Consensus on the therapeutic management of atopic dermatitis ‒ Brazilian Society of Dermatology: an update on phototherapy and systemic therapy using e-Delphi technique

Pruritus in atopic dermatitis: a cross-sectional study of adult patients from a tertiary university hospital in São Paulo, Brazil

BACKGROUND

Chronic pruritus is the defining symptom of atopic dermatitis (AD). Although AD is common in Latin America, there is little data regarding pruritus intensity, characteristics, and effects on quality of life in this population.

OBJECTIVE

This cross-sectional study aimed to evaluate pruritus in 91 patients with AD at a tertiary university hospital in São Paulo, Brazil. Patients aged 14‒65-years old were included in this study.

METHODS

Patients completed the Itch Questionnaire, the ItchyQoL, and the POEM questionnaires and were asked to rate their itch severity using a 10-point peak pruritus Numerical Rating Scale (NRS). AD severity was assessed via the EASI and the vIGA-AD.

RESULTS

The mean age was 29.68 ± 12.87years, and 56.0% of patients were White. 97.8% of patients were currently experiencing pruritus with an average NRS of 7.32 ± 2.22. Patients had associated bleeding (71.4%), heat sensation (63.7%), and pain (54.9%). Worsening factors included stress (93.4%), dry skin (91.2%), and sweat (75.8%). The mean total ItchyQoL score was 78.93 ± 17.20. Female gender was significantly associated with a higher total ItchyQoL score (p = 0.009). Pruritus on the neck, foot, and whole body was associated with higher total ItchyQoL scores in adjusted models (p < 0.05). The EASI, vIGA-AD, and POEM were moderately correlated with itch intensity (r = 0.434, 0.406, and 0.610) and total ItchyQoL score (r = 0.425, 0.436, and 0.631).

STUDY LIMITATIONS

The predominantly White population cohort may not be representative of the diverse AD phenotypes in the Brazilian patient population. Children under the age of 14 and adults over the age of 65 were excluded from the population cohort. Furthermore, patients included in the study may suffer from other non-dermatological diseases that cause itch, which may influence the outcomes oberserved.

CONCLUSIONS

Patients with AD in Brazil experience significant pruritus that impacts their quality of life. Gender, body location of itch, associated pain, and stress should all be taken into consideration when evaluating AD patients with pruritus.

Prurigo: review of its pathogenesis, diagnosis, and treatment

Prurigo is a reactive, hyperplastic skin condition characterized by pruritic papules, plaques, and/or nodules. The temporal classification includes acute/subacute and chronic disease (≥ 6 weeks), with different clinical variants, synonymies, and underlying etiological factors. The immunology of chronic prurigo shows similarities with atopic dermatitis due to the involvement of IL-4 and IL-13, IL-22, and IL-31. Treatment includes antihistamines, topical steroids, dupilumab, and JAK inhibitors. Several conditions manifest clinically as prurigo-like lesions, and the correct clinical diagnosis must precede correct treatment. Furthermore, chronic prurigos represent a recalcitrant and distressing dermatosis, and at least 50% of these patients have atopic diathesis, the treatment of which may induce adverse effects, especially in the elderly. The quality of life is significantly compromised, and topical treatments are often unable to control symptoms and skin lesions. Systemic immunosuppressants, immunobiologicals, and JAK inhibitors, despite the cost and potential adverse effects, may be necessary to achieve clinical improvement and quality of life. This manuscript reviews the main types of prurigo, associated diseases, their immunological bases, diagnosis, and treatment.