Impact of chronic prurigo nodularis on daily life and stigmatization.

Abstract

Dear Editor, Chronic prurigo nodularis (CP) is a disease with a severe impact on quality of life.1 We were interested in its impact on daily life and stigmatization. A self-administered questionnaire was distributed to members of the French patient advocacy group Association France Prurigo Nodulaire and to outpatients with CP from 2 departments of dermatology. Validated tools were used: Dermatology Life Quality Index (DLQI; score from 0 to 30),2 Patient Unique Stigmatization Holistic tool in Dermatology (PUSH-D; score from 0 to 88),3 EuroQol-5 Dimensions-3 Levels (EQ-5D-3L) utilities (score from −1 to 1) and visual analogic scale (VAS; from 0 to 100)4 and Epworth sleepiness scale (score from 0 to 24).5 Seventy patients were recruited, mostly women (n = 43, 61.4%). The mean age was 46.7 years (±16.2). The diagnosis of CP was confirmed by a dermatologist for 95% of the patients. The average delay between the first symptoms (pruritus, nodules) and the diagnosis was 24.2 months (±35.6; minimum: 1 month, maximum: 180 months). While 62% of the patients did not declare any other skin disease, 24.3% (n = 17) declared that they also had atopic dermatitis. Notably, 38.6% of the patients were partially satisfied and 24.3% totally satisfied with the overall management of their PN; 62.9% wanted more effective treatment and 31.4% a better quality of life. The average DLQI score was 13.3 (±7.0; from 1 to 29), higher in women (15.5) than in men (10.5) (p < 0.01) and 74.3% of the patients had a score above 10. The Epworth scale (mean: 9.1 ± 4.5; from 0 to 21) showed that 44.3% of the patients had a very disturbed sleep (score ≥ 10). Using the EQ-5D VAS mean score, indicating the general health status, was 48.5/100 (±20.6; from 10 to 98). The PUSH score was 25.2 (±14.1; from 0 to 68). Spearman's correlations showed a significant negative correlation between the DLQI and the EQ-5D_VAS (r = −0.56807/p < 0.0001), the EQ-5D utility index (r = −0.44298/p = 0.0001) and a significant positive correlation with the PUSH stigma score (r = 0.58560/p < 0.0001). In the last 3 months, 21.4% missed at least 1 day of work, learning, training, school or university; 72.9% gave up a leisure or sport activity; 62.9% refused an invitation to a dinner or a party because of their CP. Comparisons between patients with mild disease according to DLQI score (<7) or moderate-to-severe disease (≥7) are given in Table 1. This study shows that the daily life of patients with CP is deeply modified by this disease, with consequences on sleep, leisures and work. These consequences are more important if the general health status and the quality of life (according to DLQI score) are more altered and the stigmatization is higher. A recent meta-analysis showed that the most common quality of life instrument used in CP was the DLQI.6 Our results suggest that PUSH-D, DLQI, EQ-5D and Epworth tools are also relevant for measuring the consequences of CP. In our study, we used for the first time after its validation the newly developed PUSH-D.3 To our knowledge, there is only another study showing that stigmatization levels were high in CP7 but this study was focused on body dysmorphia and stigmatization was only a covariate in multivariate models and was not analysed in the single diseases. The authors showed that feelings of stigmatization were significantly related to body dismorphic disorder symptoms using the Perceived Stigmatization Questionnaire.7 We would like to thank all patients for their participation. Sanofi. None. The study complied with local legal requirements study and received approval from ethics committee (CPP Ile-de-France VII; N°2020-A01620-39 /20–075). All patients confirmed their non-objection to the anonymised use of their personal data in this study.