Acta Dermato-Venereologica 98-7CompleteContent | Seite 7

636 CLINICAL REPORT Course and Predictors of Pruritus Following Burns: A Multilevel Analysis Kelly A. A. KWA 1,2 , Anouk PIJPE 2 , Zjir M. RASHAAN 1,2 , Wim E. TUINEBREIJER 2 , Roelf S. BREEDERVELD 1,2 and Nancy E. E. VAN LOEY 3,4 1 Department of Traumasurgery, Leiden University Medical Centre, Leiden, 2 Burn Centre Beverwijk, Red Cross Hospital, 3 Association of Dutch Burn Centres, Department of Behavioural Research, Beverwijk, and 4 Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands Itch is a common problem after burns. Although the topic receives increasing attention, the number of pro- spective studies is limited. The aim of this study was to assess the influence of acute traumatic stress symp- toms, controlled for injury characteristics, age and sex, on itch over a period of 18 months using multilevel analysis. A total of 226 respondents provided itch sco- res. Participants completed the Burn Itch Questionn- aire during admission (n  = 208) and at 3 (n  =179), 12 (n  =143) and 18 (n  =99) months post-burn. They com- pleted the Impact of Event Scale to assess acute trau- matic stress symptoms during admission. Skin graft requirement, a higher level of acute traumatic stress symptoms and younger age were statistically signifi- cant predictors of a higher itch score. Younger age was particularly associated with higher itch scores during admission, whereas the effect of skin grafting was par- ticularly observed at 3 months post-burn. This study replicates the predictive role of traumatic stress symp- toms, which warrants further research. Key words: pruritus; itch; burns; scars; predictors. Accepted Mar 27, 2018; Epub ahead of print Mar 27, 2018 Acta Derm Venereol 2018; 98: 636–640. Corr: Nancy E. E. van Loey, Association of Dutch Burn Centres, Depart- ment of Behavioural Research, Zeestraat 27-29, 1941 AJ Beverwijk, The Netherlands. E-mail: [email protected]. P ruritus is a common and impairing problem in patients after burn injury, with a negative impact on quality of life (1–3). Pruritus occurs in the early stages of wound healing as well as years after burn scar maturation. Preva- lence rates of burn pruritus are high, affecting up to 87% of patients within 3 months of discharge (4–6). As much as 67–76% of patients experience itch 2 years post-burn, of which 23% is defined as moderate to severe itching (2, 5, 7). Several demographic factors and injury characteristics were described to be associated with itch in burn patients. Female sex and younger age are associated with the pre- sence and severity of itch (1, 5, 7, 8). The most consistent injury characteristic associated with higher itch scores is the percentage total body surface area (TBSA) burned (1, 5, 9, 10). Furthermore, some studies have shown that an increase in TBSA burned is associated with a higher doi: 10.2340/00015555-2935 Acta Derm Venereol 2018; 98: 636–640 SIGNIFICANCE Itch is a common symptom in burn patients that affects quality of life, and is difficult to treat. Our study assessed which factors can predict the occurrence and severity of itch in burn patients. Two-hundred and twenty-six patients from 5 burn centres in the Netherlands and Belgium were inclu- ded and provided data via the Burn Itch Questionnaire. We found that age, skin grafting and traumatic stress symp- toms are predictors of itch up to 18 months post burn. These findings emphasize the need to understand the in- teraction between stress symptoms and the presence and severity of itch in burn patients. itch severity (1, 2, 5–7, 11). Other injury characteristics associated with the severity of itch include grafted areas, a higher number of surgeries and a longer time to wound healing (1, 5, 12). Four studies have investigated the influence of psy- chological factors on the occurrence and severity of itch (2, 5, 10, 13). The presence of acute traumatic stress symptoms was predictive of itch up to 2 years post-burn in a prospective cohort of 510 burn patients (5). A cross- sectional study including 67 burn patients 2–7 years post-burn found no association between post-traumatic stress symptoms and itch, but personality traits, such as aggression and social desirability, were associated with more severe pruritus (2). A cross-sectional study of 161 burn patients, on average 11 years post-burn, found that persistent pruritus was positively associated with sub- missive personality traits and less support seeking, while occasional pruritus was associated with anxiety (10). An experimental study including burn patients with chronic itch reported a heightened sensitivity to itch stimuli and found that patients who experienced post-traumatic stress symptoms displayed higher levels of itch (13). Overall, although burn severity and a younger age consistently showed an association with itch, the evidence for the role of sex and psychological variables remains scarce. Moreover, only 3 of the above-mentioned studies used a prospective design and only one study investiga- ted both demographics, burn severity characteristics and psychological factors as predictors of itch over time (2, 5, 10). Therefore, the purpose of this study was to repli- cate an earlier study that showed an effect of acute stress This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2018 Acta Dermato-Venereologica.