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279 INVESTIGATIVE REPORT Characteristics of Pruritus in Relation to Self-assessed Severity of Atopic Dermatitis Flavien HUET 1,2# , Marie-Sarah FAFFA 1# , Florence POIZEAU 3.4 , Stéphanie MERHAND 5 , Laurent MISERY 1,2 and Emilie BRENAUT 1,2 Department of Dermatology, University Hospital, 2 Laboratory on Interactions Neurons-Keratinocytes (LINK), University of Western Brittany, Brest, 3 Rennes University, UPRES EA 7449 REPERES Pharmacoepidemiology and Health Services Research, 4 Department of Dermatology, University Hospital, Rennes, and 5 French Association of Eczema, Redon, France # These authors contributed equally to this work. 1 The objective of this study was to explore characte- ristics of pruritus in atopic dermatitis (AD) in relation to the severity of AD. A web-questionnaire was used, which included the Patient-Oriented SCORing Atopic Dermatitis index, the 5-D itch scale and the Brest questionnaire. A total of 170 participants were inclu- ded (86.5% women, mean age 30.9 years). Severity of AD was mild for 8.2% of patients, moderate for 38.2% and severe for 53.5%. Mean 5-D itch scale was 13.2. The mean intensity of pruritus was 5.8, and mean sleep loss was 4.7 (from 0 to 10). The participants frequent- ly described burning (61.8%) and stinging (58.8%); these symptoms suggest a neuropathic component. Pruritus was worse in severe AD compared with mode- rate AD, exhibiting a higher impact on sleep and more associated symptoms. The majority of participants re- ported sleep disturbance as a result of pruritus. The characteristics of pruritus varied depending on the se- verity of AD. to the severity of AD, using Patient-Oriented SCORing Atopic Dermatitis (PO-SCORAD). Key words: atopic dermatitis; pruritus; questionnaire; itch; web questionnaire; PO-SCORAD; 5-D itch scale. PATIENTS AND METHODS Accepted Sep 27, 2018; E-published Sep 28, 2018 Acta Derm Venereol 2019; 99: 279–283. Corr: Emilie Brenaut, Department of Dermatology, University Hospital, FR-29609 Brest, France. E-mail: [email protected] P ruritus is defined as an unpleasant sensation that provokes the desire to scratch (1, 2). It is a frequent symptom in many skin diseases, as well in systemic diseases (3, 4). Pruritus is a primary symptom of atopic dermatitis (AD) and constitutes one of the major diag- nostic criteria, according to Hanifin & Rajka’s (5) and the UK Working Party’s diagnostic criteria for AD (6). AD is a common, chronic, pruritic, relapsing inflammatory skin condition, which is an increasingly important public health problem worldwide, with a prevalence of 10–30% in children and 2–10% in adults (7). In France, the preva- lence of AD is estimated at 3.6–4.7% in adults (8, 9). The condition has a high burden, with serious psycho-social impact and impaired quality of life (10–12). However, only a few studies have explored the characteristics of pruritus in AD (4, 11, 13–15), and none have analysed the correlation of pruritus with severity of AD. The aim of the current study was to characterize pruritus in relation SIGNIFICANCE Pruritus is a frequent symptom in atopic dermatitis and it has a major impact on quality of life. Only a small number of studies have explored the characteristics of pruritus in atopic dermatitis. The aim of our study was to characterize pruritus while considering the severity of atopic dermatitis, thanks to a web-questionnaire. One hundred and seventy participants were included. The mean intensity of pruritus was 5.8, and the mean sleep loss was 4.7 (from 0 to 10). The participants frequently described burning (61.8%) and stinging (58.8%). In severe atopic dermatitis compared to moderate atopic dermatitis, pruritus was more severe, exhibiting a higher impact on sleep and more associated symptoms. A web questionnaire on pruritus in AD was available on the website of the French Association of Eczema (Association Française de l’Eczéma) between January 2015 and March 2016. This association was established in 2011 for patients with AD or contact eczema and provides information and advice regarding these diseases via its website and social networks. The initial questions were related to age, sex and eczema type (atopic dermatitis, contact eczema or other). The severity of AD was evaluated using the validated self-assessed AD severity score: the PO-SCORAD index. The PO-SCORAD, established in 2011 by Stalder et al. (16), measures the severity of AD during the previous 3 days and integrates objective and subjective symptoms with the help of an illustrated tutorial (16). The score ranges from 0 to 103, with a higher score indicating a more severe disease. The evalua- tion of severity of AD by PO-SCORAD is divided into several parts: surface area of skin affected by eczema, objective symptoms from 0 (non-existent) to 3 (severe): dryness of the skin without eczema and redness, swelling, oozing/crust, scratching, and thick- ening of the skin affected by eczema, and a visual analogue scale from 0 (absence) to 10 (very important) to evaluate pruritus and sleep loss. In the next section, participants responded to the Brest questionnaire, which has been used in previous studies of different diseases, such as small-fibre neuropathies, neurofibromatosis 1 or systemic sclerosis (13, 17–19). Participants were asked about the duration, chronology, and intensity of pruritus in AD. The intensity of pruritus was assessed with a visual analogue scale from 0 to 10 (i.e. at its worst, best, average, and at the time of the study). Participants were asked about symptoms associated with pruritus: sweating, headaches, pain, heat and cold in the region This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica. doi: 10.2340/00015555-3053 Acta Derm Venereol 2019; 99: 279–283