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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
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