Background. Itch is a key dermatological symptom with variety of clinical characteristics, provoking and etiological factors, as well as consequences, including its impact on psychological parameters. Previously, we have proposed an integrative psychodermatological typology of itch based on the assessment of its duration and impact on quality of life. Aim: Based on a comparative clinical and psychometric assessment, to rank by severity the types of itch previously identified according to the chronicity criteria and impact on quality of life, taking into account their associations with psychosomatic characteristics (anxiety, depression, dysmorphophobia, perceived stress, and stigmatization), and to determine the predictors of a patient getting into the groups with severe types of itch. Methods: This was a multicenter, cross-sectional observational study conducted in three outpatient dermatology clinics from November 2021 to December 2024. During the initial study step, 203 patients with itch were selected for subsequent analysis from those with atopic dermatitis (n = 106), psoriasis (n = 101), acne (n = 104), melanocytic nevi (n = 105), melanoma (n = 88), and skin toxic reactions to anti-tumor treatments (n = 93). Based on a two-step cluster analysis of seven quantitative characteristics of itch (intensity, numerical rating scale), frequency, impact on everyday life, communication with others, sleep, life satisfaction and mood (5PLQ), as well as one categorical variable qualifying itch as acute / chronic (less / more than 6 weeks), we have identified four itch clusters (types): 1) chronic itch with a little impact on quality of life; 2) acute itch with a little impact on quality of life; 3) acute itch with a strong impact on quality of life; 4) chronic itch with a strong impact on quality of life. In this study (step 2), the types of itch identified were compared depending to the severity of associated psychosomatic disorders according to psychometric evaluation for anxiety (GAD-2), depression (PHQ-2, both parts of PHQ-4 anxiety and depression screening scale), for perceived stress (PSS-10), stigmatization (PSQ), and dysmorphophobia (DCQ). We also looked for predictors of severe itch types. Results: The study included 203 patients with itch and various dermatoses and skin neoplasms, as well as skin toxic reactions to antitumor therapy (71.9% women, median age 45 years, 95% confidence interval CI: 30–60 years). The patients with the identified four types of itch did not differ in terms of education (p = 0.07), marital status (p = 0.653), employment (p = 0.124), and body mass index (p = 0.192). There were significant differences between the patients with different types of itch on all the scales used and the parameters evaluated, with an increase in parameters from cluster 1 to cluster 4, respectively, as follows: the median total score of anxiety and depression (PHQ-4: 3,00; 3,00; 5,00; 8,00; p 0,001), anxiety score (GAD-2: 2; 2; 3; 4; p 0.001), depression (PHQ-2: 1; 1; 3; 3; p 0.001), dysmorphophobia score (DCQ: 5; 5; 5; 11; p 0.001), stigmatization level (PSQ: 11; 16; 17; 26.5; p 0.001), the proportion of patients with depression (17.7; 17.8; 51.4; 65.9%; p 0.001), anxiety (15.2; 28.9; 51.4; 65.9%; p 0.001) and dysmorphophobia (6.3; 4.4; 17.1; 34.1; p 0.001) above diagnostic thresholds, the level of perceived stress on the PSS-10 scale (p 0.001). Dysmorphophobia parameters and the perceived stigmatization level were the predictors of more severe types of itch: an increase in these indices was associated with an increase in the odds ratio (OR) of getting into itch clusters 3 and 4 (OR 1.77, 95% CI: 1.33–2.36 and OR 1.66, 95% CI: 1.25–2.19, respectively). Conclusion: The validity of the previously proposed by us typology is confirmed by identification of statistically significant differences found in this study with the psychometric assessment of associated psychosomatic characteristics. The increments in the parameters from the 1st to the 4th cluster allow us to rank the previously selected types of itch according to severity: 1) chronic itch, which has little effect on quality of life, as mild; 2) acute itch with little effect on quality of life as mild-to-moderate; 3) acute itch severely affecting quality of life, as moderate-to severe; 4) chronic itch with strong effects on quality of life, as severe one. Differentiation of the types of itch by severity is of practical importance, since it allows us to reasonably identify groups of patients most severely affected by and potentially being in need of comprehensive interdisciplinary management.
Миченко et al. (Thu,) studied this question.
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