261 Characterization of stress sensitivity of itch in a population of chronic itch patients

Abstract

The relationship between stress and itch is complex. Itch includes an emotional aspect that can be perceived as unpleasant or stressful; additionally, external stressors have been reported to be a major exacerbating factor for itch. However, the features of stress-induced exacerbation of itch are largely unknown. We aimed to characterize stress sensitivity of itch in a population of chronic itch patients. Cross-sectional survey data were obtained from 324 adult patients with chronic pruritus at Temple University and University of Miami between 2015 and 2018. Survey questions included demographic information, itch intensity, a validated survey of itch characteristics, and the itch-related quality of life scale ItchyQoL. Subjects were divided into two groups (“stress-sensitive” and “stress-insensitive”) based on whether they identified stress as an exacerbating factor for their itch. The stress-sensitive group was significantly younger (p<0.0001) and contained a higher proportion of female subjects (p<0.01). The average itch intensity scores at the time of survey were similar in both groups. However, stress-sensitive patients reported significantly greater pain-related characteristics associated with their itch (p<0.05). Stress-sensitive patients were also significantly more likely to report sweat, contact with irritants, contact with allergens, foods, hot water, salt water, and acids as additional exacerbating factors for itch (p<0.05). Additionally, stress-sensitive patients scored significantly higher (p<0.0001) on all three subscales of the ItchyQoL compared to stress-insensitive patients, indicating worse quality of life. In conclusion, despite reporting similar itch intensity ratings, stress-sensitive and stress-insensitive groups displayed different itch characteristics and itch-related quality of life. Individuals with stress-sensitivity itch may therefore benefit from an integrative approach that addresses the emotional components of itch.