Itch in the General Internal Medicine Setting: A Cross-Sectional Study of Prevalence and Quality-of-Life Effects

Abstract

Background: Itch is a well-established symptom in cutaneous disease. However, little is known about the burden of itch outside the dermatology setting.

Purpose: To determine the prevalence and impact of itch on quality of life (QOL) in the general internal medicine setting.

Methods: We performed a cross-sectional study of 2076 adults from an outpatient general internal medicine clinic, using an audio computer-assisted self-administered interview. A history of itch (acute or chronic) and other physical symptoms in the past week, Patient-Reported Outcomes Measurement Information System (PROMIS) 10-item Global Health Questionnaire scores, and Patient Health Questionnaire-2 scores were assessed.

Results: The prevalence of itch was 39.9 % and increased with age from 33.1 % at age 19-39 years to 45.9 % at age ≥80 years. In multivariable models controlled for socio-demographics, even feeling "a little" or "some" distress from itch was significantly associated with lower PROMIS global physical and mental health T-scores and estimated health utility scores (P ≤ 0.01). Further, feeling "quite a lot" of distress or "very much" distress from itch was associated with higher adjusted odds ratios for depressed mood (4.91 [95 % confidence interval (CI) 3.36-7.18]) and anhedonia (4.46 [95 % CI 3.07-6.47]). The patient burden of itch was similar to those of pain, constipation, sexual dysfunction, cough, and weight loss.

Conclusions: Itch occurs commonly in the primary care setting and is associated with poor QOL. Physicians should inquire about itch and its associations during review of systems. Future studies are needed to distinguish between the effects of acute and chronic itch.

Fig. 1

Associations between distress from itch and poorer quality of life. Responses for itch were divided into no itch, “a little” distress or “some” distress from itch, and “quite a lot” of distress or “very much” distress from itch. Box-and-whisker plots and overlaid jitter plots of a Patient-Reported Outcomes Measurement Information System (PROMIS) total raw scores, b PROMIS physical health T-scores, c PROMIS mental health T-scores, and d EuroQol 5D total scores are presented for each level of itch. P <0.0001 for all comparisons between no itch and a little distress or some distress, between no itch and quite a lot of distress or very much distress, and between a little distress or some distress and quite a lot of distress or very much distress