Patients with chronic prurigo commonly experience psychological comorbidities

Key takeaways:

• Patients with chronic prurigo suffer from anxiety, depression, suicidal ideation, stigmatization, stress and body dysmorphic disorder.
• Each comorbidity had predictors including younger age and lower income.

Patients with chronic prurigo experience high levels of perceived stress, stigmatization and body dysmorphia which are driven by both demographic and disease factors, according to a study.

Chronic prurigo, also known as prurigo nodularis, is a disease characterized by extremely itchy lesions. Due to this persistent itch, patients with this disease tend to experience psychological distress.

“Prurigo patients have high levels of stress, anxiety and depression,” Laurent Misery, MD, PhD, professor of dermatology and venerology at the University of Brest and head of the department of dermatology at the University Hospital of Brest, France, told Healio. “These patients even feel stigmatized.”

But what drives these psychological comorbidities and to what level do these stressors impact patients? The authors set out to answer these questions by analyzing different psychological comorbidities of chronic prurigo and their predictors, including perceived stress, stigmatization, body dysmorphic disorders, anxiety, depression and quality of life.

Using data from a European Society for Dermatology and Psychiatry (ESDaP) observational, cross-sectional multicenter study across 17 European countries that evaluated global psychological results among all dermatological conditions, the authors’ analyzed results from 127 adults with chronic prurigo (mean age, 54.7 years; 59.1% women) and 2,808 controls (mean age, 43.1 years; 67% women).

According to the Patient Health Questionnaire, patients with chronic prurigo had higher combined levels of depression and anxiety compared with controls (4.4 ± 3.4 vs. 2.2 ± 2.4; P < .0001).

Patients with chronic prurigo also reported higher levels of stress (16.9 ± 6.8 vs. 14.2 ± 6.3; P < .0001) and stigmatization (1.8 ± 0.6 vs. 1.7 ± 0.4; P = .003) compared with controls, according to the Perceived Stress Scale questionnaire and Perceived Stigmatization Questionnaire, respectively.

Patients with chronic prurigo were also more than seven times more likely to have body dysmorphic concerns than controls. According to the study, these concerns were more related to pruritus rather than the severity of the disease or visibility of lesions.

The wider ESDaP study stated that patients with dermatological conditions as a whole considered hostile and confused behavior by others as a response to the signs of their disease. This has led the authors to believe that there is a strong correlation between body dysmorphic disorder and perceived stigmatization scores.

While these psychological comorbidities were associated with itch intensity and chronic prurigo severity, they were not the only predictors.

“All these comorbidities are more significant the more intense the pruritus and the younger the patients,” Misery explained, adding that lower income levels played a role as well. “This is because younger age and lower income levels are also associated with more psychological fragility and lower self-esteem.”

Overall, the authors concluded that stigmatization was associated with higher stress and having severe disease, whereas stress was linked to younger age and lower income. Depression and anxiety were also associated with lower income and higher itch intensity, whereas body dysmorphia was correlated with younger age and dissatisfaction with appearance.

For more information

Laurent Misery, MD, PhD can be reached at Laurent.misery@univ-brest.fr.