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