Itch characteristics in Chinese patients with atopic dermatitis using a new questionnaire for the assessment of pruritus

Background: Although pruritus is the predominant and commonest feature of atopic dermatitis, its clinical characteristics have not been explored. Objective: To characterize the clinical pattern and sensory and affective dimensions of the itch experience utilizing a comprehensive itch questionnaire. Methods: A structured itch questionnaire based on the McGill pain questionnaire was given to 102 Chinese patients with known atopic dermatitis. Results: There were 100 patients with atopic dermatitis who fully filled the questionnaire. In 87% of the patients pruritus appeared on a daily basis. It had a prolonged duration (mean duration 10.7 ± 7.3 years). It involved all body areas mostly in the lower limbs (83%), flexures (76%), upper limbs (71%) and neck (65%). Itch intensity during its peak was nearly twice higher than the itch of a mosquito bite. Itching was most frequent at night (65%), and 84% of patients reported of difficulty falling asleep. Daily life activities which increased the severity of itch were sweat in 96%, dryness in 71%, stress in 71% and physical effort in 73%. The major factors which were found to reduce the intensity of pruritus included: Bathing with cold water in 55% and cold ambient environment in 56%. Associated symptoms were heat sensation (51%), sweating (40%) and pain in the pruritic area (45%). The various anti-pruritic therapies had limited long-term effect. The pruritus was bothersome (52%) and a major distress to the patient. The effective score correlated to itch intensity during its peak (r = 0.4, P < 0.001). Conclusions: The study provided a detailed description of pruritus in atopic dermatitis with new data on affective and sensory dimensions and associated symptoms. The questionnaire was found to be a useful tool in characterization of itch.