Criteria Suggestive of Psychological Components of Itch and Soma­toform Itch: Study of a Large Sample of Patients with Chronic Pruritus

Abstract

While psychological factors are relevant in many patients with chronic pruritus, not all patients can be offered psychologic, psychosomatic or psychiatric consultation. The aim of this exploratory study was to identify criteria suggestive of psychological factors relevant for the etiology of chronic pruritus and of somatoform pruritus. Routine data from the database of the Center for Chronic Pruritus of the University Hospital Münster were used, including the Neuroderm Questionnaire, Dermatology Life Quality Index and Hospital Anxiety and Depression Scale. Chronic pruritus patients ( n = 3,391) without a psychiatric diagnosis in their medical history were compared to the 331 chronic pruritus patients with diagnoses of “psychological factors associated with etiology and course of chronic pruritus” (ICD-10:F54) or “somatoform pruritus” (F45.8) confirmed by an expert. The latter reported more pruritus triggers, especially “strain” and “emotional tension” and used more emotional adjectives to describe their pruritus. They reported more often scratching leading to excoriations, higher levels of pruritus, impairment of quality of life, anxiety and depression. These aspects suggest the presence of psychological factors in the etiology of chronic pruritus and somatoform pruritus. Prospective validation, however, needs to be carried out.

Prevalence of Pruritus and Association with Anxiety and Depression in Patients with Nonalcoholic Fatty Liver Disease

“…(ii) Secondly, anxiety and depression are independently associated with NAFLD and may therefore also interact with pruritus [ 8 , 9 , 10 ]. Depression and anxiety may even be the primary cause of pruritus, especially in patients with high pruritus intensity or impaired quality of life [ 35 , 36 , 37 ]. These patients tend to report more pruritus triggers and use a higher number of emotional adjectives to describe their pruritus.…”

“…If this is observed in individual cases, one should consider involving a psychologist or psychiatrist in diagnosis and therapy. It is known that anxiety and depression have the potential to be pruritus-increasing factors, so psychological interventions should also be considered in the treatment of pruritus in general [ 35 ].…”

Neuropathic Itch

“…Mechanistic studies of psychogenic itch are challenging due to the close relationship itch has with psychiatric conditions. Chronic itch leads to depression and anxiety, which in turn can enhance sensation of itch [ 80 ]. This mixed causality makes it difficult to distinguish primary drivers of disease.…”

Management of psychocutaneous disorders: A practical approach for dermatologists

“…34 Several studies have been published with this scale in the context of dermatology and psychodermatology. 33,35,36 This scale consists of 14 items (7 items for anxiety and 7 items for depression) with each item scored from 0 to 3 points. The total score may range from 0 to 21.…”