Chronic nodular prurigo: clinical profile and burden. A European cross‐sectional study

Abstract

Background Chronic nodular prurigo (CNPG) is a condition characterized by chronic itch, a prolonged scratching behaviour and the presence of pruriginous nodules. A comprehensive understanding of this condition, especially regarding its clinical characteristics and impact on quality of life is still lacking. Objectives Aim of this pan-European multicentre cross-sectional study was to establish the clinical profile of CNPG, including its associated burden. Methods Fifteen centres from 12 European countries recruited CNPG patients presenting at the centre or using the centres' own databases. Patients were asked to complete a questionnaire in paper or electronic format. Demography, current co-morbidities, underlying disease, itch intensity, additional sensory symptoms, quality of life, highest burden and emotional experience of itch were assessed. Results A total of 509 patients (210 male, median age: 64 years [52; 72]) were enrolled. Of these, 406 reported itch and CNPG lesions in the previous 7 days and qualified to complete the whole questionnaire. We recorded moderate to severe worst itch intensity scores in the previous 24 h. Scores were higher in patients with lower educational levels and those coming from Eastern or Southern Europe. Most patients experience itch often or always (71%) and report that their everyday life is negatively affected (53%). Itch intensity was considered to be the most burdensome aspect of the disease by 49% of the patients, followed by the visibility of skin lesions (21%) and bleeding of lesions (21%). The majority of patients was unaware of an underlying condition contributing to CNPG (64%), while psychiatric diseases were the conditions most often mentioned in association with CNPG (19%). Conclusions This multicentre cross-sectional study shows that itch is the dominant symptom in CNPG and reveals that the profile of the disease is similar throughout Europe.

The burden in chronic prurigo: patients with chronic prurigo suffer more than patients with chronic pruritus on non‐lesional skin

“…Accordingly, important therapeutic goals of CPG patients comprised also healing of the skin lesions and to be able to show oneself more often in public. These observations support previous studies showing that the visibility of skin lesions and bleeding from lesions are contributing factors for disease burden 17 …”

“…Itch plays a central role in CPG and is considered by CPG patients to be the highest burden of the disease 17 . We found that itch is more severe in CPG patients compared to CP‐NL under several aspects.…”

“…In recent past, CPG and its associated burden have got more awareness and were recently investigated in a multicentre cross‐sectional study enrolling over 500 patients with CPG 17 . Accordingly, patients considered itch as the most burdensome aspect of the disease.…”

Pruritus as a Distinctive Feature of Type 2 Inflammation

“…In PN patients, itch intensity is disproportionately high, leading to profound interference with sleep and work ability, leisure activities, and social relationships. A complex comorbidity profile and atopic predisposition are frequently reported in PN patients [80]. As one of the itchiest skin conditions, PN is characterized by the development of a pathological itch-scratch cycle and neuronal sensitization, leading to disease chronicity, independent of the initial disease-triggers.…”

Google search trends for itch in Europe: a retrospective longitudinal study

“…Such sensory qualities are often reported in neuropathic itch 23 and in neuropathic pain conditions. 24 However, these sensory qualities are also found in other pruritic conditions such as atopic dermatitis, 25,26 psoriasis 25 and chronic prurigo, 27,28 suggesting a possible neuropathic component in these diseases. Accordingly, the epidermal neural architecture is altered in chronic inflammatory pruritic conditions, and cutaneous mechano-and heat-sensitive C-fibres, which transmit burning and stinging sensations in addition to itch, 29 are sensitized in chronic itch conditions.…”