Abstract
Itch and worry about itch are predominant symptoms in atopic dermatitis (AD). Mindfulness refers to paying attention in a certain way, non-judgementally and on purpose. In patients with chronic pain, which shares several similarities with chronic itch, a significant relationship between pain intensity, mindfulness and pain catastrophizing has been found. The aim of this study was to investigate whether itch intensity and mindfulness are related to itch catastrophizing in AD patients. Participants receiving treatment for AD (n = 155; 58 male; mean age: 46.5 ± 12 years) completed measures of itch-related catastrophizing (Itch Cognitions Questionnaire; ICQ) and mindfulness (Comprehensive Inventory of Mindfulness; CHIME) during their stay at a rehabilitation center in Borkum, Germany. In addition to other variables, their average itch intensity during the last 2 weeks was assessed by means of a visual analog scale. A positive relationship between itch intensity and itch catastrophizing was found (r = 0.409; p < 0.01). Moreover, the mindfulness scales “acting with awareness,” “accepting and non-judgemental orientation,” and “non-reactive orientation” were negatively related to itch catastrophizing. A linear regression analysis revealed that itch intensity in combination with “acting with awareness” was able to explain more than 27 % (corrected R2 = 0.274; p < 0.001) of the variance of itch catastrophizing. Thus, itch intensity and certain facets of mindfulness were associated with itch catastrophizing in AD patients. Psychological interventions aiming to increase acting with awareness might have a buffering effect on itch catastrophizing, which in turn could lead to lower itch intensity in patients with AD. Future RCTs should test this hypothesis.
Highlights
Itch or pruritus is an unpleasant bodily sensation usually accompanied by scratching behavior [1]
Their mean age was 46.5 ± 12 years. Their mean atopic dermatitis (AD) severity measured by the PO-SCORAD was 47.9 ± 19.9, which indicates that on average patients suffered from a moderate AD
The Pearson correlation analyses revealed that itch catastrophizing and itch intensity during the last 2 weeks were significantly positively related (r = 0.409)
Summary
Itch or pruritus is an unpleasant bodily sensation usually accompanied by scratching behavior [1]. Chronic itch is a common symptom in patients with skin diseases like atopic dermatitis (AD) [3]. It has been shown that itch and scratching behavior play a role in the maintenance and exacerbation of AD as the mechanic stimulation of the skin through scratching can provoke increased inflammation whilst removing any topical treatments that have been applied [4]. In addition to the direct behavior of scratching, psychological, and social factors play an important role in the maintenance and worsening of the itch-scratch cycle in AD. The biopsychosocial model of chronic itch [5] proposes that internal (e.g., personality) and external factors (e.g., stress) can lead to illness cognitions, social reactions, and behaviors, which can increase physiological responses (e.g., activation of certain brain areas) leading to itch [5]. The relationship between stress and itch was mediated by itch-related cognitions and patients, who reacted to stress with negative itch-related cognitions reported higher itch intensities than patients with the opposite cognitive reaction [7]
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