A Qualitative Tool to Guide in the Interpretation of the Numerical Rating Scale for Pruritus Intensity in Patients with Atopic Dermatitis
DOI:
https://doi.org/10.2340/actadv.v104.18255Keywords:
atopic dermatitis, atopic eczema, pruritus, quality of life, rating scaleAbstract
Atopic dermatitis is a cutaneous inflammatory disease characterized by intense pruritus, which is often underestimated despite its direct impact on patients’ health-related quality of life and the high burden it poses. The authors’ goal was to design a qualitative tool to guide patients and healthcare professionals in their assessment and interpretation of pruritus intensity using a numerical rating scale. The draft of this tool, henceforth “guideline”, was developed based on a systematic literature review and focus groups comprising patients and a scientific committee. This draft was validated with an independent group of patients and the final version was designed following their feedback. According to the results of the systematic review, pruritus impacts 6 health-related quality of life domains: sleep quality; emotional status; overall health-related quality of life; physical function; social/sexual activity; productivity, particularly affecting sleep quality and the emotional domain. Patients considered that physical function was the most strongly affected domain, followed by sleep quality and emotional well-being, establishing that a minimum pruritus intensity of 4 and 7 points impacts moderately and severely, respectively, on the different domains of patients’ health- related quality of life. The guideline may help patients and healthcare professionals to interpret and assess pruritus intensity using a numerical rating scale and to understand the impact of pruritus on patients’ health-related quality of life.
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References
Weidinger S, Novak N. Atopic dermatitis. Lancet 2016; 387: 1109-1122.
https://doi.org/10.1016/S0140-6736(15)00149-X DOI: https://doi.org/10.1016/S0140-6736(15)00149-X
Silverberg JI, Feldman SR, Smith Begolka W, Johnson MB, Stanojev C, DiBonaventura M, et al. Patient perspectives of atopic dermatitis: comparative analysis of terminology in social media and scientific literature, identified by a systematic literature review. J Eur Acad Dermatol Venereol 2022; 36: 1980-1990.
https://doi.org/10.1111/jdv.18442 DOI: https://doi.org/10.1111/jdv.18442
Eckert L, Gupta S, Gadkari A, Mahajan P, Gelfand JM. Burden of illness in adults with atopic dermatitis: analysis of National Health and Wellness Survey data from France, Germany, Italy, Spain, and the United Kingdom. J Am Acad Dermatol 2019; 81: 187-195.
https://doi.org/10.1016/j.jaad.2019.03.037 DOI: https://doi.org/10.1016/j.jaad.2019.03.037
Weidinger S, Beck LA, Bieber T, Kabashima K, Irvine AD. Atopic dermatitis. Nat Rev Dis Primers 2018; 4: 1.
https://doi.org/10.1038/s41572-018-0001-z DOI: https://doi.org/10.1038/s41572-018-0001-z
Silverberg JI. Atopic dermatitis in adults. Med Clin North Am 2020; 104: 157-176.
https://doi.org/10.1016/j.mcna.2019.08.009 DOI: https://doi.org/10.1016/j.mcna.2019.08.009
Langan SM, Irvine AD, Weidinger S. Atopic dermatitis. Lancet 2020; 396: 345-360.
https://doi.org/10.1016/S0140-6736(20)31286-1 DOI: https://doi.org/10.1016/S0140-6736(20)31286-1
Simpson EL, Bieber T, Eckert L, Wu R, Ardeleanu M, Graham NM, et al. Patient burden of moderate to severe atopic dermatitis (AD): insights from a phase 2b clinical trial of dupilumab in adults. J Am Acad Dermatol 2016; 74: 491-498.
https://doi.org/10.1016/j.jaad.2015.10.043 DOI: https://doi.org/10.1016/j.jaad.2015.10.043
Sicras-Mainar A, Navarro-Artieda R, Armario-Hita JC. Severe atopic dermatitis in Spain: a real-life observational study. Ther Clin Risk Manag 2019; 15: 1393-1401.
https://doi.org/10.2147/TCRM.S226456 DOI: https://doi.org/10.2147/TCRM.S226456
Barbarot S, Auziere S, Gadkari A, Girolomoni G, Puig L, Simpson EL, et al. Epidemiology of atopic dermatitis in adults: results from an international survey. Allergy 2018; 73: 1284-1293.
https://doi.org/10.1111/all.13401 DOI: https://doi.org/10.1111/all.13401
Kaaz K, Szepietowski JC, Matusiak Ł. Influence of itch and pain on sleep quality in atopic dermatitis and psoriasis. Acta Derm Venereol 2019; 99: 175-180.
https://doi.org/10.2340/00015555-3065 DOI: https://doi.org/10.2340/00015555-3065
Silverberg JI, Gelfand JM, Margolis DJ, Boguniewicz M, Fonacier L, Grayson MH, et al. Symptoms and diagnosis of anxiety and depression in atopic dermatitis in U.S. adults. Br J Dermatol 2019; 181: 554-565.
https://doi.org/10.1111/bjd.17683 DOI: https://doi.org/10.1111/bjd.17683
Ständer S, Augustin M, Reich A, Blome C, Ebata T, Phan NQ, et al. 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: 509-514.
https://doi.org/10.2340/00015555-1620 DOI: https://doi.org/10.2340/00015555-1620
Storck M, Sandmann S, Bruland P, Pereira MP, Steinke S, Riepe C, et al. Pruritus Intensity Scales across Europe: a prospective validation study. J Eur Acad Dermatol Venereol 2021; 35: 1176-1185.
https://doi.org/10.1111/jdv.17111 DOI: https://doi.org/10.1111/jdv.17111
Yosipovitch G, Reaney M, Mastey V, Eckert L, Abbé A, Nelson L, et al. Peak Pruritus Numerical Rating Scale: psychometric validation and responder definition for assessing itch in moderate-to-severe atopic dermatitis. Br J Dermatol 2019; 181: 761-769.
https://doi.org/10.1111/bjd.17744 DOI: https://doi.org/10.1111/bjd.17744
Reich A, Szepietowski JC. Pruritus intensity assessment: challenge for clinicians. Expert Rev Dermatol 2013; 8: 291-299.
https://doi.org/10.1586/edm.13.25 DOI: https://doi.org/10.1586/edm.13.25
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372: n71.
https://doi.org/10.1136/bmj.n71 DOI: https://doi.org/10.1136/bmj.n71
Higgins J, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al. Cochrane Handbook for systematic reviews of interventions, 2nd ed. Chichester, UK: Wiley, 2019.
https://doi.org/10.1002/9781119536604 DOI: https://doi.org/10.1002/9781119536604
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 2008; 61: 344-349.
https://doi.org/10.1016/j.jclinepi.2007.11.008 DOI: https://doi.org/10.1016/j.jclinepi.2007.11.008
Howick J, Chalmers I, Glasziou P, Greenhalgh T, Heneghan C, Liberati A, et al. The 2011 Oxford CEBM Levels of Evidence (Introductory Document). Oxford Centre for Evidence-Based Medicine. [Accessed October 2023] Available from: https://www.cebm.ox.ac.uk/resources/levels-of-evidence/ocebm-levels-of-evidence.
Barbour R. Doing focus groups, 2nd ed. The SAGE Qualitative Research Kit, 2018.
https://doi.org/10.4135/9781526441836 DOI: https://doi.org/10.4135/9781526441836
Chang YS, Chiang BL. Sleep disorders and atopic dermatitis: a 2-way street? J Allergy Clin Immunol 2018; 142: 1033-1040.
https://doi.org/10.1016/j.jaci.2018.08.005 DOI: https://doi.org/10.1016/j.jaci.2018.08.005
Bawany F, Northcott CA, Beck LA, Pigeon WR. Sleep disturbances and atopic dermatitis: relationships, methods for assessment, and therapies. J Allergy Clin Immunol Pract 2021; 9: 1488-1500.
https://doi.org/10.1016/j.jaip.2020.12.007 DOI: https://doi.org/10.1016/j.jaip.2020.12.007
Hertenstein E, Feige B, Gmeiner T, Kienzler C, Spiegelhalder K, Johann A, et al. Insomnia as a predictor of mental disorders: a systematic review and meta-analysis. Sleep Med Rev 2019; 43: 96-105.
https://doi.org/10.1016/j.smrv.2018.10.006 DOI: https://doi.org/10.1016/j.smrv.2018.10.006
Marron SE, Tomas-Aragones L, Boira S, Campos-Rodenas R. Quality of life, emotional wellbeing and family repercussions in dermatological patients experiencing chronic itching: a pilot study. Acta Derm Venereol 2016; 96: 331-335.
https://doi.org/10.2340/00015555-2263 DOI: https://doi.org/10.2340/00015555-2263
Salfi F, Amicucci G, Ferrara M, Tempesta D, De Berardinis A, Chiricozzi A, et al. The role of insomnia in the vulnerability to depressive and anxiety symptoms in atopic dermatitis adult patients. Arch Dermatol Res 2023; 315: 1577-1582.
https://doi.org/10.1007/s00403-023-02538-0 DOI: https://doi.org/10.1007/s00403-023-02538-0
Fasseeh AN, Elezbawy B, Korra N, Tannira M, Dalle H, Aderian S, et al. Burden of atopic dermatitis in adults and adolescents: a systematic literature review. Dermatol Ther (Heidelb) 2022; 12: 2653-2668.
https://doi.org/10.1007/s13555-022-00819-6 DOI: https://doi.org/10.1007/s13555-022-00819-6
Armario-Hita JC, Artime E, Vidal-Vilar N, Huete T, Díaz-Cerezo S, Moro RM, et al. Patient-reported outcome measures in real-world atopic dermatitis studies in Spain: a systematic review. Actas Dermosifiliogr 2022; 113: 685-704. DOI: https://doi.org/10.1016/j.ad.2022.05.010
https://doi.org/10.1016/j.ad.2022.01.025 DOI: https://doi.org/10.1016/j.ad.2022.01.025
Kantor R, Dalal P, Cella D, Silverberg JI. Research letter: Impact of pruritus on quality of life - a systematic review. J Am Acad Dermatol 2016; 75: 885-886.e884.
https://doi.org/10.1016/j.jaad.2016.07.016 DOI: https://doi.org/10.1016/j.jaad.2016.07.016
Wei W, Anderson P, Gadkari A, Blackburn S, Moon R, Piercy J, et al. Discordance between physician- and patient-reported disease severity in adults with atopic dermatitis: a US cross-sectional survey. Am J Clin Dermatol 2017; 18: 825-835.
https://doi.org/10.1007/s40257-017-0284-y DOI: https://doi.org/10.1007/s40257-017-0284-y
Torrelo A, Ortiz J, Alomar A, Ros S, Prieto M, Cuervo J. Atopic dermatitis: impact on quality of life and patients' attitudes toward its management. Eur J Dermatol 2012; 22: 97-105.
https://doi.org/10.1684/ejd.2011.1560 DOI: https://doi.org/10.1684/ejd.2011.1560
Paul C, Bushmakin A, Cappelleri J, Mallbris L, Mamoto C. Do patients and physicians agree in their assessment of the severity of psoriasis? Insights from tofacitinib phase 3 clinical trials. J Dermatol Clin Res 2015; 3: 1048.
Chee A, Branca L, Jeker F, Vogt DR, Schwegler S, Navarini A, et al. When life is an itch: what harms, helps, and heals from the patients' perspective? Differences and similarities among skin diseases. Dermatol Ther 2020; 33: e13606.
https://doi.org/10.1111/dth.13606 DOI: https://doi.org/10.1111/dth.13606
Takeuchi S, Oba J, Esaki H, Furue M. Non-corticosteroid adherence and itch severity influence perception of itch in atopic dermatitis. J Dermatol 2018; 45: 158-164.
https://doi.org/10.1111/1346-8138.14124 DOI: https://doi.org/10.1111/1346-8138.14124
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