Acta Dermato-Venereologica 99-2CompleteContent | Page 21

220 SHORT COMMUNICATION Pruritus in Chronic Liver Disease: A Questionnaire Survey on 216 Patients Makiko KIDO-NAKAHARA 1 , Takeshi NAKAHARA 2 , Norihiro FURUSYO 3 , Shinji SHIMODA 4 , Kazuhiro KOTOH 5 , Masaki KATO 5 , Jun HAYASHI 6 , Toshimasa KOYANAGI 7 and Masutaka FURUE 1,2 1 Department of Dermatology, 2 Division of Skin Surface Sensing, 4 Department of Medicine and Biosystemic Science and 5 Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812- 8582, 3 Department of General Internal Medicine, Kyushu University Hospital, 6 Kyushu General Internal Medicine Center, Haradoi Hospital, and 7 Department of Internal Medicine, Fukuoka City Hospital, Fukuoka, Japan. E-mail: [email protected] Accepted Oct 11, 2018; E-published Oct 11, 2018 Many patients with chronic liver disease develop pruritus with or without skin lesions. The prevalence of pruritus in patients with primary biliary cholangitis (PBC) has been reported to be especially high, at around 70% (1, 2). How­ ever, the prevalence of pruritus in patients with chronic hepatitis C varies, depending on the study, with reported values ranging from 5.1% to 58.4% (3–6). Moreover, the prevalence of pruritus in patients with other chronic liver diseases, such as chronic hepatitis B, autoimmune hepa- titis (AIH), non-alcoholic fatty liver disease (NAFLD), alcoholic liver disease (ALD), liver cirrhosis, and hepa- tocellular carcinoma (HCC), has hardly been reported. Pruritus causes both physical and mental stress and af- fects the quality of life of the afflicted patients. To better understand the current status of pruritus, we assessed its pre- valence and intensity in patients with chronic liver diseases by performing a questionnaire survey on 216 patients. PATIENTS AND METHODS A total of 216 patients who visited departments of internal medicine at our 3 general hospitals for the diagnosis and treatment of chronic liver disease from September 2015 to March 2016 were recruited in this study. The patients’ characteristics and diagnoses are sum- marized in Table I. A total of 49 patients were treated for pruritus by antipruritic agents, of whom 59.2% received them only exter- nally, 10.2% received them only orally, and 26.5% received them both externally and orally. Data were not available for two cases. We asked the patients to complete a questionnaire (Appendix S1 1 ) when they visited our departments in the daytime. In the questionnaire, the patients were asked about the occurrence of pruritus and its intensity in the daytime and at night within a 24-h period using a visual analog scale (VAS) and verbal rating scale (VRS). The VAS involves a 10-cm-long horizontal line, the begin- ning of which represents “no itch” (0 mm) and the end of which represents “worst imaginable itch” (100 mm), on which patients indicate the intensity of pruritus by crossing the line at the point Table I. Profile of 216 patients with chronic liver disease Demographic data Sex (male/female/unknown), n 97/117/2 Age, years, mean (range) 63.5 (50–76) Etiology of chronic liver disease, n Chronic hepatitis C (HCV)/ chronic hepatitis B (HBV) 116/36 Primary biliary cholangitis (PBC) 18 Autoimmune hepatitis (AIH) 11 Non-alcoholic fatty liver disease (NAFLD) 14 Alcoholic liver disease (ALD) 13 Others 13 Liver cirrhosis (HCV/HBV/PBC/AIH/NAFLD/ALD/others), n 46 (23/7/0/0/4/4/8) HCC (HCV/HBV/PBC/AIH/NAFLD/ALD/others), n 22 (12/5/0/0/0/3/2) HCC: hepatocellular carcinoma. doi: 10.2340/00015555-3064 Acta Derm Venereol 2019; 99: 220–221 corresponding to the severity of their pruritus. The VRS consists of a list of phrases that describe increasing levels of pruritus intensity: no pruritus, mild pruritus, moderate pruritus, severe pruritus, and very severe pruritus. This study was approved by the local ethics committees of Kyushu University. Mean values and standard errors were calculated. Where appro- priate, the following tests were used: Student’s t-test, χ 2 test, and one-way analysis of variance (ANOVA) with Bonferroni’s post hoc test or Dunnett’s post hoc test. In this study, p-values < 0.05 were considered statistically significant. All data were analyzed using Microsoft Excel 2012 (Microsoft Corporation) or GraphPad Prism 5 (GraphPad Software). RESULTS Pruritus frequency The prevalence of pruritus according to the underlying liver disease is summarized in Fig. 1. In the present study, 41.2% of the patients suffered from pruritus (Fig. 1). Those with PBC (72.2%), AIH (54.5%), and liver cirrhosis (54.3%) showed a relatively high prevalence of pruritus, whereas those with chronic hepatitis B (24.3%) and NA- FLD (14.3%) showed a lower prevalence. The prevalence rates of pruritus in those with chronic hepatitis C, ALD, and HCC were 44.4%, 38.5% and 36.4%, respectively. In patients with hepatitis C, pruritus was more frequently detected in those with liver cirrhosis (65.2%) than in those without it (39.6%) (χ 2 test: p < 0.01). In contrast, there was no significant difference in the prevalence of pruritus bet- ween the hepatitis B patients with liver cirrhosis (42.9%) and those without it (21.4%) (Fig. 1b, c). Pruritus severity The mean VAS scores of pruritus during the daytime and at night were 21.78  ±  2.11 and 27.42  ±  2.43, respectively, in all patients with chronic liver diseases who had pruritus. Pruritus was significantly more severe at night than during the day (p < 0.01, Fig. S1a 1 ). There were no significant disease-specific differences in VAS in both the daytime and at night (Fig. S2a, b 1 ). Notably, VAS score at night was significantly higher in patients with liver cirrhosis than in those without it (Student’s t-test: p < 0.01), although such a significant difference of VAS was not observed in the daytime (Fig. S1b, c 1 ). There were no significant differences of VAS between the patients with and without HCC (data https://www.medicaljournals.se/acta/content/abstract/10.2340/00015555-3064 1 This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica.