Assessing Pruritus in Hidradenitis Suppurativa: A Cross-Sectional Study

Abstract

BackgroundPruritus is still a forgotten aspect of hidradenitis suppurativa (HS) and, to date, has never been adequately studied.ObjectiveThe aim of this study was to determine the prevalence, and explore the characteristics, of pruritus in a well-defined cohort of HS patients.SettingAn academic hospital-based cross-sectional study in The Netherlands.MethodsA numerical rating scale (NRS, 0–10) was used to determine the prevalence of HS-related itch (NRS score ≥3). Candidate predictors for pruritus were subsequently determined using logistic regression models, and the impact of pruritus was assessed using a modified five-dimensional (5-D) itch scale. Associated serological and histological markers of pruritus were (semi-)quantitatively investigated in a subpopulation.ResultsThe prevalence rate of pruritus in 211 HS patients was 57.3%, with a mean NRS score of 6.1 ± 2.0. Patients with a pruritus NRS score ≥3 had more HS-affected body sites than patients with a score <3 (p < 0.001). The occurrence of a pruritus NRS score ≥3 was associated with Hurley III disease (odds ratio [OR] 7.73; p = 0.003) and pain (OR 1.34; p < 0.001). Pruritus affected sleep and activities of daily living (ADL) in the majority of cases, with an associated modified 5-D itch score of 13.7 ± 3.6 (on a scale from 5 to 25) in 52 HS patients. Histological examination showed eosinophilic granulocytes were present in 25% (2/8) of the perilesional skin and 63% (10/16) of the lesional skin, while a perineural infiltrate was found in 25% (2/8) and 69% (11/16) of the perilesional and lesional skin, respectively.ConclusionPruritus is a frequent but underreported symptom in patients with HS. Its moderate to severe intensity and significant impact on daily activities have great potential to impair patients’ quality of life.Electronic supplementary materialThe online version of this article (doi:10.1007/s40257-017-0280-2) contains supplementary material, which is available to authorized users.

Proceeding report of the third symposium on Hidradenitis Suppurativa advances (SHSA) 2018

“…Recent studies suggested that pruritus may be an important symptom associated with HS, especially in the prodromal stage. [43] Histopathology reports found an increase in mast cells in all stages of HS (including perilesional skin) accompanying the inflammation of the involved skin. Mast cells in conjunction with other immune cells secrete a variety of proinflammatory cytokines responsible for the symptoms observed in various skin conditions including cutaneous swelling and pruritus.…”

“…Serum levels of anti‐inflammatory molecules and TNF‐alpha receptors also increase during pregnancy. However, pregnancy weight gain may exacerbate HS due to increased friction and adipocyte secretion of proinflammatory cytokines . Medical therapies that may be utilized during pregnancy depends on the severity of the disease, for mild disease topical and oral antibiotics (clindamycin, erythromycin and metronidazole) and metformin can be used.…”

“…Recent studies suggested that pruritus may be an important symptom associated with HS, especially in the prodromal stage . Histopathology reports found an increase in mast cells in all stages of HS (including perilesional skin) accompanying the inflammation of the involved skin.…”

Novel cytokine and chemokine markers of hidradenitis suppurativa reflect chronic inflammation and itch

“…abundance in the HS infiltrate by immunohistochemistry, but was not detected in skin homogenates, possibly because CCL-26 is too strongly bound to its receptor on the many eosinophils present in the HS infiltrate. 4 The cutaneous upregulation of IL-16 and chemokines CCL-4 and CXCL-10 is not surprising because they are produced by many immune cells and play a crucial role in the induction and modulation of immune responses during infection and inflammation. 5,6 In addition, our results obtained in the skin confirm previous findings demonstrating overexpression of IL-17 pathway-associated cytokines and chemokines such as IL-17A, IL-23p40, and CXCL-8 in HS.…”

Correlation of the refined Hurley classification for hidradenitis suppurativa with patient‐reported quality of life and objective disease severity assessment

“…One study showed that patients with HS have the highest DLQI scores of almost all dermatological diseases . This impact is due to the painful and draining lesions, which can soil clothing, can be malodorous, and can be very itchy . Furthermore, lesions are often located in intimate body areas such as the inguino‐genital area and buttocks and may be unsightly and disfiguring, increasing feelings of embarrassment .…”