Pruritus pp 73-79 | Cite as


  • Elke WeisshaarEmail author
  • Florence Dalgard


Epidemiology is the discipline concerned with disease frequency and the associations between risk factors and outcome in the population. This perspective is different from the clinical perspective and has the advantage to add information on risk factors for itch that cannot so easily be explored in patient populations. Itch is definitely the most frequent symptom of the skin. Clinical populations are highly selective and depend for instance on perceived severity of symptoms and access to health services. Patients with chronic diseases like e.g. atopic dermatitis, end stage renal disease, cholestasis and hematological as well as neurological and psychiatric diseases are frequently affected. The purpose of this chapter is to describe what we know about the distribution of itch in the general population and in selected patient populations.


Chronic kidney disease Community Epidemiology General population Itch Incidence Prevalence Pruritus Skin diseases 


  1. 1.
    Afifi Y, Azubin F, Puzenat E, et al. Pruritus sine materia: a prospective study of 95 patients. Rev Med Interne. 2004;25:490–3.CrossRefPubMedGoogle Scholar
  2. 2.
    Al-Mutari N, Zaki A, Sharma AK, et al. Cutaneous manifestations of diabetes mellitus. Med Princ Pract. 2006;15:427–30.CrossRefGoogle Scholar
  3. 3.
    Bhopal R, Hayes L, White M, et al. Ethnic and socio-economic inequalities in coronary heart disease, diabetes and risk factors in Europeans and South Asians. J Public Health Med. 2002;24:95–105.CrossRefPubMedGoogle Scholar
  4. 4.
    Bigby M, Jack S, Jick H, et al. Drug-induced cutaneous reactions. A report from the Boston Collaborative Drug Surveillance Program on 15,438 consecutive inpatients, 1975–1982. JAMA. 1986;256:3358–63.CrossRefPubMedGoogle Scholar
  5. 5.
    Bork K. Pruritus precipitated by hydroxyethyl starch: a review. Br J Dermatol. 2005;152:3–12.CrossRefPubMedGoogle Scholar
  6. 6.
    Brekke M, Hjortdahl P, Thelle DS, et al. Disease activity and severity in patients with rheumatoid arthritis: relations to socio-economic inequality. Soc Sci Med. 1999;48(12):1743–50.CrossRefPubMedGoogle Scholar
  7. 7.
    Brekke M, Hjortdahl P, Kvien TK. Severity of musculoskeletal pain: relations to socio-economic inequality. Soc Sci Med. 2002;54(2):221–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Dalgard F, Svensson A, Holm JO, et al. Self-reported skin complaints: validation of a questionnaire for population surveys. Br J Dermatol. 2003;149:794–800.CrossRefPubMedGoogle Scholar
  9. 9.
    Dalgard F, Svensson Å, Holm JØ, et al. Self-reported skin morbidity in Oslo: associations with socio-demographic factors among adults in a cross sectional study. Br J Dermatol. 2004;151:452–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Fett N, Haynes K, Propert KJ, Margolis DJ. Five-year malignancy incidence in patients with chronic pruritus: a population-based cohort study aimed at limiting unnecessary screening practices. J Am Acad Dermatol. 2014;70:651–8.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Halvorsen JA, Kupfer J, Dalgard F. The prevalence and intensity of itch among dermatological patients in 13 European countries. Abstract. Acta Derm Venereol. 2013;91:620.Google Scholar
  12. 12.
    Hajdarbegovic E, Thio HB. Itch pathophysiology may differ among ethnic groups. Int J Dermatol. 2012;51:771–6.CrossRefPubMedGoogle Scholar
  13. 13.
    Johannesdottir SA, Farkas DK, Vinding GR, Pedersen L, Lamberg A, Sorensen HT, et al. Cancer incidence among patients with a hospital diagnosis of pruritus: a nationwide Danish cohort study. Br J Dermatol. 2014;171:839–46.CrossRefPubMedGoogle Scholar
  14. 14.
    Kantor GR, Lookingbill DP. Generalised pruritus and systemic disease. J Am Acad Dermatol. 1983;9:375–82.CrossRefPubMedGoogle Scholar
  15. 15.
    Kaushik SB, Cerci FB, Miracle J, Pokharel A, Chen SC, Chan YH, Wilkin A, Yosipovitch G. Chronic pruritus in HIV-positive patients in the southeastern United States: its prevalence and effect on quality of life. J Am Acad Dermatol. 2014;70(4):659–64.CrossRefPubMedGoogle Scholar
  16. 16.
    Kopyciok ME, Ständer HF, Osada N, Steinke S, Ständer S. Prevalence and characteristics of pruritus: a one-week cross-sectional study in a German dermatology practice. Acta Derm Venereol. 2015. doi: 10.2340/00015555-2166.Google Scholar
  17. 17.
    Krueger G, Koo J, Lebwohl M, et al. The impact of psoriasis on quality of life. Results of a 1998 national psoriasis foundation patient membership survey. Arch Dermatol. 2001;137:280–4.PubMedGoogle Scholar
  18. 18.
    Lomholt G. Prevalence of skin diseases in a population; a census study from the Faroe islands. Dan Med Bull. 1964;11:1–7.PubMedGoogle Scholar
  19. 19.
    Macbeth HP, S. Health and ethnicity, vol. Chapter 4. London: Taylor and Francis; 2001.Google Scholar
  20. 20.
    Maleki K, Weisshaar E. Drug-induced pruritus. Hautarzt. 2014;65:436–42.CrossRefPubMedGoogle Scholar
  21. 21.
    Marmot MG, Adelstein AM, Bulusu L. Lessons from the study of immigrant mortality. Lancet. 1984;1(8392):1455–7.CrossRefPubMedGoogle Scholar
  22. 22.
    Marmot. Social Determinants of Health: Oxford University Press. 2001.Google Scholar
  23. 23.
    Marmot MG, Smith GD, Stansfeld S, et al. Health inequalities among British civil servants: the Whitehall II study. Lancet. 1991;337:1387–93.CrossRefPubMedGoogle Scholar
  24. 24.
    Matterne U, Strassner T, Apfelbacher CJ, et al. Measuring the prevalence of chronic itch in the general population: development and validation of a questionnaire for use in large-scale studies. Acta Derm Venereol. 2009;89(3):250–6.CrossRefPubMedGoogle Scholar
  25. 25.
    Matterne U, Apfelbacher CJ, Loerbroks A, et al. Prevalence, correlates and characteristics of chronic pruritus: a population-based cross-sectional study. Acta Derm Venereol. 2011;91(6):674–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Matterne U, Apfelbacher CJ, Vogelgsang L, Loerbroks, et al. Incidence and determinants of chronic pruritus: a population-based cohort study. Acta Derm Venereol. 2013;93(5):532–7.CrossRefPubMedGoogle Scholar
  27. 27.
    Meding B, Liden C, Berglind N. Self-diagnosed dermatitis in adults. Results from a population survey in Stockholm. Contact Dermatitis. 2001;45(6):341–5.CrossRefPubMedGoogle Scholar
  28. 28.
    Mistik S, Utas S, Ferahbas A, et al. An epidemiology study of patients with uremic pruritus. JEADV. 2006;20:672–8.PubMedGoogle Scholar
  29. 29.
    Murray CJ, Lopez AD. Global mortality, disability, and the contribution of risk factors: global burden of disease study. Lancet. 1997;349:1436–42.CrossRefPubMedGoogle Scholar
  30. 30.
    Nazroo JY. South Asian people and heart disease: an assessment of the importance of socio-economic position. Ethn Dis. 2001;11(3):401–11.PubMedGoogle Scholar
  31. 31.
    Neilly JB, Martin A, Simpson N, et al. Pruritus in diabetes mellitus: investigation of prevalence and correlation with diabetes control. Diabetes Care. 1986;9:273–5.CrossRefPubMedGoogle Scholar
  32. 32.
    Olayemi O, Fehintola FA, Osungbade A, et al. Pattern of chloroquin-induced pruritus in antenatal patients of the University College Hospital Ibadan. J Obstet Gynaecol. 2003;23:490–5.CrossRefPubMedGoogle Scholar
  33. 33.
    Oppenheimer GM. Paradigm lost: race, ethnicity, and the search for a new population taxonomy. Am J Public Health. 2001;91:1049–55.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Rea JN, Newhouse ML, Halil T. Skin disease in Lambeth. A community study of prevalence and use of medical care. Br J Prev Soc Med. 1976;30:107–14.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Reyes H, Gonzales MC, Ribalta J, et al. Prevalence or intrahepatic cholestais of pregnancy in Chile. Ann Int Med. 1978;88:487–93.CrossRefPubMedGoogle Scholar
  36. 36.
    Roger D, Vaillant L, Fignon A, et al. Specific pruritic dermatoses of pregnancy. A prospective study of 3,192 pregnant women. Arch Dermatol. 1994;130:734–9.CrossRefPubMedGoogle Scholar
  37. 37.
    Rook A. Textbook of dermatology, vol. 1, chapter 6. Malden: Blackwell Science; 1998.Google Scholar
  38. 38.
    Rose G. The Strategy of Preventive Medicine: Oxford University Press. 1992.Google Scholar
  39. 39.
    Schmidt E, Rose C, Mulyowa GK, et al. Dermatology at the University Hospital of Mbarara, Uganda. J Dtsch Dermatol Ges. 2004;2:920–7.CrossRefPubMedGoogle Scholar
  40. 40.
    Shanmugam S, Thappa DM, Habeebullah S. Pruritus gravidarum: a clinical and laboratory study. J Dermatol. 1998;25:582–6.CrossRefPubMedGoogle Scholar
  41. 41.
    Siegrist J, Marmot M. Health inequalities and the psychosocial environment – two scientific challenges. Soc Sci Med. 2004;58(8):1463–73.CrossRefPubMedGoogle Scholar
  42. 42.
    Ständer S, Schäfer I, Phan NQ, et al. Prevalence of chronic pruritus in Germany: results of a cross-sectional study in a sample working population of 11,730. Dermatology. 2010;221(3):229–35.CrossRefPubMedGoogle Scholar
  43. 43.
    Ständer S, Stumpf A, Osada N, et al. Gender differences in chronic pruritus: women present different morbidity, more scratch lesions and higher burden. Br J Dermatol. 2013;168(6):1273–80.CrossRefPubMedGoogle Scholar
  44. 44.
    Tey HL, Yosipovitch G. Itch in ethnic populations. Acta Derm Venereol. 2010;90:227–34.CrossRefPubMedGoogle Scholar
  45. 45.
    Thaipisuttikul Y. Pruritic skin diseases in the elderly. J Dermatol. 1998;25:153–7.CrossRefPubMedGoogle Scholar
  46. 46.
    Townsend P, Davidson N. The black report. London: Penguin; 1992.Google Scholar
  47. 47.
    Vlahov D, Galea S. Urban health: a new discipline. Lancet. 2003;362:1091–2.CrossRefPubMedGoogle Scholar
  48. 48.
    Valdes-Rodriguez R, Mollanazar NK, González-Muro J, Nattkemper L, Torres-Alvarez B, López-Esqueda FJ, Chan YH. Yosipovitch G. Itch prevalence and characteristics in a Hispanic geriatric population: a comprehensive study using a standardized itch questionnaire. Acta Derm Venereol. 2015;95:417–21.CrossRefPubMedGoogle Scholar
  49. 49.
    Weiss M, Mettang T, Tschulena U, Passlick-Deetjen J, Weisshaar E. Prevalence of chronic itch and associated factors in hemodialysis patients: a representative cross-sectional study. Acta Derm Venereol. 2015;98:816–21.Google Scholar
  50. 50.
    Weisshaar E, Apfelbacher CJ, Jäger 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
  51. 51.
    Weisshaar E, Dalgard F. The epidemiology of itch: adding to the burden of skin morbidity. Act Derm Venereol. 2009;89:339–50.CrossRefGoogle Scholar
  52. 52.
    Weisshaar E, Matterne U. Epidemiology of itch. In: Carstens E, Akiyama T, editors. Itch: mechanisms and treatment. Boca Raton: CRC Press; 2014. Chapter 2.Google Scholar
  53. 53.
    Weisshaar E, Weiss M, Passlick-Deetjen J, Tschulena U, Maleki K, Mettang T. Laboratory and dialysis characteristics in hemodialysis patients suffering from chronic itch–results from a representative cross-sectional study. BMC Nephrol. 2015;4;16:184Google Scholar
  54. 54.
    Yalçin B, Tamer E, Toy GG, et al. The prevalence of skin diseases in the elderly: analysis of 4,099 geriatric patients. Int J Dermatol. 2006;45:672–6.CrossRefPubMedGoogle Scholar
  55. 55.
    Yosipovitch G, Hodak E, Vardi P, et al. The prevalence of cutaneous manifestations in IDDM patients and their association with diabetes risk factors and microvasculature complications. Diabetes Care. 1998;21:506–9.CrossRefPubMedGoogle Scholar
  56. 56.
    Yosipovitch G, Goon A, Wee J, et al. The prevalence and clinical characteristics of pruritus among patients with extensive psoriasis. Br J Dermatol. 2000;143:969–73.CrossRefPubMedGoogle Scholar
  57. 57.
    Zirwas MJ, Seraly MP. Pruritus of unknown origin: a retrospective study. J Am Acad Dermatol. 2001;45:892–6.CrossRefPubMedGoogle Scholar
  58. 58.
    Zucker I, Yosipovitch G, David M et al. Prevalence and characterization of uremic pruritus in patients undergoing hemodialysis: Uremic pruritus is still a major problem for patients with end-stage renal disease. J Am Acad Dermatol 2003;49:842–46.Google Scholar

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© Springer-Verlag London 2016

Authors and Affiliations

  1. 1.Department of Clinical Social Medicine, Occupational and Environmental DermatologyUniversity Hospital, Ruprecht Karls Universit HeidelbergHeidelbergGermany
  2. 2.National Center for Dual DiagnosisInnlandet Hospital TrustOsloNorway
  3. 3.Department of DermatologyUniversity of OsloOsloNorway

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