Uwe Matterne

Prevalence, Correlates and Characteristics of Chronic Pruritus: A Population-based Cross-sectional Study

Pruritus is the most frequent symptom in dermatology. Its impact on quality of life is substantial. Epidemiological data on chronic pruritus (>6 weeks) at the population level is sparse, but is important in order to understand the burden and risk factors of this distressing symptom. The aim of this population-based cross-sectional study was to estimate the point, 12-month and lifetime prevalence of chronic pruritus, assessing its association with sociodemographic variables and describing its characteristics. A validated postal questionnaire was sent to 4,500 individuals in from the German General population. Three contact attempts were made. The response rate was 57.8% (n=2,540). The point prevalence of chronic pruritus was 13.5% (95% confidence interval (95% CI) 12.2-14.9%), 12-month prevalence 16.4% (15.0-17.9%) and lifetime prevalence 22.0% (20.4-23.7%). Multivariate analyses found only ethnic origin independently associated with chronic pruritus. The impact of chronic pruritus on quality of life and emotional well-being appears to depend on severity rather than on the presence of the symptom alone. This is the first study to investigate various prevalence estimates of chronic pruritus at the population level. Despite its limitations (self-report and potential self-selection) this study indicates a high burden of chronic pruritus in society.

Measuring the Prevalence of Chronic Itch in the General Population: Development and Validation of a Questionnaire for Use in Large-scale Studies

Itching is the most frequent symptom in dermatology. Little is known about its occurrence and its characteristics in the general population. Instruments specifically designed to measure itch are scarce. The aim of this pilot study was to develop and validate an instrument measuring prevalence and characteristics of chronic itch in the general population. A questionnaire was developed and administered to a sample from the general population (n = 200) and a sample (n = 100) of itch-clinic patients. Life time prevalence of itch was 22.6% in non-patients and 100% in patients. Principal component, internal consist ency and correlational analyses revealed the instrument to be able to reliably and validly measure itch. Strength of itch was higher in patients and was associated with itch- related quality of life and affect in both groups. Preliminary results indicate that itch is prevalent in the general population. We intend to utilize this parsimonious and easy-to-administer questionnaire in a forthcoming population-based study.

Incidence and determinants of chronic pruritus: a population-based cohort study.

Epidemiological data on chronic pruritus (> 6 weeks) in the general population are sparse. We aimed to provide data on the incidence and prevalence of chronic pruritus, and identify its determinants based on cross-sectional and longitudinal analyses. A cohort of 1,190 participants from a cross-sectional baseline-study (response rate: 57.8%) was followed up after one year. The questionnaire assessed occurrence of chronic pruritus, medical, lifestyle and psychosocial variables. Incident chronic pruritus was defined as reported chronic pruritus at follow-up in those subjects free-of-the-symptom at baseline. Cross-sectional analyses of data from the follow-up assessments addressed potential associations of medical, lifestyle and psychosocial factors with prevalent chronic pruritus. Longitudinal analyses examined sociodemographic factors as potential predictors of incident chronic pruritus. The follow-up response rate was 83.1%. The mean age of subjects was 56 years, and 58% were female. The 12-month cumulative-incidence equalled 7.0% (95% confidence interval (95% CI) 5.2-9.2%. Lifetime prevalence was 25.5% (95% CI 21.8-27.8%). Incidence was significantly associated with age. Determinants of prevalent chronic pruritus in multi-variable analyses were: liver disease, asthma, eczema and dry skin within the medical domain, an elevated body mass index within the lifestyle domain and higher anxiety scores within the psychosocial domain. Findings suggest a considerable 12-month incidence and lifetime prevalence and provide important directions for future research.

How do nephrologists in haemodialysis units consider the symptom of itch? Results of a survey in Germany

BACKGROUND Despite advances in dialysis treatment of end-stage renal disease, pruritus remains a widespread and distressing concomitant of chronic renal failure. The prevalence of uraemic pruritus (UP) across countries ranges from 10 to 77%. Data from the DOPPS study showed that moderate to severe UP occurs in >40% of patients on haemodialysis. We aimed to provide data on how common and how serious a problem pruritus is as perceived by nephrologists in daily haemodialysis practice. Method. A national cross-sectional survey in 1420 nephrologists assessed information on the number of dialysed patients, gender distribution, perceived prevalence of UP, time-related aspects of UP, characteristics of UP and its association with dialysis and therapy of UP. RESULTS Most respondents reported UP to be prevalent in 1-30% of their patients, and 30% reported an association between UP and dialysis. Seventy-five percent reported an undulating pattern. Nearly half the sample suggested a relationship between quality of dialysis and UP. No substantial differences in recognition and management of UP as a function of organizational affiliation were detected. CONCLUSIONS The prevalence of UP may be underestimated by nephrologists. Large variation in the reported prevalence of UP and the undulating pattern of UP after dialysis may impede the recognition of UP.

No high level evidence to support the use of oral H1 antihistamines as monotherapy for eczema: a summary of a Cochrane systematic review

BackgroundThe most important symptom as well as one of the major diagnostic criteria for eczema is itch. Although oral antihistamines continue to be prescribed for people with eczema, it is unclear if they are effective and safe in relieving itch and skin lesions. We sought to evaluate the available evidence on effectiveness of oral antihistamines (H1 antagonists) as monotherapy in children and adults with eczema.MethodsSearches included 10 databases and trial registers as well as conference proceedings (January 2014). Randomised controlled trials that assessed the effects of oral H1 antihistamines as monotherapy in children and adults with eczema were included.ResultsOur searches retrieved 757 references, but no randomised controlled trial met our inclusion criteria. Most studies allowed concomitant treatments, making the assessment of the individual effects of oral H1 antihistamines impossible.ConclusionsThere is currently no high-level evidence to support or refute the efficacy or safety of oral H1 antihistamines used as monotherapy for eczema. A further review of studies that assesses the effects of oral H1 antihistamines as ‘add-on’ therapy together with concomitant treatments is warranted to determine the beneficial effects of this group of medications in the treatment of eczema.

Health-related quality of life in health care workers with work-related skin diseases.

Background: Occupational skin diseases (OSDs) are common among health care workers (HCWs). Little is known about how OSD impacts on health‐related quality of life (HRQoL) in HCWs with suspected OSD and associated factors.

A longitudinal application of three health behaviour models in the context of skin protection behaviour in individuals with occupational skin disease

Occupational skin disease (OSD) is common, associated with poor prognosis and poses a significant burden to the individual and society. We applied the theory of planned behaviour (TPB), the prototype-willingness model (PWM) and the health action process approach (HAPA) to the prediction and explanation of occupationally relevant skin protection behaviour in individuals with OSD. We used a longitudinal design. In this study, 150 individuals participating in a 3-week inpatient tertiary prevention programme completed measures assessing the constructs of the TPB, PWM and HAPA at admission (T 0), discharge (T 1) and once the individual had returned to work and worked for 4 consecutive weeks (T 2) (n = 117). Intention was measured at T 0 and skin protection behaviour at T 2. Path analysis was used to assess the longitudinal associations of the models’ constructs with intention and skin protection behaviour. TPB as well as PWM variables accounted for 30% of variance in behaviour, HAPA variables for 33%. While not all predictions were confirmed by the data, all three models are able to inform us about the formation of skin protection intention and behaviour in individuals with OSD. The findings are discussed in light of future interventions and research.

Effects of a health-educational and psychological intervention on socio-cognitive determinants of skin protection behaviour in individuals with occupational dermatoses

PurposeOccupational skin diseases are a significant public health concern. Little is known about the cognitive representations individuals with occupational skin disease have towards measures of personal skin protection and occupational safety and whether they change during an intervention. We aimed to evaluate whether social cognitions as embodied by the theory of planned behaviour become more favourable during a tertiary inpatient individual prevention programme (TIP) and whether the model’s predictions hold in a setting to which the model has not been applied.MethodsWe used a longitudinal design. A questionnaire, assessing the theory of planned behaviour variables attitude, subjective and descriptive norm, perceived behavioural control and behavioural intention was developed and administered to 101 patients before (at admission) and after (at discharge) a 3-week inpatient TIP.ResultsThe scales showed good internal consistency. Before the TIP, patients had favourable cognitions towards skin protection measures and these improved during the TIP. Attitude, perceived behavioural control and intention to perform skin protection significantly increased during TIP. Attitude and perceived behavioural control were significant predictors of behavioural intention in multiple regression analyses with perceived behavioural control being the strongest predictor in the equations. Descriptive norm was a significant predictor of intention only at admission but not at discharge.ConclusionThis is the first study attempting to explain the motivation to perform skin protection measures in patients with occupational skin disease by applying an otherwise well established health-behaviour theory. The results emphasise the importance of health-educational and psychological interventions for patients with occupational skin disease. Promoting personal control over and attitudes towards skin protection measures may enhance the occupational health of individuals with occupational skin disease.

Gender Differences in FOBT Use: Evidence from a Large German Survey

We examined prevalence and correlates of fecal occult blood testing (FOBT) uptake in a sample of men and women aged 50 to 70 years without a personal history of cancer (n=15,810). The data was collected in 2004 through the Health Care Access Panel (HCAP), a nationally generalizable survey of German households. A pronounced gender difference in FOBT use emerged. Women reported regular use more often, while men reported irregular use with a higher frequency. Nearly every third men (29.6%), compared to 17.5% of the women had never made use of FOBT. The influence of socioeconomic factors on FOBT uptake was negligible. Family history of cancer was significantly associated with FOBT but the effect was very small. Use of medical checkups and physician recommendation were the most important predictors of FOBT use in men and women. Gender differences in use of medical checkups and physician recommendation to undergo an examination for the early detection of cancer partly mediated the gender differences in FOBT use.

Effects of structured patient education in adults with atopic dermatitis: Multicenter randomized controlled trial

Background Atopic dermatitis (AD) is a chronic relapsing skin disease prevalent in 1% to 3% of adults in Western industrialized countries. Objective We sought to investigate the effectiveness of educational training in an outpatient setting on coping with the disease, quality of life, symptoms, and severity in adults with AD. Methods In this German prospective, randomized controlled multicenter study, adult patients with moderate‐to‐severe AD were educated by referring to a comprehensive 12‐hour training manual consented by a multiprofessional study group from different centers (Arbeitsgemeinschaft Neurodermitisschulung für Erwachsene [ARNE]). Patients were randomly allocated to the intervention or waiting control groups. Study visits were performed at baseline and after 1 year (1 year of follow‐up). Primary outcomes were defined as a decrease in (1) “catastrophizing cognitions” with respect to itching (Juckreiz‐Kognitions‐Fragebogen questionnaire), (2) “social anxiety” (Marburger Hautfragebogen questionnaire), (3) subjective burden by symptoms of the disease (Skindex‐29 questionnaire), and (4) improvement of disease signs and symptoms assessed by using the SCORAD index at 1 year of follow‐up. Data were analyzed on an intention‐to‐treat basis. Results At 1 year of follow‐up, patients from the intervention group (n = 168) showed a significantly better improvement compared with the waiting group (n = 147) in the following defined primary study outcomes: coping behavior with respect to itching (P < .001), quality of life assessed by using the Skindex‐29 questionnaire (P < .001), and the SCORAD index (P < .001). Conclusions This is the first randomized, controlled multicenter study on patient education in adult AD. The ARNE training program shows significant beneficial effects on a variety of psychosocial parameters, as well as AD severity.