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Pruritus pp 289-294 | Cite as

The Burden of Itch

  • Florence DalgardEmail author
  • Jörg Kupfer
  • Laurent Misery
Chapter

Abstract

The burden of disease refers to the impact of a health problem in terms of financial cost, morbidity, or other indicators. Itch is a major symptom from the skin and few studies have assessed the burden of pruritus. The impact of itch on the lives of individuals is reflected by studies on quality of life. Those studies are important because they show the burden from a patient perspective. Quality of life can be assessed in different ways both with generic and more specific instruments such as the new itch specific quality of life ItchyQoL, a promising instrument that will soon be available in many languages. Psychological factors such as personality also play a role for how burdensome itch is perceived in an individual. Recently the burden of skin symptoms has been highlighted by the demonstration of the association of mood disorders such as anxiety and depression with itch. Also in experimental settings induced negative emotions may increase the sensation of itch and insights in neuroimmunology has improved our understanding of stress and itch. Nevertheless further studies are needed to explore the relation between itch and stress factors. On the whole the burden of itch is still poorly recognized and future research exploring interactions between pruritus and psychological factors is highly needed.

Keywords

Quality of life Stress Psychological Mental Burden 

References

  1. 1.
    Prüss-Ustün A, Corvalán C. Preventing disease through healthy environment: towards an estimate of the environmental burden of disease.Quantifying environmental health impacts. World Health Organization.Google Scholar
  2. 2.
    Kay D, Prüss A, Corvalán C. Methodlogy fo assessment of environmental burden of disease. ISEE session on environmental burden of disease. Buffalo; 2000.Google Scholar
  3. 3.
    Prüss-Üstün A, Mathers C, Corvalán C, Woodward A. Assessing the environmental burden of disease at national and local levels: introduction and methods, WHO Environmental Burden of Disease Series, vol. 1. Geneva: World Health Organization; 2003.Google Scholar
  4. 4.
    Snauwaert JJL, Yuen WY, Jonkman MF, Moons P, Naulaers G, Morren MA. Burden of itch in epidermolyis bullosa. Br J Dermatol. 2014;171:73–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Hagstrom EL, Patel S, Karimkhani C, Boyers LN, Williams HC, Hay RJ, Weinstock MA, Armstrong AW, Dunnick CA, Margolis DJ, Dellavalle RP. Comparing cutaneous research funded by the US National Institutes of Health (NIH) with the US skin disease burden. J Am Acad Dermatol. 2015;73:383–91.CrossRefPubMedGoogle Scholar
  6. 6.
    Ständer S, Zeidler C, Riepe C, Steinke S, Fritz F, Bruland P, Soto-Rey I, Storck M, Agner T, Augustin M, Blome C, Dalgard F, Evers Aw, Garcovich S, Gonçalo M, Lambert J, Legat Fj, Leslie T, Misery L, Raap U, Reich A, Şavk E, Streit M, Serra-Baldrich E, Szepietowski J, Wallengren J, Weisshaar E, Dugas M. European eadv network on assessment of severity and burden of pruritus (PruNet): first meeting on outcome tools. J Eur Acad Dermatol Venereol; Sep 15 Epub.Google Scholar
  7. 7.
    Valery PC, Powell E, Moses N, et al. Systematic review: unmet supportive care needs in people diagnosed with chronic liver disease. BMJ Open. 2015;5:e007451.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Moberg C, Alderling M, Meding B. Hand eczema and quality of life: a population-based study. Br J Dermatol. 2009;161:397–403.CrossRefPubMedGoogle Scholar
  9. 9.
    Finlay AY. The burden of skin disease: quality of life, economic aspects and social issues. Clin Med. 2009;9:592–4.CrossRefGoogle Scholar
  10. 10.
    Finlay AY. Quality of life measurement in dermatology: a practical guide. Br J Dermatol. 1997;136:305–14.CrossRefPubMedGoogle Scholar
  11. 11.
    Chren MM. The Skindex instruments to measure the effects of skin disease on quality of life. Dermatol Clin. 2012;30:231–6, xiii.CrossRefPubMedGoogle Scholar
  12. 12.
    Ofenloch RF, Diepgen TL, Weisshaar E, et al. Assessing health-related quality of life in hand eczema patients: how to overcome psychometric faults when using the dermatology life quality index. Acta Derm Venereol. 2014;94:658–62.CrossRefPubMedGoogle Scholar
  13. 13.
    Ofenloch RF, Weisshaar E, Dumke AK, et al. The Quality of Life in Hand Eczema Questionnaire (QOLHEQ): validation of the German version of a new disease-specific measure of quality of life for patients with hand eczema. Br J Dermatol. 2014;171:304–12.CrossRefPubMedGoogle Scholar
  14. 14.
    Hay RJ, Johns NE, Williams HC, et al. The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions. J Invest Dermatol. 2014;134:1527–34.CrossRefPubMedGoogle Scholar
  15. 15.
    Dalgard FJ, Gieler U, Tomas-Aragones L, et al. The psychological burden of skin diseases: a cross-sectional multicenter study among dermatological out-patients in 13 European countries. J Invest Dermatol. 2015;135:984–91.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Weisshaar E, Apfelbacher C, Jager G, et al. Pruritus as a leading symptom: clinical characteristics and quality of life in German and Ugandan patients. Br J Dermatol. 2006;155:957–64.CrossRefPubMedGoogle Scholar
  17. 17.
    Warlich B, Fritz F, Osada N, et al. Health-related quality of life in chronic pruritus: an analysis related to disease etiology, clinical skin conditions and itch intensity. Dermatology. 2015;31(3):253–9.Google Scholar
  18. 18.
    Janowski K, Steuden S, Bogaczewicz J. Clinical and psychological characteristics of patients with psoriasis reporting various frequencies of pruritus. Int J Dermatol. 2014;53:820–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Verhoeven EW, de Klerk S, Kraaimaat FW, et al. Biopsychosocial mechanisms of chronic itch in patients with skin diseases: a review. Acta Derm Venereol. 2008;88:211–8.PubMedGoogle Scholar
  20. 20.
    Ruppert L, Apfelbacher C, Molin S, et al. Itching in patients with chronic hand eczema: data from the CARPE registry. Dermatology. 2014;229:146–53.CrossRefPubMedGoogle Scholar
  21. 21.
    Susel J, Batycka-Baran A, Reich A, et al. Uraemic pruritus markedly affects the quality of life and depressive symptoms in haemodialysis patients with end-stage renal disease. Acta Derm Venereol. 2014;94:276–81.CrossRefPubMedGoogle Scholar
  22. 22.
    Beynon T, Radcliffe E, Child F, et al. What are the supportive and palliative care needs of patients with cutaneous T-cell lymphoma and their caregivers? A systematic review of the evidence. Br J Dermatol. 2014;170:599–608.CrossRefPubMedGoogle Scholar
  23. 23.
    Dalgard F, Svensson A, Holm JO, et al. Self-reported skin morbidity among adults: associations with quality of life and general health in a Norwegian survey. J Investig Dermatol Symp Proc. 2004;9:120–5.CrossRefPubMedGoogle Scholar
  24. 24.
    Carr CW, Veledar E, Chen SC. Factors mediating the impact of chronic pruritus on quality of life. JAMA Dermatol. 2014;150:613–20.CrossRefPubMedGoogle Scholar
  25. 25.
    Krause K, Kessler B, Weller K, et al. German version of itchy QoL: validation and initial clinical findings. Acta Derm Venereol. 2013;93:562–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Caspi A, Roberts BW, Shiner RL. Personality development: stability and change. Ann Rev Psychol. 2005;56:453–84.CrossRefGoogle Scholar
  27. 27.
    White A, Horne Dj De L, Varigos GA. Psychological profile of the atopic eczema patient. Australas J Dermatol. 1990;31:13–6.CrossRefPubMedGoogle Scholar
  28. 28.
    Al-Ahmar HF, Kurban AK. Psychological profile of patients with atopic dermatitis. Br J Dermatol. 1976;95:373–7.CrossRefGoogle Scholar
  29. 29.
    Ginsburg IH, Prystowksy JH, Kornfeld DS, Wolland H. Role of emotional factors in adults with atopic dermatitis. Int J Dermatol. 1993;32:656–60.CrossRefPubMedGoogle Scholar
  30. 30.
    Jordan JM, Whitlock FA. Emotions and the skin: the conditioning of scratch responses in cases of atopic dermatitis. Br J Dermatol. 1972;86:574–85.CrossRefPubMedGoogle Scholar
  31. 31.
    Conrad R, Geiser F, Haidl G, Hutmacher M, Liedtke R, Wermter F. Relationship between anger and pruritus perception in patients with chronic idiopathic urticaria and psoriasis. J Eur Acad Dermatol Venereol. 2008;22:1062–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Schneider G, Hockmann J, Stander S, Luger TA, Heuft G. Psychological factors in prurigo nodularis in comparison with psoriasis vulgaris: results of a case-control study. Br J Dermatol. 2006;154:61–6.CrossRefPubMedGoogle Scholar
  33. 33.
    Misery L. Psychogenic pruritus or functional itch disorder. Expert Rev Dermatol. 2008;3:49–53.CrossRefGoogle Scholar
  34. 34.
    van Laarhoven AIM, Kraaimaat FW, Wilder-Smith OH, Evers AWM. Role of attentional focus on bodily sensations in sensitivity to itch and pain. Acta Derm Venereol. 2010;90:46–51.CrossRefPubMedGoogle Scholar
  35. 35.
    Chrostowska-Plak D, Reich A, Szepietowski JC. Relationship between itch and psychological status of patients with atopic dermatitis. J Eur Acad Dermatol Venereol. 2013;27:239–42.CrossRefGoogle Scholar
  36. 36.
    Gupta MA, Gupta AK, Schork NJ, Ellis CN. Depression modulates pruritus perception: a study of pruritus in psoriasis, atopic dermatitis, and chronic idiopathic urticaria. Psychosom Med. 1994;56:6–40.CrossRefGoogle Scholar
  37. 37.
    Verhoeven EWM, Kraaimaat F, Duller P, et al. Cognitive, behavioral, and physiological reactivity to chronic itching: analogies to chronic pain. Int J Behav Med. 2006;13:237–43.CrossRefPubMedGoogle Scholar
  38. 38.
    Schneider G, Driesch G, Heuft G, Evers S, Luger TA, Stander S. Psychosomatic cofactors and psychiatric comorbidity in patients with chronic itch. Clin Dermatol. 2006;31:762–7.CrossRefGoogle Scholar
  39. 39.
    Evers AW, Lu Y, Duller P, Van Der Valk PG, Kraaimaat FW, van de Kerkhof PC. Common burden of chronic skin diseases? Contributors to psychological distress in adults with psoriasis and atopic dermatitis. Br J Dermatol. 2005;152:1275–81.CrossRefPubMedGoogle Scholar
  40. 40.
    Gieler U, Niemeier V, Brosig B, Kupfer J. Psychosomatic aspects of pruritus. Dermatol Psychosom. 2002;3:6–13.CrossRefGoogle Scholar
  41. 41.
    Sheehan-Dare RA, Henderson MJ, Cotterill JA. Anxiety and depression in patients with chronic urticaria and generalized pruritus. Br J Dermatol. 1990;123:769–74.CrossRefPubMedGoogle Scholar
  42. 42.
    van Os-Medendorp H, Eland-De Kok PCM, Grypdonck M, Bruinzeel-Koomen CAFM, Ros WJG. Prevalence and predictors of psychosocial morbidity in patients with chronic pruritic skin diseases. J Eur Acad Dermatol Venereol. 2006;20:810–7.PubMedGoogle Scholar
  43. 43.
    Picardi A, Abeni D, Melchi CE, Pasquini P. Psychiatric morbidity in dermatological outpatients. An issue to be recognized. Br J Dermatol. 2000;143:983–91.CrossRefPubMedGoogle Scholar
  44. 44.
    Scholz OB, Hermanns N. Krankheitsverhalten und Kognitionen beeinflussen die Juckreiz-Wahrnehmung von Patienten mit atopischer Dermatitis. Z Klin Psychol. 1994;23:127–35.Google Scholar
  45. 45.
    van Laarhoven A, Walker AL, Wilder-Smith OH, Kroeze S, van Riel PLCM, van de Kerkhof PCM, et al. Role of induced negative and positive emotions in sensitivity to itch and pain in women. Br J Dermatol. 2012;167:262–9.CrossRefPubMedGoogle Scholar
  46. 46.
    Verhoeven EWM, Kraaimaat FW, de Jong EMGJ, Schalkwijk J, van de Kerkhof PCM, Evers AWM. Individual differences in the effect of daily stressors on psoriasis: a prospective study. Br J Dermatol. 2009;161:295–9.CrossRefPubMedGoogle Scholar
  47. 47.
    Schut C, Bosbach S, Gieler U, Kupfer J. Personality traits, depression and itch in patients with atopic dermatitis in an experimental setting: a regression analysis. Acta Derm Venereol. 2014;94:20–5.CrossRefPubMedGoogle Scholar
  48. 48.
    Schut C, Muhl S, Reinisch K, Claßen A, Jäger R, Gieler U, Kupfer J. Agreeableness and self-consciousness as predictors of induced scratching and itch in patients with psoriasis. Int J Behav Med. 2015. doi: 10.1007/s12529-015-9471-5.PubMedGoogle Scholar
  49. 49.
    Paus R, Schmelz M, Biro T, Steinhoff M. Frontiers in pruritus research: scratching the brain for more effective itch therapy. J Clin Invest. 2006;116:1174–85.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Edwards AE, Shellon WV, Wright ET, Dignam TF. Pruritic skin diseases, psychological stress and the itch sensation. A reliable method for the induction of experimental pruritus. Arch Dermatol. 1976;112:339–43.CrossRefPubMedGoogle Scholar
  51. 51.
    Gupta MA, Gupta AK, Kirby S, Weiner HK, Mace TM, Schork NJ. Pruritus in psoriasis: a prospective study of some psychiatric and dermatologic correlates. Arch Dermatol. 1988;124:1052–7.CrossRefPubMedGoogle Scholar
  52. 52.
    Gupta MA, Gupta AK. Stressful major life events are associated with a higher frequency of cutaneous sensory symptoms: an empirical study of non-clinical subjects. J Eur Acad Dermatol Venereol. 2004;18:560–5.CrossRefPubMedGoogle Scholar
  53. 53.
    Dalgard F, Svensson A, Sundby J, Dalgard OS. Self-reported skin morbidity and mental health. A population survey among adults in a Norwegian city. Br J Dermatol. 2005;153:145–9.CrossRefPubMedGoogle Scholar
  54. 54.
    Niemeier V, Nippesen M, Kupfer J, Schill WB, Gieler U. Psychological factors associated with hand dermatoses: which subgroup needs additional psychological care ? Br J Dermatol. 2002;146:1031–7.CrossRefPubMedGoogle Scholar
  55. 55.
    Zachariae R, Zachariae A, Blomqvist K, Davidsson S, Molin L, Mork C. Self-reported stress reactivity and psoriasis-related stress of Nordic psoriasis sufferers. J Eur Acad Dermatol Venereol. 2004;18:27–36.CrossRefPubMedGoogle Scholar
  56. 56.
    Grandgeorge M, Misery L. Mediators of the relationship between stress and itch. Exp Dermatol. 2015;24:334–5.CrossRefPubMedGoogle Scholar
  57. 57.
    Peng XY, Huang Y, Wang XL, Cao LF, Chen LH, Luo WF, Liu T. Adrenergic β2-receptor mediates itch hypersenistivity following heterotypic chronic stress in rats. Neuroreport. 2015;26:1003–10.CrossRefPubMedGoogle Scholar
  58. 58.
    Schut C, Weik U, Tews N, Gieler U, Deinzer R, Kupfer J. Coping as a mediator of the relationship between stress and itch in patients with atopic dermatitis: a regression and mediation analysis. Exp Dermatol. 2015;24:148–50.CrossRefPubMedGoogle Scholar
  59. 59.
    Zachariae R, Zachariae COC, Lei U, Pedersen AF. Affective and sensory dimensions of pruritus severity: associations with psychological symptoms and quality of life in psoriasis patients. Acta Derm Venereol. 2008;88:121–7.CrossRefPubMedGoogle Scholar
  60. 60.
    Mazeh D, Melamed Y, Cholostoy A, Aharonovitzch V, Weizman A, Yosipovitch G. Itching in the psychiatric ward. Acta Derm Venereol. 2008;88:128–31.CrossRefPubMedGoogle Scholar
  61. 61.
    Schut C, Mollanazar Nk, Kupfer J, Gieler U, Yosıpovitch G. Pscyhological interventions in the treatment of chronic itch. Acta Derm Venereol. 2016;96(2):157–61.Google Scholar

Copyright information

© Springer-Verlag London 2016

Authors and Affiliations

  • Florence Dalgard
    • 1
    • 2
    Email author
  • Jörg Kupfer
    • 3
  • Laurent Misery
    • 4
  1. 1.National Center for Dual DiagnosisInnlandet Hospital TrustBrumundalNorway
  2. 2.Department of DermatologyUniversity Hospital of OsloOsloNorway
  3. 3.Institute of Medical PsychologyJustus Liebig UniversityGiessenGermany
  4. 4.Laboratory of Neurosciences of Brest, Department of DermatologyUniversity Hospital, University of BrestBrestFrance

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