5D Itch Scale Research Articles

Clinico-mycological validation of dermatophytosis severity score and its correlation with patient-reported outcome measures.

Dermatophytosis impacts a significant portion of the global population. Recent shifts in the disease's presentation, severity and response to treatment, primarily due to emerging drug resistance, underscore the need for reliable assessment tools. The Dermatophytosis Severity Score (DSS) aims to standardise the evaluation of the disease's severity and monitor therapeutic responses. In a cross-sectional pilot study, 25 adults with clinically diagnosed dermatophytosis were evaluated using the DSS. The study also aimed to establish the correlation of DSS with different stages of treatment, dermatophyte species and patient-reported outcomes. Participants were recruited from a dermatology outpatient clinic, and the DSS was applied at baseline, Weeks 4 and 8. The validity and reliability of the DSS were assessed using statistical measures, including Cronbach's alpha and intraclass correlation coefficient. The study comprised of a near-equal distribution of male (52%) and female (48%) patients, primarily within the age group of 20-39 years. A high recurrence rate of dermatophytosis (60%) was noted, and more than half of the patients (56%) had used topical steroids before presentation. The mean DSS significantly decreased from baseline to the final visit, mirroring the substantial reduction in the 5D itch scale and Dermatology Life Quality Index, with strong positive correlations observed between these measures. The DSS demonstrated high inter-rater reliability and internal consistency, indicating its utility as a reliable clinical tool for assessing dermatophytosis severity. The strong correlation of DSS with itch intensity and quality of life validates its role in patient-centered care. Continued use and further validation of the DSS are recommended to enhance dermatophytosis management and treatment outcomes.

Identification of House Dust Mite and the Risk Factor of Cronic Itch in Elderly

Introduction: Senile pruritus etiology is uncertain. However, well as intrinsic factors, one of the extrinsic risk factors causing pruritus is house dust mites (HDM) as. Aim of this study was to analyze the association between house dust mite density and the pruritus level among elderly residents. Methods: This is an observational study with cross-sectional design. The 34 elderly who met the criteria were included in this study. The pruritus level was obtained using questionnaire as to duration, degree, direction, disability, distribution (5D) itch scale based on NRS (numerical rating scale) categories divided into 4 categories (no, low, moderate, and severe itch). House dust mite density was checked using flotation method and the results categorized into low, moderate, and high density. The dust sample was checked for the species by microscope. The preventive activity to prevent the pruritus were also analyzed. The relationship between itch scale, preventive activity with HDM density was analyzed using STATA 17. Results and Discussion: A total of 34 elderly was included. Elderly were dominated with women (67.6%), moderate itch scale (38.2%) and moderate HDM density (58.8%). Most of the correlation between itch scale based NRS and preventive activity with HDM density p-value was not significant. But the elderly’s’ habit to clean the mattress was significantly correlated with HDM density (p=0.00). The Dermatophagoides sp were the dominant mites found in elderly’s’ room. Conclusion: Itch scale in elderly were not related with HDM density, but correlated with the habit to clean the mattress.

Effects of an ice roller on chronic kidney disease-associated pruritus in patients receiving haemodialysis.

Chronic kidney disease-associated pruritus is a distressing symptom and has a far-reaching impact on patients' sleep and quality of life for most patients receiving haemodialysis. Traditional therapies have limited effectiveness. This study aimed to invent a self-operated ice roller and evaluate its efficacy in relieving pruritus, sleep quality, and quality of life. This study was experimental with a two-arm parallel group design. A convenient sampling method was used to recruit 60 patients receiving haemodialysis who reported pruritus (5D-Itch Scale score >5) lasting over 4 weeks in Taiwan. The participants were randomly assigned to one of two groups: the intervention group used an ice roller for 7 days, while the control group received no anti-pruritus treatment. This study was experimental with a two-arm parallel group design. The measurement instruments included the 5D-Itch Scale, Pittsburgh Sleep Quality Index and WHOQOL-BREF-Taiwan Version. The analysis of covariance, chi-square, Independent t tests,and partial Eta2 (η2 p) were used to analyse the data. The participants' mean age was 62.77 years. Application of the ice roller significantly decreased overall pruritus (p < .05; η2 p = .09) and distribution of pruritus-associated bodily parts (p = .03; η2 p = .08). There were no statistically significant differences in sleep quality and related indicators between the experimental and control groups at the study endpoint. Regarding quality of life, only the social relationship domain significantly differed between the two groups (p = .02; η2 p = .08). The ice roller can decrease pruritus and its distribution in patients receiving haemodialysis, serving as an adjunct therapy alongside conventional anti-pruritus treatments.

The factors that are associated with itching in chronic kidney patients and evaluation of itching with the 5d itch scale.

Uremic pruritus is a distressing complication of chronic kidney disease (CKD), associated with mortality, and negatively impacts quality of life. The 5D-Itch Scale (5D-IS) is an easy-to-apply technique that evaluates 5 different dimensions of itching such as duration, severity, course, disability, and prevalence. We aimed to investigate the prevalence of itching in different CKD stages using the 5D-IS and to investigate the factors associated with itching in CKD patients. 5D-IS was used to evaluate itching in chronic hemodialysis (HD) and Stage 3-5 CKD patients. Total itching score and sub-scores consist of duration, severity, course, disability and distribution were obtained. Itching scores and prevalence according to CKD stages were investigated. Also the relationships between itching scores and some laboratory and clinical parameters such as iPTH, Ca, P, CRP levels were examined. 158 CKD patients included in the study included (110 Stage 3-5 and 48 HD). The frequency of itching was higher in HD patients than in predialysis patients (62.5% vs 46.4%; p = 0.04). The total itching score increased along with CKD stages 3 to 5 (7.75 ± 3.39, 7.82 ± 4.11 and 9.08 ± 5.12 respectively; p = 0.14). The severity, duration and course scores of itching were similar between the groups, but the distribution scores increased as the CKD stage increased. The laboratory and clinical characteristics of patients with and without itching were not different. Even if a significant positive correlation was detected between the parathyroid hormone levels and both the total 5D-IS scores and all of the sub-scores, Ca and P values were not correlated with itching scores. In the multiple regression analysis, the only parameter that had an effect on the total 5D-IS Score was the parathyroid hormone level. In CKD, itching affects 40-70% of patients from the early stages. As the CKD stage increases, itching spreads throughout the body. The only parameter that seems to be associated with itching is the PTH level.

Pruritus and protein-bound uremic toxins in patients undergoing hemodialysis: a cross-sectional study.

Patients undergoing hemodialysis frequently experience pruritus; its severity is associated with poor quality of life and mortality. Recent progress in hemodialysis treatment has improved the removal of small- and middle-molecular-weight molecules; however, the removal of protein-bound uremic toxins (PBUTs) remains difficult. It is possible that pruritus is associated with serum PBUTs in patients undergoing hemodialysis. We conducted a multicenter cross-sectional study in patients undergoing hemodialysis (n=135). The severity of pruritus was assessed using the 5D-itch scale and medication use. Serum PBUTs, including indoxyl sulfate, p-cresyl sulfate, indole acetic acid, phenyl sulfate, and hippuric acid, were measured using mass spectrometry; the PBUT score was calculated from these toxins using principal component analysis. Univariate and multiple regression analyses were performed to examine independent predictors of pruritus. Pruritus was reported by 62.2%, 21.5%, and 13.3%, 1.5% and 0.7% as 5 (not at all), 6-10, 11-15, 16-20, and 21-25 points, respectively. The PBUT score was higher in patients undergoing dialysis having pruritus than those without pruritus (0.201 [-0.021 to 0.424] vs -0.120 [-0.326 to 0.087]; P=0.046). The PBUT score was shown to have an association with the presence of pruritus (coefficient 0.498[Formula: see text]0.225, odds ratio: 1.65 [1.06-2.56]; P=0.027). Uremic pruritus was frequently found and associated with the PBUT score in patients undergoing hemodialysis. Further studies are required to clarify the impact of PBUTs on uremic pruritus and to explore therapeutic strategies in patients undergoing hemodialysis.

Characterization of health concerns in people with neurofibromatosis type 1.

Neurofibromatosis 1 (NF1) is a common cancer predisposition syndrome. Affected individuals require lifelong surveillance and often suffer progressive disfigurement due to cutaneous neurofibromas. The aim of this research was to characterize health concerns and quality of life (QOL) in a population cohort. An online survey was completed by 68 adults and 32 parents of children with NF1, and 60 controls. The survey included the Skindex-29 QOL scale, 5D-itch scale, and additional health questions. Frequency of itch was high in children (50%) and adults (69%), with most expressing interest in treatment for itch. The presence of itch and increased visibility of NF1 were predictors of poorer QoL. Many adults (53%) and parents (44%) desired access to treatment to improve cosmetic appearance. Muscle weakness/tiredness was also prevalent amongst (60-70%) adults and children with NF1. Two-thirds of adults with NF1 reported limited awareness of NF1 services and poor knowledge of surveillance, particularly breast screening in young women. This study highlights the impact of NF1-related itch and visibility in adults and children with a need for cosmetic and itch treatment. The findings emphasize a need for strategies to promote awareness, and access to management and treatment of NF1 in adults.

MO915: Factors Related to Chronic Kidney Disease–Associated Pruritus in Patients Undergoing Haemodialysis and its Effects on Quality of Life

Abstract BACKGROUND AND AIMS Chronic kidney disease-associated pruritus (CKD-aP) is an often overlooked, common and debilitating problem for patients undergoing haemodialysis. Although the prevalance of CKD-aP has decreased over the years, it continues to be a problem associated with quality of life impairment, sleep disturbances, increased mortality and morbidity. With this study, we aim to investigate factors related to CKD-aP and its impact on patients’ quality of life. METHOD We conducted a cross-sectional study of in-centre HD patients in the city of Eskişehir, Turkey. A total of 298 patients undergoing HD for &amp;gt;3 months were enrolled in the study. We analysed demographic characteristics, routine laboratory values, interdialytic weight gain, residual urine output, xerosis, 5D itch scale scores (multidimensional itch-related questionnaire), VAS score (ranging from no itching to the worst itching imaginable) and LANSS score (neuropathic pain assessment scale) of enrolled patients. RESULTS Mean age of 298 patients was 64.6 ± 13.2 and 52% of patients were male. Pruritus prevalence in the study group was 45%. The 5D scores were higher among patients with &amp;lt; 200 mL residual urine output versus patients with &amp;gt;500 mL residual urine output (P = .034). The 5D scores were higher among patients with xerosis (P &amp;lt; .001). The 5D scores were again higher among patients with a LANSS score of ≥ 12 (P &amp;lt; .001). The 5D scores were lower among the low-flux membrane group versus the high-flux membrane group (P = .001). The 5D scores were correlated with interdialytic weight gain (r = 0.124; P = .033), Kt/V (r = –0.228; P &amp;lt; .001), ALT levels (r = 0.135; P = .02), total iron binding capacity (r = .13; P = .025) and VAS scores (r = 0.969; P &amp;lt; .001). There were no statistically significant correlations between 5D scores and age, body mass index, HD duration, creatinine, BUN, calcium, phosphorus, calcium-phosphorus product (CAxP) and other routinely tested laboratory values. CONCLUSION In our study, we identified residual urine output, xerosis, neuropathic pain, HD membrane type, interdialytic weight gain, Kt/V, ALT and TIBC as factors related to CKD-aP. The strong relationship between itch severity and neropathic pain scores was especially notable. More research in this field may be beneficial for identifying new therapeutic targets for CKD-aP.

AN OPD BASED PROSPECTIVE EXPLORATORY STUDY OF DERMATOPHYTOSIS - FOCUS ON TREATMENT OUTCOMES, MEDICATION ADHERENCE, AND QUALITY OF LIFE

Objective: The study was planned primarily to judge the effectiveness, safety, and adherence of the prescribed treatments in dermatophytosis along with the effect on the Quality of Life (QoL) of the affected individuals. Methods: In this prospective observational study, spanning over 5 months, participants (dermatophytosis patients) were assessed at baseline and 6 week-follow-up at study site. Information about their clinical presentation, QoL (Quality of Life) parameters, medication adherence, and adverse drug reaction (ADR) were entered in the Case Report Form (CRF) prepared by utilizing global standard tools such as 5D-itch scale, Dermatology Life Quality Index (DLQI), Medication Adherence Rating Scale (MARS), and WHO-ADR reporting form respectively. Results: Total 60 subjects (33 males and 27 females) had completed the study. Overall, tinea cruris (40%) was the most common variety followed by combination of tinea corporis and cruris (35%), tinea corporis (20%), and tinea incognito (3%). Pruritus was the predominant symptom. There was a significant (p&lt;0.001) improvement of both 5D-itch &amp; DLQI scores from baseline to follow-up stage (after 6 weeks). Treatment regimens were well tolerated (only eight subjects reported any adverse event such as gastric irritation and sedation). Medication adherence to the prescribed treatment was good; (mean MARS score 7.588±1.82). Mostly prescribed regimen was a combination of antifungal (oral plus topical) and antihistamine tablet (58/60, 96.66%). The most common drug combination was capsule itraconazole, luliconazole cream, and cetirizine or levocetirizine tablet with or without ketoconazole soap (35/60, 58.33%). Conclusion: Prescribed treatment regimen for dermatophytosis was effective, tolerable, acceptable with high medication adherence and also improved the QoL of the study subjects.

Seladelpar improved measures of pruritus, sleep, and fatigue and decreased serum bile acids in patients with primary biliary cholangitis.

Primary biliary cholangitis (PBC) can result in life-altering cholestatic pruritus and fatigue, but treatment options are limited. Seladelpar, a peroxisome proliferator-activated receptor-delta (PPARδ) agonist, has demonstrated potent anti-cholestatic effects in clinical studies. This open-label, uncontrolled phase 2 study in PBC patients evaluated the effects of 1-year of seladelpar treatment on measures of pruritus and quality of life. Self-reported experiences of 101 PBC patients were collected at baseline and after 1year of seladelpar treatment using the pruritus visual analog scale (VAS), 5D-itch scale, and PBC-40 questionnaires along with bile acid profiles. In patients with moderate-to-severe pruritus, substantial improvement in pruritus was seen in 58% and 93% of patients in 5/10mg and 10mg treatment groups, respectively. After 1year, patients reporting improvement substantially outnumbered those who worsened in the total 5-D itch (including individual domains) and PBC-40 (itch and fatigue domains) questionnaires. Improvement in sleep disturbance at 1-year was reported in 81% (5/10mg) and 78% (10mg) of the patients with baseline itch-related sleep disturbance by 5-D itch score with similar results using the PBC-40 sleep questionnaire. Seladelpar-treated patients had significant reductions of 46% (5/10mg) and 31% (10mg) in the serum bile acid precursor C4 and reductions of up to 38% in serum bile acids. Seladelpar treatment for 1year led to consistent improvement in both symptom burden and biochemical response, suggesting its potential as a single agent to address two key unmet needs in PBC patients.

Evaluation of the role of bile acids and serotonin as markers of pruritus in children with chronic cholestatic liver disease

Background and study aimsPruritus is an annoying symptom with an unclear pathogenesis accompanied by chronic cholestasis. This cross-sectional study was conducted to define the relationship between serum levels of presumed pruritogens (bile acids (BAs) and serotonin) and severity of pruritus in pediatric patients with chronic cholestatic liver disease. Patients and methodsA total of 28 children suffering from pruritus due to chronic cholestatic liver disease and 29 age- and sex-matched healthy control subjects were examined. Scores obtained used the 5-D itch scale were evaluated among patients. Serum levels of BAs and serotonin were determined using enzymatic assays and high-performance liquid chromatography, respectively. ResultsPatients had higher serum BA levels and lower serotonin levels than control subjects. Serum BA levels were significantly elevated in 61% of patients. The 5-D itch scale scores were significantly higher in cholestatic individuals with normal γ-glutamyl transpeptidase levels. Neither BA nor serotonin levels correlated with the severity of the 5-Ditch scale score. ConclusionNeither BA nor serotonin levels correlated with the severity of pruritus, indicating that they may not be good laboratory markers for the intensity of itch in children with cholestasis. Our findings suggest that it is necessary to identify another potential pruritogenic mediator, most probably of a biliary origin.

Chronic kidney disease-associated pruritus significantly impacts on quality of life of patients on haemodialysis and associates with increased levels of serum calcium and phosphorus

Purpose of the studyChronic kidney disease-associated pruritus (CKD-aP) is common among patients on maintenance haemodialysis (HD). We performed a study to explore the clinical features of patients with CKD-aP and...

Acupuncture for patients with chronic pruritus: protocol of a systematic review and meta-analysis

IntroductionChronic pruritus (CP) frequently occurs in many skin and systemic diseases, and adversely affects quality of life. This systematic review aims to evaluate treatment effects of acupuncture on CP.Methods and...

P1509SEVERITY OF PRURITUS IN HEMODIALYSIS PATIENTS: RELATIONSHIP TO UREMIC TOXINS AND DIALYSIS MODALITY

Abstract Background and Aims Pruritus is a complication that can impair the quality of life of patients with chronic kidney disease (CKD). A previous report has suggested that the severity of pruritus is correlated with high serum concentrations of β2-microglobulin, calcium, and phosphorus, however recent developments in hemodialysis (HD), especially use of high-flux membrane and online hemodiafiltration (OLHDF), may improve the severity of pruritus. Protein-bound uremic toxins (PBUTs), such as indoxyl sulfate and p-cresyl sulfate, are known to be factors associated with atherosclerosis and impaired bone metabolism in CKD and may also be associated with pruritus, especially in those undergoing dialysis treatments. The aim of our study was to assess the severity of pruritus using a new tool, the 5D-itch scale (5D), as well as its relation to circulating PBUTs and dialysis modality in patients with end-stage kidney disease. Method This was a prospective cohort multicenter study, wherein we analyzed the baseline data. The 5D score (5–25 points) was measured in maintenance dialysis patients. The serum concentrations of indoxyl sulfate, p-cresyl sulfate, phenyl sulfate and hippuric acid were measured with mass spectrometry before a dialysis session. The correlations of the 5D scores with serum PBUTs, dialysis modality (HD or OLHDF) and the other background factors were assessed with Spearman correlation coefficients and the generalized linear model. Results This study included 135 dialysis patients (98 HD and 37 OLHDF). The mean 5D score was 6.84 (±SD 3.14). The mean serum concentrations of indoxyl sulfate, p-cresyl sulfate, indole acetic acid, phenyl sulfate, and hippuric acid were 2.99 ± 1.40, 2.05 ± 1.54, 0.11 ± 0.08, 0.94 ± 0.71, and 4.52 ± 3.17 mg/dL, respectively. There was a significant correlation between the 5D score and dialysis modality (correlation coefficient = 0.24, p &amp;lt; 0.01). Dialysis method was associated with the 5D score by the generalized linear model, and OLHDF was associated with a lower 5D score. There were no significant associations between the 5D score and serum concentrations of the various PBUTs (e.g., for indoxyl sulfate, the correlation coefficient was 0.11, p = 0.20) Conclusion Pruritus, as assessed by the 5D score, was associated with dialysis modality, but not with the serum concentration of PBUTs. Further studies will be needed to understand the mechanism of the effect of OLHDF on pruritus as well as the role of uremic toxins in the itchy skin in CKD patients.

Hemodiyaliz Hastalarında Kaşıntının Varlığı ile Uyku ve Anksiyete Arasındaki İlişkinin İncelenmesi

Amaç: Bu çalışmanın amacı hemodiyaliz hastalarının yaşadığı kaşıntıyı çok boyutlu değerlendirmek ve kaşıntının, uyku ile anksiyete arasındaki ilişkisini incelemektir. Gereç ve Yöntem: Tanımlayıcı nitelikte olan bu çalışma, Ocak- Mart 2020 tarihleri arasında Akdeniz bölgesinde iki devlet hastanesinin diyaliz merkezinde gerçekleştirildi. Çalışmaya hemodiyaliz tedavisi alan 114 hasta dahil edildi. Çalışmanın verileri, Tanıtıcı Bilgi Formu, 5 D Kaşıntı ölçeği, Richard-Campbell Uyku Ölçeği, Spielberg Durumluk-Sürekli Kaygı Ölçeği kullanılarak elde edildi. Bulgular: Çalışmada hastaların yarısına yakınının ciddi ve orta derecede kaşıntı yaşadığı belirlendi. Hastaların 5 D kaşıntı ölçeğinden toplam 12.44 ± 7.11 (orta şiddette); sürekli kaygı ölçeğinden toplam 49.54±13,03; Richard-Campbell Uyku Ölçeğinden toplam 50.44±27.71 puan aldıkları saptandı. Hastaların % 41.2’sinin çok kötü uyku kalitesine sahip olduğu belirlendi. Kaşıntı ve uyku arasında orta derecede (p=.000; r=-.679); kaşıntı ve anksiyete arasında yüksek derede (p=.000; r=.706) korelasyonel bir ilişki bulundu. Yapılan lineer regresyonda kaşıntı hem anksiyetenin hem de uykunun belirleyicisi olarak saptandı. Sonuç: Bu çalışmada hemodiyaliz hastalarının yarısına yakınının orta ve şiddetli derecede kaşıntı yaşadığı ve günlük yaşamlarının önemli derecede etkilendiği belirlendi. Çalışmanın diğer önemli bir sonucu da kaşıntı ile uyku kalitesi ve anksiyete arasındaki ilişkinin varlığıdır. Bu sonuçlara dayanarak hemodiyaliz hastalarında etkin semptom yönetiminin sağlanması için kaşıntı semptomlarının diyaliz hemşireleri tarafından çok boyutlu değerlendirilmesi önerilmektedir. Kaşıntı semptomlarının hemodiyaliz hastalarında çok boyutlu değerlendirilmesi ile uyku, anksiyete ve yaşam kalitesi üzerindeki etkisinin belirlenmesini sağlayarak hastaların morbiditesini azaltacağı ve yaşam kalitesini artıracağı öngörülmektedir.

PUK28 EMULATING EQ-5D DATA FROM AVAILABLE PROS TO OPTIMIZE CLINICAL TRIAL PLANNING IN CHRONIC KIDNEY DISEASE-ASSOCIATED PRURITUS

We aimed to assess the expected sensitivity of EQ-5D-5L in a multi-morbid patient population on hemodialysis (HD) suffering from moderate or severe chronic kidney disease-associated pruritus (CKD-aP) to inform design and sample size calculation for a phase-3-study intended to collect payer-relevant quality of life (QoL) data. Using available patient-level data from a phase-2-study (CR845-CLIN2101) in 174 CKD-aP patients treated with difelikefalin (DFK) 0.5, 1.0, and 1.5 mcg/kg or placebo that collected itch intensity, Skindex-10 and 5D-Itch Scale, we emulated EQ-5D-5L health states by matching related questions from available patient-reported outcomes (PRO) instruments to the relevant EQ-5D dimension and applied the United Kingdom (UK) valuation set. To account for differences in the questions and rating scales used in each instrument, different mapping scenarios were assessed. Treatment with DFK resulted in a statistically significant 8.2 point higher improvement on the Skindex-10 and of 2.5 points on the 5D-Itch scale (both p<0.001 versus placebo). Depending on the mapping applied to emulate EQ-5D-5L health states, this translated into improved QoL scores of 0.1 to 0.21 based on the UK tariff. Emulated QoL scores are similar to those directly measured with EQ-5D-5L in HD patients in other studies, supporting the validity of the results. This emulation increased the confidence in the ability of EQ-5D-5L to detect relevant differences in patients’ utilities when treating CKD-aP, despite potential confounding by the underlying morbidity. While these results do not allow to claim any actual effect on patients’ utility, the quantification of the magnitude of the expected effect helped to appropriately power the future studies in the absence of any analogue cases.

Chronic Kidney Disease-Associated Pruritus and Quality of Life in Malaysian Patients Undergoing Hemodialysis.

CKD-associated pruritus is one of the common symptoms in patients undergoing dialysis, thus contributing to the diminished and compromised quality of life. This study aimed to explore the association between the CKD-associated pruritus on quality of life of patients undergoing hemodialysis in Malaysia. A cross-sectional multicenter study, carried out from February to September 2017 at tertiary care settings in Kuala Lumpur, Malaysia. Patients aged 18 years and above, undergoing hemodialysis, understanding Malay language and willing to participate were included. The CKD-associated pruritus was assessed by using Malay 5D-itch scale and Malay FANLTC questionaiare. To determine the factors associated with pruritus and quality of life, multivariate logistic regression analysis was used having P value < 0.05 as statistically significant. Among n = 334 recruited patients with a response rate of 100%, 59.6% were males and total of 61.3% were having CKD-associated pruritus. The results showed a statistically significant weak negative correlation between CKD-associated pruritus and quality of life. Multivariate linear regression revealed none of these factors were found to be associated with pruritus; however, CKD-associated prurtius was found to be associated with quality of life score. CKD-associated pruritus is have a negative impact on the patient's quality of life including physical, social, mental/emotional, and functional well-being. Despite the high prevalence and negative impact of CKD-associated pruritus on quality of life, it is disregarded by most health care professionals. It is thus pertinent to monitor the potential risk factors and consider providing timely treatment implications for CKD-associated pruritus in hemodialysis patients, in order to improve their quality of life.

Sleep disturbance among Malaysian patients with end-stage renal disease with pruritus

BackgroundChronic kidney disease-associated pruritus (CKD-aP) is a well-recognized, frequent and compromising complication among patients on hemodialysis. Despite advancement in basic medical sciences, CKD-aP is still a major complication and a challenge for both physicians and patients to manage. The aim of this study was to estimate the prevalence of CKD-aP among hemodialysis patients in Malaysia, to determine the impact of CKD-aP on sleep quality and any factors associated with CKD-aP.MethodA multi-centered, cross-sectional study design was conducted from February 2017 to September 2017 at a tertiary hospital and its affiliated dialysis centers, in Kuala Lumpur, Malaysia. Included were patients > 18 years of age who were undergoing hemodialysis and could understand Malay. Participants were asked to fill the Malay 5D-itch scale and the Malay Pittsburgh sleep quality index (PSQI) upon recruitment.ResultsA total of 334/334 patients were recruited (response rate = 100%). The majority were male (59.6%) and Chinese (61.7%). A total of 61.3% had pruritus, of which most patients (63.4%) reported that their pruritus was mild. More than half (54.1%) reported that they slept > 6 h, and 93.2% experienced no sleep disturbances during the night. However; the overall PSQI median score [IQR] was 6.0 [5.0–9.0]. No significant association was found between demographic and clinical characteristics of patients with the severity of pruritus. Patients with moderate to severe pruritus were found to be 5.47 times more likely to experience poor sleep quality as compared to patients with mild or no pruritus.ConclusionIn Malaysia, the prevalence of CKD-aP was 61.3%, of which the majority reported that their pruritus was mild. Patients with moderate to severe pruritus were found to be 5.47 times more likely to experience poor sleep quality as compared to patients with mild or no pruritus.

240 A Randomized Controlled Trial of Hypnosis for Pain and Itch Following Burn Injury

Burn survivors report that pruritus (also categorized as neuropathic pain) is common for years after injury and can affect all aspects of quality of life. Pharmacological interventions have not consistently shown to be effective and often have side effects. Hypnosis has been successfully used to treat burn pain and nonburn-related pruritus. We hypothesized that hypnosis would provide greater postburn itch and pain relief than the control at 48 hours, 1, 3, 6, 12-months post-intervention. Following IRB approval, adult burn patients who had been undergoing pharmacologic therapy (gabapentin, diphendhydramine and/or cetirizine) and who scored ≥ 4 on a 0–10 Numerical Rating Scale (NRS) for itch or pain were eligible for the study. Subjects were randomly assigned to receive 4 sessions of hypnosis or treatment as usual. Both groups continued to receive pharmacologic and topical therapy. Outcome measures included NRS for pain and itch, and the 5-D Itch Scale. We conducted an intent to treat analysis of change over time for the two treatment groups on all measures. A total of 27 patients participated in the study, 62% were Caucasian and 60% were male. There were no significant differences between the groups on any outcome measure and both groups demonstrated improved pain and itch over time. There was a large effect size for Itch as measured by the NRS (intensity) and the 5D Itch Scale from baseline to 1 month. Of note, those in the hypnosis group had a larger burn size (24.1% TBSA burn vs 14.7%); however, this was not statistically significant. Our sample size was smaller than our target enrollment due to difficulties in subject recruitment. A total of 106 eligible participants were approached for the study but only 29 consented (two were lost to follow up). Top reasons for refusal included “did not believe in hypnosis” (25%), lost to follow up after screening but prior to consent (24%), and geographic distance prohibiting return to burn center (10%). Itch and pain seem to improve over time. Barriers to making hypnosis a feasible nonpharmacological option for patients who report burn pain and itch as impacting quality of life should be addressed. Our study demonstrates a need to educate the public about the potential benefits of hypnosis as a safe and efficacious nonpharmacological medical intervention. Further, future studies should validate the efficacy of hypnosis delivered via video or CD to reduce travel burden on patients returning for the intervention.

A Psychometric Evaluation of the Chinese Version of the 5D Itch Scale in Taiwanese Elderly

A Psychometric Evaluation of the Chinese Version of the 5D Itch Scale in Taiwanese Elderly

PSS22 - Real World, Prospective, Observational, Patient Reported Outcome Study of Hydroxyzine Hydrochloride in Indian Patients with Chronic Pruritis

To assess effectiveness & tolerability of hydroxyzine hydrochloride in management of Indian patients with chronic pruritus in real world setting A prospective, observational, patient reported outcomes study of 400 patients across 7 centres (179 male, 221 female), >18 years of age, having chronic pruritus due to dermatological cause and treated with hydroxyzine hydrochloride as per clinician's discretion upto period of 12 weeks. Primary outcome was improvement from baseline in quality of life, assessed using 10-point Dermatology Quality of Life Index (DLQI) after 12 weeks of study period. Secondary outcomes were improvement in the pruritus scores (5D-Itch scale) after 12 weeks, improvements in DLQI and 5D-Itch scores at 2, 4, and 8 weeks, and clinical safety during the study period were recorded. Wilcoxon test is used to compare baseline and follow-up data for DLQI and pruritus scores. The per-protocol set (PPS) included 177 patients and full-analysis set (FAS) had 391 patients. There was significant improvement (p<0.0001) in DLQI scores at 2 weeks (13.10%), 4 weeks (37.40%), 8 weeks (57.01%) and 12 weeks (76.33%) period in PPS patients. Similar significant improvement in DLQI was noted in FAS at 2, 4, 8 & 12 weeks (p<0.0001). The pruritus scores also decreased significantly (p<0.0001) at 2 weeks (10.56%), 4 weeks (26.32%), 8 weeks (37.71%) and 12 weeks (57.76%) period in PPS patients. Similar significant reduction in pruritus scores was observed in FAS patients at 2, 4, 8 & 12 weeks (p<0001). Total 10 (2.5%) patients reported mild to moderate adverse events (total 11 events) which were dizziness (4), constipation (2), drowsiness (2), dry mouth (2) and sedation (1). All events resolved without any intervention. This real world, observational, patient reported outcome study demonstrates hydroxyzine hydrochloride to significantly decrease symptoms of pruritus and improve quality of life in patients with chronic pruritus over 12 weeks treatment period