Feelings of Depression, Stigmatization Strongly Associated with Itch Intensity of Dermatologic Conditions

Individuals diagnosed with itchy dermatoses exhibit distinct associations between the severity of itch and reports of depression, anxiety, and stigmatization, according to recent findings, suggesting the need for psychological evaluations involving focus on itch itself as well as the related psychological elements.¹

These findings and more were the results of a recent study assessing the link between depression, anxiety, feelings of stigmatization, and more using a larger cohort of participants with different types of dermatoses involving itch.

This research was led by Claudia Zeidler, MD, from the department of dermatology and center for chronic pruritus at the University Hospital Münster in Münster, Germany. Zeidler and colleagues noted that while there is research on such topics, including on itch being a major predictor of stigmatization, the subject had not been fully assessed among those of different itchy dermatoses separately and using itch as a major variable.²

“We hypothesize that patients with itchy skin conditions display higher stress and stigmatization levels as well as more often clinically relevant signs of anxiety and depression than patients without itch,” Zeidler and colleagues wrote.

Background and Methods

The investigators looked at data which had been drawn from the observational, cross-sectional, multi-center study titled ESDaP-study II. They carried out this research in 17 European nations.

The research team noted that the study protocols and research had been detailed previously, adding that findings were concerning body dysmorphic disorder (BDD) and stigmatization in this context.² Training, prior to participant recruitment, had been provided to centers that were participating, and all materials were put through a translation process.

Study participants were recruited through 22 dermatological outpatient clinics in the timeframe between September 2017 - December 2019, and subsequent refinement of dermatological condition classification took place thanks to the work of 4 dermatologists in 2020. These dermatologists integrated insights from prior ESDaP research and ICD-10 guidelines, seeking to implement statistical analyses by using adequate representation of patients within each condition group.

A panel of dermatologists then identified a subset of 3399 individuals known to have 14 distinct skin conditions connected to itch. These doctors had substantial prior experience in helping patients to manage chronic itch and dermatosis-itch associations.

There ended not being any modifications made to the final list of 14 itch-associated skin conditions, and the list was given an author review by the research team. Questionnaires were given by the investigators to participants to look into ratings of stress, stigmatization perceptions, overall health, clinically relevant depression or anxiety signs, itch-related quality of life, duration of itch, frequency of itch, and intensity of itch.

Findings

Overall, the research team found there to be several substantial links between severity of patients’ itch and perceptions of stress, and this was particularly pronounced in individuals with rosacea (correlation coefficient r = 0.314). Those with seborrheic dermatitis were also shown by the team to have exhibited substantial correlations between intensity of itch and reports of stigmatization, depression, and anxiety (correlation coefficients r = 0.317, r = 0.400, r = 0.356, respectively).

Following the team’s implementation of their stepwise linear regression analysis, they found that anxiety levels, patients’ gender, depression, and perceptions of stigmatization all collectively impacted 9.3% of variation in itch intensity throughout the cohort. Specifically, the investigators found that females and those with heightened anxiety experiences, depression, and perceived stigmatization were found to have reported stronger itch intensities versus their counterparts.

“As a consequence psychological interventions should target both itch and related psychological variables,” they wrote. “In certain instances, it is crucial to refer individuals to an appropriate healthcare service for additional psychological evaluation.”

References

1. ^{Zeidler C, Kupfer J, Dalgard FJ, Bewley A, Evers AWM, Gieler U, et al. Dermatological patients with itch report more stress, stigmatization experience, anxiety and depression compared to patients without itch: Results from a European multi-centre study. J Eur Acad Dermatol Venereol. 2024; 00: 1–13. https://doi.org/10.1111/jdv.19913.}
2. ^{Van Beugen S, Schut C, Kupfer J, Bewley AP, Finlay AY, Gieler U, et al. Perceived stigmatization among dermatological outpatients compared with controls: an observational multicentre study in 17 European countries. Acta Derm Venereol. 2023; 103: adv6485.}