986
SHORT COMMUNICATION
Chronic Pain in Patients with Skin Disorders
Laurent MISERY 1,2 , Markéta SAINT AROMAN 3 , Asmaa ZKIK 4 , Alain BRIANT 5 , Ludovic MARTIN 6 , Michèle-Léa SIGAL 7 , Christine
BODEMER 8 , Gérard GUILLET 9 , Martine BAGOT 10 and Charles TAIEB 11,12
Laboratory of Neurosciences of Brest, University of Western Brittany, 2 Department of Dermatology and Venereology, University Hospital,
FR-29609 Brest, 3 A-Derma Laboratories, Lavaur, 4 Pierre Fabre Médicament & Santé, Boulogne, 5 Office of Dermatology, Toulouse, 6 Department
of Dermatology, University Hospital of Angers, Angers, 7 Department of Dermatology, Victor Dupouy Hospital, Argenteuil, 8 Department of
Dermatology and 11 Department of Public Health, University Hospital Necker-Enfants Malades, Paris, 9 Department of Dermatology, University
Hospital of Poitiers, Poitiers, 10 Department of Dermatology, University Hospital Saint Louis, Paris, and 12 EMMA, Fontenay-sous-Bois, France.
E-mail: [email protected]
1
Accepted May 10, 2017; Epub ahead of print May 12, 2017
Itching and pain have both been found to be highly pre-
sent in patients with skin disorders and associated with
depression, which can also lower the threshold for both
sensory symptoms (1).
A systematic literature review of the MEDLINE da-
tabase using the keywords “pain” and “skin” revealed
increasing interest in the topic (from 54 articles in 1970
to 1,484 in 2015). However, very few of these studies
specifically assessed pain in patients with skin diseases.
The current study analysed the presence and frequency
of pain in patients seeking dermatological care, and in-
vestigated variations in pain by age and sex, clinical cha-
racteristics of pain, with a focus on neuropathic pain, and
associations between skin diseases and burden of pain.
PATIENTS AND METHODS
Outpatients older than 18 years seeking consultations at 7 investi-
gator centres in France completed self-administered questionnaires.
Dermatological diagnoses were assessed by dermatologists, and
only those skin disorders thought to be associated with pain, inclu-
ding leg and pressure ulcers, psoriasis, atopic dermatitis (AD), sexu-
ally transmitted diseases (STD) and reactive skin, were proposed
to the investigator for selection as a diagnosis associated with pain.
The DN4 (Douleur Neuropathique – 4 questions) is a questionn-
aire designed to detect neuropathic pain (2). A score of DN4i ≥ 3
is indicative of neuropathic pain syndrome (3).
Statistical analysis was performed using SAS ® V9.4 software
(SAS Institute, Raleigh, NC, USA). Student’s t-tests and Wilcoxon
tests were used for analysis when distributions of variables were
normal and not normal, respectively. The significance level was
set at p = 0.05.
STD, and 27.5% of patients with other diagnoses. The
mean duration of pain was 25.8 months (range 0–552
months). The pain was chronic in 25.7% and transitory
in 74.3% of patients. The pain had been treated in only
59.3% of patients. The mean pain intensity was 4.7 ± 2.4
out of a possible score of 10 in patients reporting pain,
of whom 22.6% reported a pain intensity > 7.
Skin pain was frequently associated with other sen-
sations (Table I).
Calculation of a DN4i score was possible for only 402
patients. The mean ± standard deviation (SD) score was
2.65 ± 1.58, and did not differ significantly by type of skin
disease. The score was ≥ 3 in 53% and < 3 in 47% of the
402 patients. No significant differences in score were
noted by age, sex, or type of skin disease, and DN4i > 3
were identified in 58.3% of patients with psoriasis, 57.5%
of patients with AD and 56.1% of patients with leg ulcers.
The burden of pain was moderate (Fig. S1 1 ), but it was
significantly greater in patients with a pain intensity > 7
than in those < 7 (p < 0.0001) (Table II) and in patients
with neuropathic pain, as assessed by DN4i > 3, than in
those without neuropathic pain (p < 0.0001).
The population was divided into 2 groups: patients
aged < 50 years (n = 666, 59.9% females and 40.1%
males) and patients aged >50 years (n = 921, 50.9%
females and 49.1% males). Only leg ulcers (0.3 vs.
7.8%, p < 0.0001), pressure ulcers (0 vs.0.7%) and
STDs (0.9 vs.0%) differed significantly between the 2
groups for all dermatological diagnosis. In the younger
group, 33.6% reported skin pain, while 38.5% reported
skin pain in the older group (p = 0.05). There were no
RESULTS
Overall, 1,587 patients were contacted and 1,565
responded to the questionnaire. Mean age was 53.1
years (range 18–100 years; 54.7% women, 45.3%
men) with the following diagnoses: psoriasis (13.6%),
AD (9.8%), leg ulcers (4.7%), reactive skin (1.6%),
pressure ulcers (0.4%), STDs (0.4%) and other
(62.6%).
Skin pain was reported by 36.4% of patients;
specifically, by 67.6% of patients with leg ulcers,
54.7% of patients with AD, 54.2% of patients with
reactive skin, 51.9% of patients with psoriasis, 50%
of patients with pressure ulcer, 20% of patients with
doi: 10.2340/00015555-2694
Acta Derm Venereol 2017; 97: 986–988
https://www.medicaljournals.se/acta/content/abstract/10.2340/00015555-2694
1
Table I. Percentage of patients experiencing other sensations associated
with pain by type of skin disease diagnosis
Sensation Atopic
Leg
dermatitis Psoriasis ulcers
n (%)
n (%)
n (%) Pressure
ulcers
n (%) Reactive
skin
n (%)
Burning
Cold pain sensations
Electric shock sensations
Tingling
Prickling
Numbness
Itch 45 (71.4)
6 (14.3)
11 (25.6)
10 (25.6)
30 (65.2)
9 (23.7)
60 (96.8) 2
1
1
0
0
1
1 6
1
2
2
4
1
5
65 (72.2)
8 (11.0)
17 (22.1)
18 (26.1)
45 (57.7)
14 (20.3)
8