Gender differences in chronic pruritus: women present different morbidity, more scratch lesions and higher burden

BACKGROUND: Although sex and gender are increasingly perceived as important factors in medicine, there is only very little knowledge on these issues in patients with chronic pruritus (CP). OBJECTIVES: The aim of this retrospective study was to compare multiple parameters of CP in a large representative group of patients and to assess any sex and gender differences. METHODS: Patients (n = 1037, 54·8% women) with CP (> 6 weeks' duration) were analysed concerning gender differences in multiple parameters, including quality of life, CP-underlying diseases, co-morbidities and clinics. We used McNemar tests for dependent variables, and χ(2) tests and t-tests for independent variables, to evaluate gender-specific differences. RESULTS: Men were significantly older (P < 0·001) than women and had significantly more often cardiovascular (P < 0·001) and urogenital (P < 0·0001) co-morbidities, a higher number of co-medications (P = 0·041), and more often dermatological and systemic diseases leading to CP. Women had more neuropathic and psychosomatic diseases underlying the CP. They significantly more often showed a worsening of the CP by emotional (P = 0·002) and psychosomatic factors (P = 0·046). Women reported more often on localized itching occurring in attacks, with stinging, warmth and painful qualities (P < 0·05). Women significantly more often showed chronic scratch lesions and prurigo nodularis (P = 0·001), in contrast to men who significantly more frequently had CP on noninflamed skin (P = 0·004). In addition, women obtained higher visual analogue scale scores (P = 0·031) and reported a higher impact on quality of life (P = 0·033) than men. CONCLUSIONS: There are gender-specific differences not only in the quality, localization and triggering of CP but also in the underlying disease and scratching behaviour. These facts must be taken into account in the medical care of patients with CP and when conducting any kind of clinical research on itch. Further research is needed to achieve a gender-specific and gender-adapted diagnostics and treatment of CP.