Patient Needs and Treatment Goals in Chronic Atopic Pruritus: Does Eczema Make a Difference?
DOI:
https://doi.org/10.2340/actadv.v105.42773Keywords:
atopic dermatitis, atopic comorbidity, chronic pruritus, patient reported outcomes, patient-centred careAbstract
Chronic pruritus (≥ 6 weeks) is a frequent symptom in atopic diseases, with phenotypes ranging from non-lesional skin to inflammatory diseases like atopic dermatitis. Data on patients’ needs and treatment goals depending on the skin phenotype and disease burden are limited. This study aimed to analyse the impact of distinct phenotypes of chronic atopic pruritus on disease burden and treatment goals. Another objective was to investigate whether the disease burden influences the treatment goals. Patient-reported outcomes of 1,086 adult patients (n = 529 with atopic dermatitis, n = 557 with chronic pruritus on non-lesional skin with atopic skin diathesis) were analysed age- and gender-matched (mean age 49.7 ± 19.0 years; n = 605 female [55.7%]), comparing pruritus intensity (Numeric Rating Scale), quality of life (Dermatology Life Quality Index, ItchyQol), anxiety and depression (Hospital Anxiety and Depression Scale), and patient needs (Patient Needs Questionnaire of the Patient Benefit Index-Pruritus). Although the disease burden was significantly higher in patients with atopic dermatitis (prolonged disease duration, increased quality of life impairment, higher pruritus intensity), the treat-ment goals of both phenotypes matched in 92.6%. The most important needs were to no longer experience itching, find a clear diagnosis and therapy, and have confidence in the therapy.
Downloads
References
Matterne U, Apfelbacher CJ, Vogelgsang L, Loerbroks A, Weisshaar E. Incidence and determinants of chronic pruritus: a population-based cohort study. Acta Derm Venereol 2013; 93: 532-537.
https://doi.org/10.2340/00015555-1572 DOI: https://doi.org/10.2340/00015555-1572
Ständer S. Classification of itch. Curr Probl Dermatol 2016; 50: 1–4.
https://doi.org/10.1159/000446009 DOI: https://doi.org/10.1159/000446009
Schneider G, Ständer S, Kahnert S, Pereira MP, Mess C, Huck V, et al. Biological and psychosocial factors associated with the persistence of pruritus symptoms: protocol for a prospective, exploratory observational study in Germany (individual project of the Interdisciplinary SOMACROSS Research Unit [RU 5211]). BMJ Open 2022;12: e060811.
https://doi.org/10.1136/bmjopen-2022-060811 DOI: https://doi.org/10.1136/bmjopen-2022-060811
Löwe B, Toussaint A, Rosmalen JGM, Huang WL, Burton C, Weigel A, et al. Persistent physical symptoms: definition, genesis, and management. Lancet 2024; 403: 2649–2662.
https://doi.org/10.1016/S0140-6736(24)00623-8 DOI: https://doi.org/10.1016/S0140-6736(24)00623-8
Lipman ZM, Yap QV, Rosen J, Nattkemper L, Yosipovitch G. The association of chronic pruritus with patients’ quality of life: a cross-sectional study. J Am Acad Dermatol 2022; 86: 448–450.
https://doi.org/10.1016/j.jaad.2021.09.062 DOI: https://doi.org/10.1016/j.jaad.2021.09.062
Steinke S, Bruland P, Blome C, Osada N, Dugas M, Fritz F, et al. Chronic pruritus: evaluation of patient needs and treatment goals with a special regard to differences according Acta Derm Venereol 2025ActaDV 7/7 S. Müller et al. “Chronic atopic pruritus: patient needs and treatment goals” to pruritus classification and sex. Br J Dermatol 2017; 176: 363–370. Acta Dermato-Venereologica ActaDV Advances in dermatology and venereology https://doi.org/10.1111/bjd.14910 DOI: https://doi.org/10.1111/bjd.14910
Thünemann J, Müller S, Steinbrink K, Ständer S, Zeidler C. Chronic prurigo. J Dtsch Dermatol Ges 2024; 22: 813–823.
https://doi.org/10.1111/ddg.15317 DOI: https://doi.org/10.1111/ddg.15317
Bieber T. Atopic dermatitis: an expanding therapeutic pipeline for a complex disease. Nat Rev Drug Discov 2022; 21: 21–40.
https://doi.org/10.1038/s41573-021-00266-6 DOI: https://doi.org/10.1038/s41573-021-00266-6
Maintz L, Welchowski T, Herrmann N, Brauer J, Kläschen AS, Fimmers R, et al. Machine learning-based deep phenotyping of atopic dermatitis: severity-associated factors in adolescent and adult patients. JAMA Dermatol 2021; 157: 1414–1424.
https://doi.org/10.1001/jamadermatol.2021.3668 DOI: https://doi.org/10.1001/jamadermatol.2021.3668
Labib A, Ju T, Yosipovitch G. Emerging treatments for itch in atopic dermatitis: a review. J Am Acad Dermatol 2023; 89: 338–344.
https://doi.org/10.1016/j.jaad.2023.04.057 DOI: https://doi.org/10.1016/j.jaad.2023.04.057
Bernstein JA, Bernstein JS, Makol R, Ward S. Allergic rhinitis: a review. JAMA 2024; 331: 866–877.
https://doi.org/10.1001/jama.2024.0530 DOI: https://doi.org/10.1001/jama.2024.0530
Zeidler C, Raap U, Witte F, Ständer S. Clinical aspects and management of chronic itch. J Allergy Clin Immunol 2023; 152: 1–10.
https://doi.org/10.1016/j.jaci.2023.04.018 DOI: https://doi.org/10.1016/j.jaci.2023.04.018
Rupert J, Honeycutt JD. Pruritus: diagnosis and management. Am Fam Physician 2022; 105: 55–64.
Heetfeld AB, Schill T, Schröder SS, Forkel S, Mahler V, Pfützner W, et al. Challenging a paradigm: skin sensitivity to sodium lauryl sulfate is independent of atopic diathesis. Br J Dermatol 2020; 183: 139–145.
https://doi.org/10.1111/bjd.18564
Ständer S. Atopic dermatitis. N Engl J Med 2021; 384: 1136–1143.
https://doi.org/10.1056/NEJMra2023911 DOI: https://doi.org/10.1056/NEJMra2023911
Müller S, Witte F, Ständer S. Pruritus bei atopischer Dermatitis - vergleichende Bewertung neuer Therapieansätze. Dermatologie (Heidelb) 2022; 73: 538–549.
https://doi.org/10.1007/s00105-022-05011-7 DOI: https://doi.org/10.1007/s00105-022-05011-7
Soto-Rey I, Rehr M, Bruland P, Zeidler C, Riepe C, Steinke S, et al. Electronic collection of multilingual patient-reported outcomes across Europe. Methods Inf Med 2018; 57: e107e114.
https://doi.org/10.1055/s-0038-1675397 DOI: https://doi.org/10.1055/s-0038-1675397
Diepgen TL, Sauerbrei W, Fartasch M. Development and validation of diagnostic scores for atopic dermatitis incorporating criteria of data quality and practical usefulness. J Clin Epidemiol 1996; 49: 1031–1038.
https://doi.org/10.1016/0895-4356(96)00119-9 DOI: https://doi.org/10.1016/0895-4356(96)00119-9
Heetfeld AB, Schill T, Schröder SS, Forkel S, Mahler V, Pfützner W, et al. Challenging a paradigm: skin sensitivity to sodium lauryl sulfate is independent of atopic diathesis. Br J Dermatol 2020; 183: 139–145.
https://doi.org/10.1111/bjd.18564 DOI: https://doi.org/10.1111/bjd.18564
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
Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI): a simple practical measure for routine clinical use. Clin Exp Dermatol 1994; 19: 210–216.
https://doi.org/10.1111/j.1365-2230.1994.tb01167.x DOI: https://doi.org/10.1111/j.1365-2230.1994.tb01167.x
Zeidler C, Steinke S, Riepe C, Bruland P, Soto-Rey I, Storck M, et al. Cross-European validation of the ItchyQoL in pruritic dermatoses. Acad Dermatol Venereol 2019; 33: 391–397.
https://doi.org/10.1111/jdv.15225 DOI: https://doi.org/10.1111/jdv.15225
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.
https://doi.org/10.1016/j.jaad.2008.04.006 DOI: https://doi.org/10.1016/j.jaad.2008.04.006
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67: 361–370.
https://doi.org/10.1111/j.1600-0447.1983.tb09716.x DOI: https://doi.org/10.1111/j.1600-0447.1983.tb09716.x
Blome C, Augustin M, Siepmann D, Phan NQ, Rustenbach SJ, Ständer S. Measuring patient-relevant benefits in pruritus treatment: development and validation of a specific outcomes tool. Br J Dermatol 2009; 161: 1143–1148.
https://doi.org/10.1111/j.1365-2133.2009.09328.x DOI: https://doi.org/10.1111/j.1365-2133.2009.09328.x
Augustin M, Radtke MA, Zschocke I, Blome C, Behechtnejad J, Schäfer I, et al. The patient benefit index: a novel approach in patient-defined outcomes measurement for skin diseases. Arch Dermatol Res 2009; 301: 561–571.
https://doi.org/10.1007/s00403-009-0928-8 DOI: https://doi.org/10.1007/s00403-009-0928-8
R Core Team (2021). R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing.
Demoly P, Aubier M, Blay F de, Wessel F, Clerson P, Maigret P. Evaluation of patients’ expectations and benefits in the treatment of allergic rhinitis with a new tool: the patient benefit index - the benefica study. Allergy Asthma Clin Immunol 2015; 11: 8.
https://doi.org/10.1186/s13223-015-0073-1 DOI: https://doi.org/10.1186/s13223-015-0073-1
Theunis J, Nordon C, Falissard B, Orri M, Mengeaud V, Misery L. Development and preliminary validation of the patient-reported Chronic Itch Burden Scale assessing health-related quality of life in chronic pruritus. Br J Dermatol 2022; 186: 8–95.
https://doi.org/10.1111/bjd.20582 DOI: https://doi.org/10.1111/bjd.20582
Traidl-Hoffmann C, Afghani J, Akdis CA, Akdis M, Aydin H, Bärenfaller K, et al. Navigating the evolving landscape of atopic dermatitis: challenges and future opportunities: the 4th Davos declaration. Allergy 2024; 79: 2605–2624.
https://doi.org/10.1111/all.16247 DOI: https://doi.org/10.1111/all.16247
Ständer S, Luger T, Kim B, Lerner E, Metz M, Adiri R, et al. Cutaneous components leading to pruritus, pain, and neurosensitivity in atopic dermatitis: a narrative review. Dermatol Ther (Heidelb) 2024; 14: 45–57.
https://doi.org/10.1007/s13555-023-01081-0 DOI: https://doi.org/10.1007/s13555-023-01081-0
Yosipovitch G, Kim B, Luger T, Lerner E, Metz M, Adiri R, et al. Similarities and differences in peripheral itch and pain pathways in atopic dermatitis. J Allergy Clin Immunol 2024; 153: 904–912.
https://doi.org/10.1016/j.jaci.2023.10.034 DOI: https://doi.org/10.1016/j.jaci.2023.10.034
Senra MS, Wollenberg A. Psychodermatological aspects of atopic dermatitis. Br J Dermatol 2014; 170: 38–43.
https://doi.org/10.1111/bjd.13084 DOI: https://doi.org/10.1111/bjd.13084
Almutawa YM, AlGhareeb M, Bhattarai E, Aljalahma J. Investigation of the impact of atopic dermatitis (AD) on stress, depression, anxiety, and suicidal ideation: a systematic review and meta-analysis. Cureus 2024; 16: e63376.
https://doi.org/10.7759/cureus.63376 DOI: https://doi.org/10.7759/cureus.63376
Mizara A, Papadopoulos L, McBride SR. Core beliefs and psychological distress in patients with psoriasis and atopic eczema attending secondary care: the role of schemas in chronic skin disease. Br J Dermatol 2012; 166: 986–993.
https://doi.org/10.1111/j.1365-2133.2011.10799.x DOI: https://doi.org/10.1111/j.1365-2133.2011.10799.x
Müller S, Maintz L, Bieber T. Treatment of atopic dermatitis: recently approved drugs and advanced clinical development programs. Allergy 2024; 79: 1501–1515.
https://doi.org/10.1111/all.16009 DOI: https://doi.org/10.1111/all.16009
Weisshaar E, Szepietowski JC, Dalgard FJ, Garcovich S, Gieler U, Giménez-Arnau AM, et al. European S2k Guideline on Chronic Pruritus. Acta Derm Venereol 2019; 99: 469–506.
https://doi.org/10.2340/00015555-3164 DOI: https://doi.org/10.2340/00015555-3164
Alvarenga JM, Bieber T, Torres T. Emerging biologic therapies for the treatment of atopic dermatitis. Drugs 2024; 84: 1379–1394.
https://doi.org/10.1007/s40265-024-02095-4 DOI: https://doi.org/10.1007/s40265-024-02095-4
Satoh T, Yokozeki H, Murota H, Tokura Y, Kabashima K, Takamori K, et al. 2020 guidelines for the diagnosis and treatment of cutaneous pruritus. J Dermatol 2021; 48: e399–e413.
https://doi.org/10.1111/1346-8138.16066 DOI: https://doi.org/10.1111/1346-8138.16066
Published
How to Cite
License
Copyright (c) 2025 Svenja Müller, Claudia Zeidler, Christian Mess, Stefan M. Kahnert, Bernd Löwe, Angelika Weigel, Felix Witte, Volker Huck, Lynhda Nguyen, Matthias Augustin, Gina Frank, Konstantin Agelopoulos, Henning Wiegmann, Ansgar Köchel, Rupert Conrad, Gudrun Schneider, Stefan W. Schneider, Sonja Ständer, Inga Hansen-Abeck, Finn Abeck
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All digitalized ActaDV contents is available freely online. The Society for Publication of Acta Dermato-Venereologica owns the copyright for all material published until volume 88 (2008) and as from volume 89 (2009) the journal has been published fully Open Access, meaning the authors retain copyright to their work.
Unless otherwise specified, all Open Access articles are published under CC-BY-NC licences, 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.
