Pruritus Characteristics in Severe Atopic Dermatitis in Adult Patients
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Atopic dermatitis (AD) is classified as a most common inflammatory skin disease. The condition is characterized by recurrent eczematous lesions and intense pruritus or itch, a hallmark of AD. The aim of this study was to identify the provoking factors of itch in severe AD adult patients. There were 34 adult patients suffering from AD of the median age of 40 years enrolled into the study and a control group that consisted of 20 healthy subjects. The severity of AD was assessed with the SCORing Atopic Dermatitis (SCORAD) index, pruritus intensity was assessed on a visual analog scale (VAS), and itch aggravating factors were assessed with a questionnaire. Specific IgE (sIgE) antibodies and interleukin IL-33 were measured in venous blood. We found that all the patients with severe AD had intensive itch (VAS: 9–10 points) during the whole day and 30 (88.2%) patients had it during nighttime. The most significant factors aggravating itch were the following: dry skin (27 patients; 79.4%), exposure to dust mite (22 patients; 64.7%,), and emotional distress (17 patients; 50%). Moreover, there was a positive correlation between the intensity of itch and the level of sIgE antibodies to dust mite (p < 0.001). The content of IL-33 was significantly higher in AD patients with severe skin lesions. This exploratory study shows that skin dryness, dust exposure, and distress play an essential role in the exacerbation of AD in the adult population.
KeywordsAtopic dermatitis Emotional distress IgE antibody Inflammation Itching Pruritus Skin
Conflicts of Interest
The authors declare no conflicts of interest in relation to this chapter.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Jagiellonian University Ethics Committee.
Written informed consent was obtained from all individual participants included in the study.
- Barbarot S, Auziere S, Gadkari A, Girolomoni G, Puig L, Simpson EL, Margolis DJ, de Bruin-Weller M, Eckert L (2018) Epidemiology of atopic dermatitis in adults: results from an international survey. Allergy 73(6):1284–1293Google Scholar
- Chen YL, Gutowska-Owsiak D, Hardman CS, Westmoreland M, MacKenzie T, Cifuentes L, Waithe D, Lloyd-Lavery A, Marquette A, Londei M, Ogg G (2019) Proof-of-concept clinical trial of etokimab shows a key role for IL-33 in atopic dermatitis pathogenesis. Sci Transl Med 11(515):pii: eaax2945CrossRefGoogle Scholar
- Hanifin JM, Rajka G (1980) Diagnostic features of atopic dermatitis. Acta Dermatol Venerol (Stockh) 92(Suppl):44–47Google Scholar
- Hu Y, Liu S, Liu P, Mu Z, Zhang J (2020) Clinical relevance of eosinophils, basophils, serum total IgE level, allergen-specific IgE, and clinical features in atopic dermatitis. J Clin Lab Anal. https://doi.org/10.1002/jcla.23214
- Katoh N, Ohya Y, Ikeda M, Ebihara T, Katayama I, Saeki H, Shimojo N, Tanaka A, Nakahara T, Nagao M, Hide M, Fujita Y, Fujisawa T, Futamura M, Masuda K, Murota H, Yamamoto-Hanada K (2019) Clinical practice guidelines for the management of atopic dermatitis 2018. J Dermatol 46(12):1053–1101CrossRefGoogle Scholar
- Nowicki RJ, Trzeciak M, Kaczmarski M, Wilkowska A, Czarnecka-Operacz M, Kowalewski C, Rudnicka L, Kulus M, Mastalerz-Migas A, Peregud-Pogorzelski J, Sokołowska-Wojdyło M, Śpiewak R, Adamski Z, Czuwara J, Kapińska-Mrowiecka M, Kaszuba A, Krasowska D, Kręcisz B, Narbutt J, Majewski S, Reich A, Samochocki Z, Szepietowski J, Woźniak A (2020) Atopic dermatitis. Interdisciplinary diagnostic and therapeutic recommendations of the Polish Dermatological Society, Polish Society of Allergology, Polish Pediatric Society and Polish Society of Family Medicine. Part I. Prophylaxis, topical treatment and phototherapy. Adv Dermatol Allergol XXXVII(1):1–10CrossRefGoogle Scholar
- Oranje AP, Glazenburg EJ, Wolkerstorfer A, de Waard-van der Spek FB (2007) Practical issues on interpretation of scoring atopic dermatitis: the SCORAD index, objective SCORAD and the three-item severity score. Br J Dermatol 157(4):645–648Google Scholar
- Scalabrin DM, Bavbek S, Perzanowski MS, Wilson BB, Platts-Mills TA, Wheatley LM (1999) Use of specific IgE in assessing the relevance of fungal and dust mite allergens to atopic dermatitis: a comparison with asthmatic and nonasthmatic control subjects. J Allergy Clin Immunol 104:1273–1279CrossRefGoogle Scholar
- Silverberg JI, Lai JS, Patel K, Singam V, Vakharia PP, Chopra R, Sacotte R, Kantor R, Hsu DY, Cella D (2020) Measurement properties of the PROMIS Itch Questionnaire – itch severity assessments in adults with atopic dermatitis. Br J Dermatol. https://doi.org/10.1111/bjd.18978
- Wahlgren CF (1991) Itch and atopic dermatitis: clinical and experimental studies. Acta Derm Venereol Suppl (Stockh) 165:1–53Google Scholar
- Wang S, Zhu R, Gu C, Zou Y, Yin H, Xu J, Li W (2020) Distinct clinical feature and serum cytokine pattern of elderly atopic dermatitis in China. J Eur Acad Dermatol Venereol. https://doi.org/10.1111/jdv.16346
- Wollenberg A, Barbarot S, Bieber T, Christen-Zaech S, Deleuran M, Fink-Wagner A, Gieler U, Girolomoni G, Lau S, Muraro A, Czarnecka-Operacz M, Schäfer T, Schmid-Grendelmeier P, Simon D, Szalai Z, Szepietowski JC, Taïeb A, Torrelo A, Werfel T, Ring J (2018) Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I. J Eur Acad Dermatol Venereol 32(5):657–682CrossRefGoogle Scholar