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Psychiatric Comorbidities in Non-Psychogenic Chronic Itch, a US

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Psychiatric Comorbidities in Non-Psychogenic Chronic Itch, a US 1/4 CLINICAL REPORT Psychiatric Comorbidities in Non-psychogenic Chronic Itch, a US- DV based Study 1 1 1 1 1 2 cta Rachel Shireen GOLPANIAN , Zoe LIPMAN , Kayla FOURZALI , Emilie FOWLER , Leigh NATTKEMPER , Yiong Huak CHAN and Gil YOSIPOVITCH1 1 2 A Department of Dermatology and Cutaneous Surgery, and Itch Center University of Miami Miller School of Medicine, Miami, USA, and Clinical Trials and Epidemiology Research Unit, Singapore Research suggests that itch and psychiatric diseases SIGNIFICANCE are intimately related. In efforts to examine the preva- lence of psychiatric diagnoses in patients with chronic The primary aim of this study was to examine the preva- itch not due to psychogenic causes, we conducted a lence of psychiatric diagnoses in patients with chronic itch retrospective chart review of 502 adult patients diag- that is not due to psychogenic causes. The secondary aim nosed with chronic itch in an outpatient dermatology of this study was to determine whether psychiatric diagno- clinic specializing in itch and assessed these patients ses have any correlation to specific itch characteristics such enereologica for a co-existing psychiatric disease. Psychiatric di- as itch intensity, or if there are any psychiatric-specific di- V sease was identified and recorded based on ICD-10 seases this patient population is more prone to. This infor- codes made at any point in time which were recor- mation will not only allow us to better understand the po- ded in the patient’s electronic medical chart, which tential factors underlying the presentation of chronic itch, includes all medical department visits at the Univer- but also allow us to provide these patients with more holis- ermato- sity of Miami. Fifty-five out of 502 (10.9%) patients tic and complete assessment and treatment in the future. D were found to have a comorbid psychiatric diagnosis based on ICD-10 codes. The most common psychiatric cta diagnoses were anxiety disorders (45.5%), followed The primary aim of this study was to examine the A by major depressive disorder (36.4%). There was no prevalence of psychiatric diagnoses in patients with significant association of any specific type of itch to a chronic itch that is not due to psychogenic causes. The particular psychiatric disorder. No unique itch charac- secondary aim of this study was to determine whether teristics were noted in patients with underlying psy- comorbid psychiatric diagnoses have any correlation to chiatric diagnoses. specific itch characteristics such as itch intensity, or if there are any psychiatric-specific diseases this patient DV Key words: itch; psychiatric; anxiety; depression; chronic; psycho logic. population is more prone to. cta Accepted Apr 21, 2020; Epub ahead of print Apr 21, 2020 A Acta Derm Venereol 2020; 100: adv00169. MATERIALS AND METHODS Corr: Gil Yosipovitch, MD, Department of Dermatology and Cutaneous Five-hundred and two adult patients diagnosed with chronic itch Surgery, and Itch Center University of Miami Miller School of Medicine, conditions between November 2017 and December 2019 who 1600 NW 10th Ave, RMSB 2067B, Miami, FL 33136, USA. E-mail: yosi- were seen at the Miami Itch Center clinic were included in the [email protected] study. Chronic itch was defined as itch lasting > 6 weeks and etiologies included dermatologic, systemic, or neuropathic, as well as idiopathic causes of itch. These patients were identified tudies have shown evidence of a correlation between based upon completion of an electronic medical record (EMR) itch Schronic itch and mental health problems (1), and in questionnaire part of the clinic assessment. The EMR itch ques- recent years, research has begun to further explore the tionnaire contains questions related to duration, characteristics, and intimate relationship between itch and the psychologi- factors associated with the patient’s itch (see Table I). All chronic itch diagnoses were made by a board-certified dermatologist with cal disorders. For example, a study found that 70% of an expertise in itch (GY). Chronic itch diagnoses were grouped hospitalized pruritus patients who were administered into 6 major categories as shown in Table II. Patients who were global rating scales on psychiatric, social, and profes- diagnosed with psychogenic itch, as defined by the French Psy- sional functioning presented with symptoms suggestive of psychiatric illness (2). Chronic pruritus has been correlated to increased psychologic burden, with hig- Table I. Itch questionnaire variables her incidences of psychiatric disturbances and suicidal Variable Outcomes ideations reported in chronic itch patients compared to 24-h total itch duration 0–2 h > 2 h non-chronic itch patients (3, 4). Furthermore, our group 24-h average itch severity On a scale of 0–10* 24-h worst itch severity On a scale of 0–10* has previously found that there is a significant component Impact on sleep Yes No (up to 32%) of chronic itch without rash amongst hospi- Itching at night Yes No Distribution of itch Localized Generalized talized psychiatric patients (5). This raises the question Scratch pleasurability Not pleasurable Neutral Pleasurable dvances in dermatology and venereology whether chronic non-psychogenic itch is associated with Total itch duration <1 year > 1 year A psychiatric comorbidities. *with 0 being no itch, and 10 being the worst itch imaginable. This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta doi: 10.2340/00015555-3487 Journal Compilation © 2020 Acta Dermato-Venereologica. Acta Derm Venereol 2020; 100: adv00169 2/4 R. S. Golpanian et al. Table II. Categorization of itch-related dermatologic diagnoses point in time were identified based upon a designated psychiatric Category Diagnoses included ICD-10 code. Of note, all cases were manually examined to assure that neuropathic causes of itch were not coded as a psychiatric 1. Inflammatory skin disease comorbidity. DV 1a. Atopic Dermatitis Dishydrotic eczema Eczematous dermatitis Nummular dermatitis Statistical analysis cta Atopic neurodermatitis 1b. Psoriasis All statistical analyses were performed using SPSS 25.0. Associa- A 1c. Prurigo nodularis tion between factors were determined by χ2 tests for categorical 1d. Lichen simplex chronicus 1e. Other Xerosis cutis variables and ANOVA for comparison of means. A p-value < 0.05 Contact dermatitis was considered significant. Steroid-induced dermatitis Urticaria Seborrheic dermatitis Scabies/post-scabetic pruritus RESULTS Mastocytoma, mastocytosis Bullous pemphigoid Five-hundred and two adult patients (191 males and Keratosis pilaris Intertrigo 311 females) with chronic itch due to dermatologic, Lichen planus systemic, and neuropathic causes filled out the EMR enereologica Venous insufficiency Dermal hypersensitivity reaction itch questionnaire during their clinic visits. Forty-one V Folliculotropic T-cell lymphoma of these patients were diagnosed with more than one Grovers disease Kyrles disease disease process contributing to their chronic itch. The Morphea prevalence of each dermatologic diagnosis can be found Keratoderma with pruritus ermato- Lichen sclerosis of the vulva in Table III. Of these patients, 55 were found to have a Mosquito bite sequelae D comorbid psychiatric diagnosis based on recorded ICD- Perforating disorder (with ESRD) Granuloma annulare 10 codes (10.9%). cta Tinea infection Ichthyosis vulgaris with PIPA A Irritant dermatitis Psychiatric diagnoses Papuloerythroderma of Ofuji Acne Of the 55 chronic itch patients with a comorbid psy- Photo recall dermatitis from chemo Pigmented purpuric dermatosis chiatric diagnosis, 19 were diagnosed with multiple 2. Chronic pruritus Chronic Pruritus of Unknown Origin ICD-10 codes. The most common psychiatric diagnosis Chronic Pruritus of Aging Chronic Pruritus not otherwise specified amongst chronic itchy patients was anxiety disorders, DV 3. Neuropathic itch Scalp dysesthesia which accounted for 25 patients (i.e. F41, 45.5%). Localized neuropathic itch (scrotal, vulvar, Eighteen patients had a recurrent or single episode of cta scalp, anal) post-herpetic neuralgia Itch in the setting of spinal compression/ major depressive disorder (F32 and F33, 36.4%), 9 A injury/back pain notalgia para Brachioradial Pruritus patients had a reaction to severe stress or adjustment Itch associated with diabetic neuropathy disorders (F43, 16.4%), 8 patients had sleep disorders 4. Pruritus secondary to Cholestatic itch not due to a substance or known physiological condi- systemic disease Scleroderma Cirrhosis tion (F51, 14.5%), 5 patients had obsessive compulsive HIV disorder (F42, 9.1%), 5 patients had substance-related Medication-induced Renal disease (including lupus nephritis) disorders (F10, F11, F17, and F19, 9.1%), 4 patients Malignancy had unspecified mood (affective) disorder (F39, 7.3%), 5. Localized pruritus of Scalp unknown origin Scrotum 3 patients had attention deficit hyperactivity disorder Anus (F90, 5.5%), and 2 patients had bipolar disorder (F31, Vulva 6. Other Aquagenic pruritus 3.6%). Other disorders represented by a single patient Pruritus due to stress/hormonal changes Autonomic overactivity Pruritus Gravidarum Fibromyalgia Table III. Prevalence of itch-related dermatologic diagnoses ESRD: End-stage renal disease; PIPA: post-inflammatory pigment alteration. Total individual diagnoses (n = 502) Diagnosis category n (%) chodermatology Group as an itch disorder where psychological 1. Inflammatory skin disease 313 (62) factors play an evident role in triggering the itch, were excluded
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