Itch Severity Scale: a self-report instrument for the measurement of pruritus severity

Background Assessing pruritus severity is difficult because of its subjective nature. A questionnaire that takes into account how the symptom is perceived by the patient may provide a more accurate representation of the pruritus. However, recently developed questionnaires do not specifically quantify severity of the symptom. Objectives To develop a self‐report questionnaire to measure pruritus severity and to provide initial evidence of its validity and reliability. Methods We modified a previously developed interview for the characterization and evaluation of pruritus, which was completed along with the RAND‐36 Health Status Inventory and Dermatology Life Quality Index by patients with psoriasis‐associated pruritus. Exploratory factor analysis, studies of internal consistency, and correlation analyses with health‐related quality of life scores were used to help determine which components of the modified pruritus interview to include in the new questionnaire, the Itch Severity Scale (ISS). The ISS was then assessed for construct validity, internal consistency reliability and test–retest reliability. Results Seven of the initial 11 components of the modified pruritus interview were included in the ISS. ISS scores correlated moderately with physical (r = −0·483) and mental (r = −0·492) health composite scores of the RAND‐36 and strongly with Dermatology Life Quality Index scores (r = 0·628), evidence of construct validity. It had an internal consistency reliability of 0·80 and a test–retest reliability of 0·95. Conclusions Based on this preliminary evidence of validity and reliability, this new seven‐item ISS may be useful in comparing pruritus severity among different disease populations or in assessing pruritus treatment effectiveness.     

Validation of a Mexican Spanish Version of the Children’s Dermatology Life Quality Index

Abstract: The Children’s Dermatology Quality Index was developed as a tool to evaluate the quality‐of‐life in children with skin diseases. While a useful, self‐administered scale, it has not been validated in Spanish for Mexican children. The aim of this study was to validate a Mexican version. Direct English‐Spanish translation of the Children’s Dermatology Quality Index was performed by two translators, and a single version was produced by a consensus of experts. Clarity was tested in a cohort of 60 healthy children. A reverse English‐Spanish translation was performed. In a second stage, the quality‐of‐life was evaluated in a cohort of 64 pediatric patients with atopic dermatitis using the SCOring Atopic Dermatitis Index and COOP‐Dartmouth questionnaires, and its severity evaluated with SCOring Atopic Dermatitis Index. Sixty‐four patients (32 males), aged 11.8 ± 2.9 years, with atopic dermatitis of 1 to 3 years of evolution were evaluated. The Mexican Spanish version of the Children’s Dermatology Quality Index showed a high internal consistency (Cronbach’s Alpha = 0.83; (CI_95% = 0.76–0.88) and a high test–retest reliability (γ_s = 0.97, p < 0.001). A high correlation was observed between Children’s Dermatology Quality Index and COOP‐Dartmouth (γ_s = 0.97, p < 0.001) and moderate correlation with SCOring Atopic Dermatitis Index (γ_s = 0.53, p < 0.001). The Children’s Dermatology Quality Index questionnaire in its Mexican Spanish version is valid and reliable for evaluating quality‐of‐life in Mexican pediatric patients with atopic dermatitis.     

[Translated article] Spanish Version of the RECAP Questionnaire to Assess Control of Atopic Eczema: Translation,Cultural Adaptation,Validation, and Correlations With Other Patient-Reported Outcome Measures

BackgroundThe 7-item RECAP (Recap of Atopic Eczema) questionnaire is used to assess the control of different degrees of eczema severity in patients of all ages. Long-term control of eczema is one of the 4 core outcome domains to be assessed in clinical trials of eczema therapies. After the RECAP was developed in the United Kingdom, it was translated into Chinese, German, Dutch, and French.ObjectivesTo produce a validated Spanish version of the RECAP questionnaire and, secondarily, to test its content validity in a group of Spanish patients with atopic eczema.Material and methodsIn a 7-step process we produced 2 forward translations and 1 back translation of the RECAP questionnaire. Experts then held two meetings to reach consensus and draft a Spanish version of the questionnaire. Fifteen adult patients with atopic eczema were interviewed to evaluate the comprehensibility, comprehensiveness, and relevance of the drafted items. These patients also completed the Atopic Dermatitis Control Tool (ADCT), the Dermatology Life Quality Index (DLQI), and the Patient-Oriented Eczema Measure (POEM). Stata software (version 16) was then used to explore the correlations between the patients’ scores on these tools and the RECAP.ResultsThe patients found the Spanish version of the RECAP to be comprehensible and easy to answer. We observed a strong correlation between results on the Spanish RECAP and the ADCT, and highly significant correlations between the RECAP and the DLQI and POEM tools.ConclusionsThe culturally adapted Spanish version of the RECAP is linguistically equivalent to the original version of the questionnaire. RECAP scores correlate highly with other patient-reported outcome measures.     

Itch and psyche: psychiatric aspects of pruritus

Itch, also referred to as pruritus, is an unpleasant cutaneous sensation provoking the desire to scratch. It is often an uncomfortable, subjective sensation responsible for decreased quality of life in a variety of psychodermatological conditions. Comorbid psychiatric conditions, including depression and anxiety, are frequently associated with itch and scratch cycle. The reciprocal and intricate relationship between the psyche and itch has been widely studied. The neurobiology of itch involves the complexity of specific mediators, itch-related neuronal pathways, and central processing of itch. The connection between itch and the psyche can be grouped under three headings: pruritic diseases with psychosocial sequelae, pruritic diseases aggravated by psychosocial factors, and psychiatric disorders causing pruritus. Itch and pain modulation go together in most circumstances and involve various substances including histamine, interleukins, protease-activated receptors, transient receptor potential receptors, opioids, and cannabinoids. The close interaction between keratinocytes and nerve endings modulating pain and itch also play a major role. Management of itch associated with its psychosomatic components is directed at an underlying cause and adopting a holistic approach to address not only dermatologic and somatosensory aspects, but also the cognitive, emotional, and psychosocial components. An integrated multidisciplinary team consisting of a dermatologist, psychiatrist, psychologist, and social worker is vital in addressing the multifaceted aspects of pruritus.     

Neuropathic Itch of the Back: A Case of Notalgia Paresthetica

Notalgia paresthetica refers to an isolated mononeuropathy involving chronic localized itch or paresthesia most often at the skin of the scapula or surrounding regions. There are no specific skin manifestations except those arising from chronic scratching and rubbing. The specific etiology remains unknown; however, it has been theorized that the neuropathic itch is caused by sensory nerve entrapment involving the posterior rami of the T2 to T6 nerve root. The entrapment is due to degenerative changes in the vertebrae. We report here a particular case of notalgia paresthetica in a 55-year-old woman. The patient visited our hospital for tingling pain around the left inferior angle of the scapula. Pruritus was first reported seven years ago with tingling pain developing only four months ago. There were no specific skin lesions observed except for excoriation and vague hyperpigmentation. A skin biopsy revealed only epidermal thinning with pigmentary incontinence. The patient was treated with 600 mg of gabapentin daily as well as capsaicin cream. The response was deemed unsatisfactory.     

Development and evaluation of a Global Acne Severity Scale (GEA Scale) suitable for France and Europe

Background and objective Many acne grading methods exist; however, there is no agreed‐upon standard. Our objective was to create and validate a reproducible acne assessment scale for rating the severity of juvenile facial acne suitable for use in France and Europe. Methods The scale we created described the different types of acne lesions in a manner similar to global assessment scales used in clinical trials. The scale was then validated by seven expert dermatologists in the field of acne [the Global Evaluation Acne (GEA) group] first on 34 photographic cases of Caucasian acne patients and second by clinical examination of 22 acne patients. Results There was good agreement in Investigators’ assessments of acne both on photographs and patients (R = 0.8057; P < 0.0001, and R = 0.8437; P = 0.0015). Conclusion The GEA Scale is a global scale validated both on photographs and acne patients which can be used either in clinical research or by the dermatologist in his office.     

Itch induction by audiovisual stimuli and histamine iontophoresis: a randomized,controlled noninferiority study

瘙痒是许多皮肤病的主要症状,在某些科学研究中,研究人员想要有意触发志愿者皮肤瘙痒。在实验室环境中有不同的瘙痒诱导方法。一种可能性是通过使用弱电流将由身体产生的瘙痒诱导物质(称为组胺)转移到皮肤中。这种方法称为组胺-离子电渗,需要“直接皮肤操作”。 与此不同,“非皮肤操纵”方法是为志愿者提供与瘙痒相关的视听材料(例如,爬虫的幻灯片或视频)。 其他研究已发现瘙痒的体验也取决于患者的注意力。 德国的研究人员旨在通过本研究查明,通过视听材料诱发(触发)的瘙痒是否与下列两种情况下组胺-离子电渗诱导的瘙痒相当:在瘙痒诱导前不关注皮肤(研究 1a),以及在瘙痒诱导前关注皮肤(研究 1b)。 在研究 1a 中,所有 80 名受试者都休息 10 分钟。然后,其中 40 名观看瘙痒诱导视频,另外 40 名应用组胺。 研究 1b 与 1a 相同,但没有 10 分钟的休息时间,而是让所有 80 名受试者观看非皮肤瘙痒诱导视频,然后或进行组胺瘙痒诱导(40 人)或观看瘙痒相关的视听材料(40 人)。 通过询问受试者最重瘙痒的强烈程度以及诱发后瞬间瘙痒的强烈程度来衡量瘙痒。 研究人员发现,视听材料诱导的最重瘙痒与组胺诱导的最重瘙痒相当,但仅限受试者在瘙痒诱导之前观看非瘙痒诱导视频(研究 1b)时。 然而,当志愿者在瘙痒诱导前未关注皮肤时,组胺诱发的瘙痒实际上更加强烈(研究 1a)。 这表明,当研究人员希望在研究中使用瘙痒相关的刺激(例如视听材料)作为组胺-离子电渗的替代方法时,在瘙痒诱导之前吸引志愿者的注意力是很重要的。 本摘要涉及研究:通过视听刺激和组胺离子电渗诱导瘙痒:一项随机、对照、非劣效性研究。     

Itch in the community: associations with psychosocial factors among adults

BACKGROUND: Itch is a major symptom in dermatology but is little explored epidemiologically. Objective To describe the prevalence and the severity of itch, and to explore its relation to psychosocial factors. METHODS: The design was cross-sectional and population-based. A total of 40 880 adults in Oslo were invited to answer a questionnaire. RESULTS: Twenty-seven per cent report itch. Individuals reporting itch were younger, the majority were female, were non-Norwegian, had lower income, were more distressed, had experienced more negative life events and had poorer social support. Individuals with poor support who had experienced more negative life events reported more itch than individuals with good support (15. 6% compared to 10. 9%). The strong association with psychosocial factors was confirmed in a logistic regression. CONCLUSION: There is a strong association between itch and psychosocial factors in the general population.