SHORT COMMUNICATION
793 ActaDV ActaDV
Advances in dermatology and venereology Acta Dermato-Venereologica
Characteristics of Chronic Itch in Systemic Sclerosis: A Cross-sectional Survey
Carolyn M. STULL 1, Leslie A. WEAVER 2, Rodrigo VALDES-RODRIGUEZ 3, Srikanth NARAMALA 4, Michael J. LAVERY 5, Yiong- Huak CHAN 6, Fabian A. MENDOZA 4 and Gil YOSIPOVITCH 7 *
1
Department of Dermatology, Rush University, Chicago, 2 Lewis Katz School of Medicine, 3 Department of Dermatology, Temple University, Philadelphia, 4 Department of Medicine, Division of Rheumatology, Thomas Jefferson University, Philadelphia, USA, 5 Department of Dermatology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK, 6 Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore, and 7 Department of Dermatology and Itch Center, University of Miami Miller School of Medicine, 1600 NW 10 th Ave, Rosenstiel Medical Science Bldg., Miami, FL 33136, USA. * E-mail: yosipog @ gmail. com Accepted May 4, 2018; Epub ahead of print May 8, 2018
Chronic itch( present for ≥ 6 weeks) is a common symptom in the systemic sclerosis( SSc) population with a reported prevalence of 42.6 %( 1). Previous studies have demonstrated that chronic itch is associated with decreased quality of life and sleep in SSc patients( 2, 3). However, little is known about the characteristics and pathogenesis of itch in the context of this disease.
METHODS
To further elucidate features of itch in SSc patients, we conducted a cross-sectional survey. The protocol for this study was approved by the Institutional Review Board at Thomas Jefferson University. Patients presenting to the rheumatology clinic with an established diagnosis of SSc were asked if they experienced itch for ≥ 6 weeks. Those who responded affirmatively completed two validated questionnaires: The Itch Questionnaire and the itch-specific quality of life( ItchyQoL)( 4, 5). Itch intensity was quantified using a numeric rating scale( NRS)( range 0 – 10). Skin involvement was assessed using the modified Rodnan skin score( mRSS)( range 0 – 51), and affected body surface area( BSA).
All analyses were performed using SPSS 24.0 with statistical significance set at p < 0.05. The differences in numerical parameters between the chronic itch and without chronic itch groups were compared using t-tests when normality and homogeneity assumptions were satisfied, otherwise Mann Whitney U tests were used. Chi-square or Fisher’ s Exact tests were used to compare categorical variables between the 2 groups.
RESULTS
Chronic itch was present in 34( 56.7 %) of 60 patients. Demographic and clinical features of our sample are presented in Table I. Characteristics of itch are presented in Table II. Chronic itch was significantly associated with xerosis( p = 0.025). The most common locations for pruritus were the back( n = 21), arms( n = 17) and scalp( n = 16). Itch was described as prickling( n = 13), painful( n = 11), burning( n = 9), and stinging( n = 8). Itch was not significantly associated with the presence of autoantibodies including anti-nuclear antibodies( ANA), anti-double stranded DNA antibodies( dsDNA), anti-topoisomerase I antibodies( Scl-70), anti-centromere antibodies, anti-RNA polymerase III antibodies, and anti-U3 RNP. In addition, there were no significant relationships between itch and systemic manifestations of SSc, including interstitial lung disease, pulmonary hypertension, renal involvement, gastrointestinal involvement, or joint
Table I. Demographic and clinical characteristics Chronic itch
Without chronic itch
Sex, n Female |
29 |
21 |
Male |
5 |
5 |
Ethnicity, n Caucasian |
25 |
20 |
African American |
3 |
3 |
Hispanic or Latino |
3 |
2 |
Asian |
3 |
1 |
Age, years, mean ± SD |
53.7 ± 13.8 |
59.9 ± 12.1 |
SSc Subtype, n Diffuse |
18 |
12 |
Limited |
16 |
14 |
SSc duration, years, mean ± SD |
10.4 ± 9.8 |
11.0 ± 9.7 |
Cutaneous involvement mRSS, mean ± SD |
4.9 ± 5.9 |
3.5 ± 2.8 |
SSc BSA(%), mean ± SD |
4.3 ± 7.4 |
2.3 ± 2.4 |
Xerosis, n |
19 |
7 |
SD: standad deviation; SSc: systemic sclerosis; mRSS: modified Rodnan skin score; BSA: body surface area.
Table II. Chronic itch characteristics
Itch intensity a, mean ± SD 4.4 ± 2.3
Pleasurability of scratching b, mean ± SD |
1.2 ± 2.5 |
Duration, years, mean ± SD |
4.5 ± 4.0 |
Prevalence, n(%) |
34( 57) |
Temporality, n(%) |
During the day |
26( 77) |
At night |
28( 82) |
Seasonality, n(%) |
Winter |
30( 88) |
Spring |
26( 77) |
Summer |
27( 79) |
Autumn |
25( 74) |
Exacerbating factors, n(%) |
Dry skin |
24( 71) |
Hot water |
11( 32) |
Location, n(%) |
Face |
7( 21) |
Scalp |
16( 47) |
Neck |
11( 32) |
Shoulders |
7( 21) |
Chest |
7( 21) |
Abdomen |
10( 29) |
Back |
21( 62) |
Arms |
17( 50) |
Forearms |
11( 32) |
Hands |
9( 27) |
Thighs |
11( 32) |
Legs |
9( 27) |
a Assessed using a numeric rating scale ranging from 0( no itch) to 10( unbearable
itch). b Assessed using a numeric rating scale ranging from – 5( highly unpleasurable) to 5( highly pleasurable).
This is an open access article under the CC BY-NC license. www. medicaljournals. se / acta Journal Compilation © 2018 Acta Dermato-Venereologica. doi: 10.2340 / 00015555-2966 Acta Derm Venereol 2018; 98: 793 – 794