Validation of Relationship between Patients’ Descriptions of Pruritus and Patient-burden of Chronic Pruritus using Structural Equation Modelling
Keywords:Chronic itch, Descriptions, Sexual dysfunction, Sleep disturbance, Quality of life
Patients with chronic itch describe their pruritus in a wide variety of ways. However, these subjective descriptions are often not taken into consideration by physicians. This study aimed to validate patients’ descriptions of pruritus, and to investigate the relationship between various descriptions of pruritus and the patient burden of chronic pruritus by examining the mediating effects of sleep disturbance and sexual dysfunction on patient’s quality of life, as predicted by various descriptions of pruritus. Exploratory and confirmatory factor analyses were performed to identify the factor structure measured by 11 descriptions of pruritus. The study then analysed differences in the degree of sleep disturbance, sexual dysfunction, and quality of life deterioration factors using a structural equation modelling method. Using data from 419 patients with chronic pruritus, 11 descriptions of pruritus were classified into 2 groups: (i) sensory pruritus (i.e. stinging, stabbing, burning, painful, formication, throbbing, and cold) that are linked with descriptions of pruritus patterns; and (ii) affective pruritus (i.e. annoying, unbearable, worrisome, and warm) from patient reports of psychological or emotional distress. The study found that affective pruritus decreases patient’s quality of life either directly or indirectly through sleep disturbance. In conclusion, clues about a patients’ sleep disturbance or poor quality of life can be obtained through their descriptions of pruritus.
Yosipovitch G, Zucker I, Boner G, Gafter U, Shapira Y, David M. A questionnaire for the assessment of pruritus: validation in uremic patients. Acta Derm Venereol 2001; 81: 108-111.
Paul J. Descriptors for itch related to chronic wounds. Wounds 2018; 30: 4-9.
Rolader R, DeGrazia TM, Zhang C, Yosipovitch G, Chen SC, Yeung H. Factor analysis of subjective descriptors of chronic pruritus and association with quality of life: a cross-sectional survey. J Am Acad Dermatol 2020; 82: 1519-1521.
Brenaut E, Garlantezec R, Talour K, Misery L. Itch characteristics in five dermatoses: non-atopic eczema, atopic dermatitis, urticaria, psoriasis and scabies. Acta Derm Venereol 2013; 93: 573-574.
Huet F, Faffa MS, Poizeau F, Merhand S, Misery L, Brenaut E. Characteristics of pruritus in relation to self-assessed severity of atopic dermatitis. Acta Derm Venereol 2019; 99: 279-283.
Briand C, Gourier G, Poizeau F, Jelti L, Bachelerie M, Quéreux G, et al. Characteristics of pruritus in bullous pemphigoid and impact on quality of life: a prospective cohort study. Acta Derm Venereol 2020; 100: adv00320.
Zachariae R, Zachariae CO, 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: 121-127.
Lim YL, H. CY, Yosipovitch G, Greaves MW. Pruritus is a common and significant symptom of acne. J Eur Acad Dermatol Venereol 2008; 22: 1332-1336.
Kini SP, DeLong LK, Veledar E, McKenzie-Brown AM, Schaufele M, Chen SC. The impact of pruritus on quality of life: the skin equivalent of pain. Arch Dermatol 2011; 147: 1153-1156.
Warlich B, Fritz F, Osada N, Bruland P, Stumpf A, Schneider G, et al. Health-related quality of life in chronic pruritus: an analysis related to disease etiology, clinical skin conditions and itch intensity. Dermatology 2015; 231: 253-259.
Erturk IE, Arican O, Omurlu IK, Sut N. Effect of the pruritus on the quality of life: a preliminary study. Ann Dermatol 2012; 24: 406-412.
Kong TS, Han TY, Lee JH, Son SJ. Correlation between severity of atopic dermatitis and sleep quality in children and adults. Ann Dermatol 2016; 28: 321-326.
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.
Sommer R, Augustin M, Hilbring C, Ständer S, Hubo M, Hutt HJ, et al. Significance of chronic pruritus for intrapersonal burden and interpersonal experiences of stigmatization and sexuality in patients with psoriasis. J Eur Acad Dermatol Venereol 2021; 35: 1553-1561.
Hawro T, Przybyłowicz K, Spindler M, Hawro M, Steć M, Altrichter S, et al. The characteristics and impact of pruritus in adult dermatology patients: a prospective, cross-sectional study. J Am Acad Dermatol 2021; 84: 691-700.
Majeski CJ, Johnson JA, Davison SN, Lauzon CJ. Itch Severity Scale: a self-report instrument for the measurement of pruritus severity. Br J Dermatol 2007; 156: 667-673.
Desai NS, Poindexter GB, Monthrope YM, Bendeck SE, Swerlick RA, Chen SC. A pilot quality-of-life instrument for pruritus. J Am Acad Dermatol 2008; 59: 234-244.
Jang YH, Kim SM, Eun DH, Park KD, Park GH, Kim BS, et al. Validity and reliability of itch assessment scales for chronic pruritus in adults: a prospective multicenter study. J Am Acad Dermatol 2020; 82: 80-86.
Pett MA, Lackey NR, Sullivan JJ. Making sense of factor analysis: the use of factor analysis for instrument development in health care research. Sage, Thousand Oaks, CA; 2003.
Brown TA. Confirmatory factor analysis for applied research. Guilford Publications, New York, NY; 2015.
Furr M. Scale construction and psychometrics for social and personality psychology. Sage Publications Ltd, Los Angeles, CA; 2011.
Raykov T. Behavioral scale reliability and measurement invariance evaluation using latent variable modeling. Behavior Therapy 2004; 35: 299-331.
Nunnally JC. Psychometric theory 3E: Tata McGraw-hill education; 1994.
Muthén B, Muthén L. Mplus. Chapman and Hall/CRC, Los Angeles, CA; 2017.
Hu Lt, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equat Model 1999; 6: 1-55.
Browne MW, Cudeck R. Alternative ways of assessing model fit. In: Bollen KA, Long JS, editors. Testing structural equation models: Newbury Park, CA: Sage; 1993: p. 136-162.
Bentler PM. Comparative fit indexes in structural models. Psychol Bull 1990; 107: 238-246.
Darsow U, Mautner V, Bromm B, Scharein E, Ring J. The Eppendorf Pruritus Questionnaire. Hautarzt 1997; 48: 730-733.
Andrade A, Kuah CY, Martin-Lopez JE, Chua S, Shpadaruk V, Sanclemente G, et al. Interventions for chronic pruritus of unknown origin. Cochrane Database Syst Rev 2020; 1: Cd013128.
How to Cite
Copyright (c) 2022 Ji Hoon Ryoo, Seon Hwa Lee, Dae-Lyong Ha, Kyung Duck Park, Jaehee Rho, Gyeong-Hun Park, Byung-Soo Kim, Kapsok Li, Chang Ook Park, Hye One Kim, Hei Sung Kim, Min Soo Jang, Dong Hun Lee, Yang Won Lee, Do Won Kim, Yong Hyun Jang, Seong-Jin Kim
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.