermatol. 2001;144(2):305–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Bender BG, Leung SB, Leung DY. Actigraphy assessment of sleep disturbance in patients with atopic dermatitis: an objective life quality measure. J Allergy Clin Immunol. 2003;111(3):598–602.CrossRefPubMedGoogle Scholar
  18. 18.
    Bender BG, Ballard R, Canono B, Murphy JR, Leung DY. Disease severity, scratching, and sleep quality in patients with atopic dermatitis. J Am Acad Dermatol. 2008;58(3):415–20.CrossRefPubMedGoogle Scholar
  19. 19.
    Benjamin K, Waterson K, Russel M, Schofield O, Diffey B, Rees JL. The development of an objective method for measuring scratch in children with atopic dermatitis suitable for clinical use. J Am Acad Dermatol. 2004;50(1):33–40.CrossRefPubMedGoogle Scholar
  20. 20.
    Bringhurst C, Waterson K, Schofield O, Benjamin K, Rees JL. Measurement of itch using actigraphy in pediatric and adult populations. J Am Acad Dermatol. 2004;51(6):893–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Hon KL, Lam MC, Leung TF, Kam WY, Lee KC, Li MC, Fok TF, Ng PC. Nocturnal wrist movements are correlated with objective clinical scores and plasma chemokine levels in children with atopic dermatitis. Br J Dermatol. 2006;154(4):629–35.CrossRefPubMedGoogle Scholar
  22. 22.
    Sandoval LF, Huang K, O’Neill JL, Gustafson CJ, Hix E, Harrison J, Clark A, Buxton OM, Feldman SR. Measure of atopic dermatitis disease severity using actigraphy. J Cutan Med Surg. 2014;18(1):49–55.PubMedGoogle Scholar
  23. 23.
    Fujita H, Nagashima M, Takeshita Y, Aihara M. Correlation between nocturnal scratch behavior assessed by actigraphy and subjective/objective parameters in patients with atopic dermatitis. Eur J Dermatol. 2014;24(1):120–2.PubMedGoogle Scholar
  24. 24.
    Hon KL, Lam MC, Leung TF, Chou CM, Wong E, Leung AK. Assessing itch in children with atopic dermatitis treated with tacrolimus: objective versus subjective assessment. Adv Ther. 2007;24(1):23–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Kobayashi S, Hayashi K, Koyama S, Tsubaki H, Itano T, Momomura M, Koyama T, Yanagawa Y. Actigraphy for the assessment of sleep quality in pediatric atopic dermatitis patients. Arerugi. 2010;59(6):706–15.PubMedGoogle Scholar
  26. 26.
    Chang YS, Chou YT, Lee JH, Lee PL, Dai YS, Sun C, Lin YT, Wang LC, Yu HH, Yang YH, Chen CA, Wan KS, Chiang BL. Atopic dermatitis, melatonin, and sleep disturbance. Pediatrics. 2014;134(2):e397–405.CrossRefPubMedGoogle Scholar
  27. 27.
    Sack R, Hanifin J. Scratching below the surface of sleep and itch. Sleep Med Rev. 2010;14(6):349–50.CrossRefPubMedGoogle Scholar
  28. 28.
    Murray CS, Rees JL. Are subjective accounts of itch to be relied on? The lack of relation between visual analogue itch scores and actigraphic measures of scratch. Acta Derm Venereol. 2011;91(1):18–23.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Wootton CI, Koller K, Lawton S, O’Leary C, Thomas KS, SWET study team. Are accelerometers a useful tool for measuring disease activity in children with eczema? Validity, responsiveness to change, and acceptability of use in a clinical trial setting. Br J Dermatol. 2012;167(5):1131–7.CrossRefPubMedGoogle Scholar
  30. 30.
    Feuerstein J, Austin D, Sack R, Hayes TL. Wrist actigraphy for scratch detection in the presence of confounding activities. Conf Proc IEEE Eng Med Biol Soc. 2011;2011:3652–5.PubMedGoogle Scholar
  31. 31.
    Noro Y, Omoto Y, Umeda K, Tanaka F, Shiratsuka Y, Yamada T, Isoda K, Matsubara K, Yamanaka K, Gabazza EC, Nishikawa M, Mizutani H. Novel acoustic evaluation system for scratching behavior in itching dermatitis: rapid and accurate analysis for nocturnal scratching of atopic dermatitis patients. J Dermatol. 2014;41(3):233–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Kogure T, Shirakawa S, Shimokawa M, Hosokawa Y. Automatic sleep/wake scoring from body motion in bed: validation of a newly developed sensor placed under a mattress. J Physiol Anthropol. 2011;30(3):103–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag London 2016

Authors and Affiliations

  1. 1.Department of DermatologyThe Jikei University School of MedicineTokyoJapan
  2. 2.Chitofuna Dermatology ClinicTokyoJapan

Personalised recommendations