Psychopathology Associated with Chronic Pruritus: A Systematic Review
DOI:
https://doi.org/10.2340/actadv.v103.8488Keywords:
pruritus, mental disorders, mental health, stress, psychological, skin diseasesAbstract
There are no previous studies of the psychopathology associated with different aetiologies of chronic pruritus. A systematic review was performed of cohort and case-control studies comparing healthy controls with patients with chronic pruritus related to primary dermatoses, systemic diseases, psychogenic pruritus, idiopathic pruritus, prurigo nodularis and/or lichen simplex chronicus. The review was registered in PROSPERO and performed according to the PRISMA statement, which allowed the inclusion of 26 studies. The quality of eligible studies was assessed using the modified Newcastle-Ottawa Scale. Most of the studies concern primary dermatoses and systemic diseases. Sleep disorders are a common comorbidity interrelated with pruritus, anxiety and depressive symptoms, in primary dermatoses. Sleep disorders are linked with pruritus and depressive symptoms in end-stage renal disease and hepatobiliary disease. Depressive and anxiety symptoms are associated with psychogenic pruritus. Psychogenic pruritus, lichen simplex chronicus and some primary dermatoses are linked with personality characteristics. Further studies are required to explore in depth the psychopathology linked with psychogenic pruritus and prurigo nodularis, as well as psychopathology linked with other primary dermatoses and systemic disorders associated with chronic pruritus, and to better differentiate psychogenic pruritus from psychopathological characteristics linked with other aetiologies of chronic pruritus, in order to improve the management of patients with chronic pruritus.
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References
Schneider G, Grebe A, Bruland P, Heuft G, Ständer S. Criteria suggestive of psychological components of itch and soma-toform itch: study of a large sample of patients with chronic pruritus. Acta Derm Venereol 2020; 100: adv00075.
https://doi.org/10.2340/00015555-3424 DOI: https://doi.org/10.2340/00015555-3424
Golpanian RS, Lipman Z, Fourzali K, Fowler E, Nattkemper LA, Chan YH, et al. Psychiatric comorbidities in non-psychogenic chronic itch, a US-based study. Acta Derm Venereol 2020; 100: adv00169.
https://doi.org/10.2340/00015555-3487 DOI: https://doi.org/10.2340/00015555-3487
Ständer HF, Elmariah S, Zeidler C, Spellman M, Ständer S. Diagnostic and treatment algorithm for chronic nodular prurigo. J Am Acad Dermatol 2020; 82: 460-468.
https://doi.org/10.1016/j.jaad.2019.07.022 DOI: https://doi.org/10.1016/j.jaad.2019.07.022
Lotti T, Buggiani G, Prignano F. Prurigo nodularis and lichen simplex chronicus. Dermatol Ther 2008; 21: 42-46.
https://doi.org/10.1111/j.1529-8019.2008.00168.x DOI: https://doi.org/10.1111/j.1529-8019.2008.00168.x
Stumpf A, Schneider G, Ständer S. Psychosomatic and psychiatric disorders and psychologic factors in pruritus. Clin Dermatol 2018; 36: 704-708.
https://doi.org/10.1016/j.clindermatol.2018.08.015 DOI: https://doi.org/10.1016/j.clindermatol.2018.08.015
Dalgard FJ, Svensson Å, Halvorsen JA, Gieler U, Schut C, Tomas-Aragones L, et al. Itch and mental health in dermatological patients across Europe: a cross-sectional study in 13 countries. J Invest Dermatol 2020; 140: 568-573.
https://doi.org/10.1016/j.jid.2019.05.034 DOI: https://doi.org/10.1016/j.jid.2019.05.034
Booth A, Clarke M, Dooley G, Ghersi D, Moher DD, Petticrew M, et al. The nuts and bolts of PROSPERO: an international prospective register of systematic reviews. Syst Rev 2012; 1: 2.
https://doi.org/10.1186/2046-4053-2-4 DOI: https://doi.org/10.1186/2046-4053-2-4
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
Da Costa Santos CM, de Mattos Pimenta CA, Nobre MR. The PICO strategy for the research question construction and evidence search. Rev Lat Am Enferm 2007; 15: 508-511.
https://doi.org/10.1590/S0104-11692007000300023 DOI: https://doi.org/10.1590/S0104-11692007000300023
Wells G, Shea B, O'Connell D, Robertson J, Peterson J, Welch V, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. 2013. [accessed 2022 Nov 2]. Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
World Health Organization. International classification of diseases for mortality and morbidity statistics (11th Revision). 2018. [accessed 2022 Nov 2] Available from: https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1040617588.
Alanne S, Nermes M, Söderlund R, Laitinen K. Quality of life in infants with atopic dermatitis and healthy infants: a follow-up from birth to 24 months. Acta Paediatr 2011; 100: e65-70.
https://doi.org/10.1111/j.1651-2227.2011.02229.x DOI: https://doi.org/10.1111/j.1651-2227.2011.02229.x
Bender BG, Leung SB, Leung DY. Actigraphy assessment of sleep disturbance in patients with atopic dermatitis: an objective life quality measure. J Allergy Clin Immunol 2003; 111: 598-602.
https://doi.org/10.1067/mai.2003.174 DOI: https://doi.org/10.1067/mai.2003.174
Holm EA, Wulf HC, Stegmann H, Jemec GB. Life quality assessment among patients with atopic eczema. Br J Dermatol 2006; 154: 719-725.
https://doi.org/10.1111/j.1365-2133.2005.07050.x DOI: https://doi.org/10.1111/j.1365-2133.2005.07050.x
Horev A, Freud T, Manor I, Cohen AD, Zvulunov A. Risk of attention-deficit/hyperactivity disorder in children with atopic dermatitis. Acta Dermatovenerol Croat 2017; 25: 210-214.
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
Mochizuki H, Lavery MJ, Nattkemper LA, Albornoz C, Valdes Rodriguez R, Stull C, et al. Impact of acute stress on itch sensation and scratching behaviour in patients with atopic dermatitis and healthy controls. Br J Dermatol 2019; 180: 821-827.
https://doi.org/10.1111/bjd.16921 DOI: https://doi.org/10.1111/bjd.16921
Oh SH, Bae BG, Park CO, Noh JY, Park IH, Wu WH, et al. Association of stress with symptoms of atopic dermatitis. Acta Derm Venereol 2010; 90: 582-588.
https://doi.org/10.2340/00015555-0933 DOI: https://doi.org/10.2340/00015555-0933
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: 20-25.
https://doi.org/10.2340/00015555-1634 DOI: https://doi.org/10.2340/00015555-1634
Tran BW, Papoiu AD, Russoniello CV, Wang H, Patel TS, Chan YH, et al. Effect of itch, scratching and mental stress on autonomic nervous system function in atopic dermatitis. Acta Derm Venereol 2010; 90: 354-361.
https://doi.org/10.2340/00015555-0890 DOI: https://doi.org/10.2340/00015555-0890
Kalinska-Bienias A, Piotrowski T, Kowalczyk E, Lesniewska A, Kaminska M, Jagielski P, et al. Actigraphy-measured nocturnal wrist movements and assessment of sleep quality in patients with bullous pemphigoid: a pilot case-control study. Clin Exp Dermatol 2019; 44: 759-765.
https://doi.org/10.1111/ced.13902 DOI: https://doi.org/10.1111/ced.13902
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: 1062-1069.
https://doi.org/10.1111/j.1468-3083.2008.02714.x DOI: https://doi.org/10.1111/j.1468-3083.2008.02714.x
Ograczyk-Piotrowska A, Gerlicz-Kowalczuk Z, Pietrzak A, Zalewska-Janowska AM. Stress, itch and quality of life in chronic urticaria females. Postepy Dermatol Alergol 2018; 35: 156-160.
https://doi.org/10.5114/ada.2018.75237 DOI: https://doi.org/10.5114/ada.2018.75237
Kaaz K, Szepietowski JC, Matusiak Ł. Influence of itch and pain on sleep quality in patients with hidradenitis suppurativa. Acta Derm Venereol 2018; 98: 757-761.
https://doi.org/10.2340/00015555-2967 DOI: https://doi.org/10.2340/00015555-2967
Jensen P, Zachariae C, Skov L, Zachariae R. Sleep disturbance in psoriasis: a case-controlled study. Br J Dermatol 2018; 179: 1376-1384.
https://doi.org/10.1111/bjd.16702 DOI: https://doi.org/10.1111/bjd.16702
Shutty BG, West C, Huang KE, Landis E, Dabade T, Browder B, et al. Sleep disturbances in psoriasis. Dermatol Online J 2013; 19: 1.
https://doi.org/10.5070/D30073R324 DOI: https://doi.org/10.5070/D30073R324
Liu JM, Hsu RJ, Chang FW, Chia-Lun Y, Chun-Fa H, Shu-Ting C, et al. Increase the risk of intellectual disability in children with scabies: a nationwide population-based cohort study. Medicine (Baltimore) 2017; 96: e7108.
https://doi.org/10.1097/MD.0000000000007108 DOI: https://doi.org/10.1097/MD.0000000000007108
Schricker S, Heider T, Schanz M, Dippon J, Alscher MD, Weiss H, et al. Strong associations between inflammation, pruritus and mental health in dialysis patients. Acta Derm Venereol 2019; 99: 524-529.
https://doi.org/10.2340/00015555-3128 DOI: https://doi.org/10.2340/00015555-3128
Yngman-Uhlin P, Johansson A, Fernström A, Börjeson S, Edéll-Gustafsson U. Fragmented sleep: an unrevealed problem in peritoneal dialysis patients. Scand J Urol Nephrol 2011; 45: 206-215.
https://doi.org/10.3109/00365599.2011.557025 DOI: https://doi.org/10.3109/00365599.2011.557025
Benito de Valle M, Rahman M, Lindkvist B, Björnsson E, Chapman R, Kalaitzakis E. Factors that reduce health-related quality of life in patients with primary sclerosing cholangitis. Clin Gastroenterol Hepatol 2012; 10: 769-775.e2.
https://doi.org/10.1016/j.cgh.2012.01.025 DOI: https://doi.org/10.1016/j.cgh.2012.01.025
Cheung AC, Patel H, Meza-Cardona J, Cino M, Sockalingam S, Hirschfield GM. Factors that influence health-related quality of life in patients with primary sclerosing cholangitis. Dig Dis Sci 2016; 61: 1692-1699.
https://doi.org/10.1007/s10620-015-4013-1 DOI: https://doi.org/10.1007/s10620-015-4013-1
Montagnese S, Nsemi LM, Cazzagon N, Facchini S, Costa L, Bergasa NV, et al. Sleep-wake profiles in patients with primary biliary cirrhosis. Liver Int 2013; 33: 203-209.
https://doi.org/10.1111/liv.12026 DOI: https://doi.org/10.1111/liv.12026
Raszeja-Wyszomirska J, Wunsch E, Krawczyk M, Rigopulou EI, Kostrzewa K, Norman GL, et al. Assessment of health related quality of life in polish patients with primary biliary cirrhosis. Clin Res Hepatol Gastroenterol 2016; 40: 471-479.
https://doi.org/10.1016/j.clinre.2015.10.006 DOI: https://doi.org/10.1016/j.clinre.2015.10.006
Altunay İK, Özkur E, Uğurer E, Baltan E, Aydın Ç, Serin E. More than a skin disease: stress, depression, anxiety levels, and serum neurotrophins in lichen simplex chronicus. An Bras Dermatol 2021; 96: 700-705.
https://doi.org/10.1016/j.abd.2021.04.011 DOI: https://doi.org/10.1016/j.abd.2021.04.011
Martín-Brufau R, Corbalán-Berná J, Ramirez-Andreo A, Brufau-Redondo C, Limiñana-Gras R. Personality differences between patients with lichen simplex chronicus and normal population: a study of pruritus. Eur J Dermatol 2010; 20: 359-363.
https://doi.org/10.1684/ejd.2010.0961 DOI: https://doi.org/10.1684/ejd.2010.0961
Martín-Brufau R, Suso-Ribera C, Brufau Redondo C, Corbalán Berná J. Differences between men and women in chronic scratching: a psychodermatologic study in lichen simplex chronicus. Actas Dermosifiliogr 2017; 108: 354-360.
https://doi.org/10.1016/j.ad.2016.12.002 DOI: https://doi.org/10.1016/j.ad.2016.12.002
Yilmaz B, Canan F, Şengül E, Özkurt FE, Tuna SF, Yildirim H. Type D personality, anxiety, depression and personality traits in patients with isolated itching of the external auditory canal. J Laryngol Otol 2016; 130: 50-55.
https://doi.org/10.1017/S0022215115003011 DOI: https://doi.org/10.1017/S0022215115003011
Epifanio MS, Ingoglia S, Alfano P, Lo Coco G, La Grutta S. Type D personality and alexithymia: common characteristics of two different constructs. Implications for research and clinical practice. Front Psychol 2018; 9: 106.
https://doi.org/10.3389/fpsyg.2018.00106 DOI: https://doi.org/10.3389/fpsyg.2018.00106
Schneider G, Grebe A, Bruland P, Heuft G, Ständer S. Chronic pruritus patients with psychiatric and psychosomatic comorbidity are highly burdened: a longitudinal study. J Eur Acad Dermatol Venereol 2019; 33: e288-e291.
https://doi.org/10.1111/jdv.15559 DOI: https://doi.org/10.1111/jdv.15559
American Psychiatric Association. DSM-5-TR: Diagnostic and Statistical Manual of Mental Disorders, 5th edn, text revision. Washington: American Psychiatric Association; 2022.
https://doi.org/10.1176/appi.books.9780890425787 DOI: https://doi.org/10.1176/appi.books.9780890425787
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