This comprehensive review investigates the significant psychological impact and profound psychological comorbidities found in individuals suffering from chronic pruritic dermatoses, including atopic dermatitis, chronic urticaria, and prurigo nodularis. Highlighting the complex, reciprocal relationship between pruritus and psychiatric conditions such as depression, anxiety, and sleep disturbances, this paper elucidates the comprehensive impact of dermatological disorders on the skin in addition to the far-reaching effects on an individual’s psychological well-being. By evaluating the efficacy of integrated psychodermatological interventions, including cognitive behavioral therapy, mindfulness practices, pharmacological treatments, and innovative telepsychiatry and digital health solutions, this review aims to lay the foundation for a more holistic approach to treatment of concurrent dermatological and psychiatric conditions. Future research endeavors should delve deeper into the mechanistic foundation of the pruritus-psychiatry interface, the refinement of tailored treatment strategies, and the evaluation of long-term patient outcomes. In doing so, this review seeks to contribute to the optimization of patient care and well-being, underscoring the pivotal role of addressing both dermatological and psychological needs in achieving comprehensive health outcomes.
References
[1]
Weisshaar, E., Szepietowski, J., Dalgard, F., Garcovich, S., Gieler, U., Giménez-Arnau, A., et al. (2019) European S2k Guideline on Chronic Pruritus. ActaDermatoVenereologica, 99, 469-506. https://doi.org/10.2340/00015555-3164
[2]
Lipman, Z.M., Ingrasci, G. and Yosipovitch, G. (2021) Approach to the Patient with Chronic Pruritus. Medical Clinics of North America, 105, 699-721. https://doi.org/10.1016/j.mcna.2021.04.007
[3]
Schneider, G., Driesch, G., Heuft, G., Evers, S., Luger, T.A. and Ständer, S. (2006) Psychosomatic Cofactors and Psychiatric Comorbidity in Patients with Chronic Itch. Clinical and Experimental Dermatology, 31, 762-767. https://doi.org/10.1111/j.1365-2230.2006.02211.x
[4]
Ständer, S., Weisshaar, E., Mettang, T., Szepietowski, J., Carstens, E., Ikoma, A., et al. (2007) Clinical Classification of Itch: A Position Paper of the International Forum for the Study of Itch. ActaDermato-Venereologica, 87, 291-294. https://doi.org/10.2340/00015555-0305
[5]
Jaworecka, K., Rzepko, M., Marek-Józefowicz, L., Tamer, F., Stefaniak, A.A., Szczegielniak, M., et al. (2022) The Impact of Pruritus on the Quality of Life and Sleep Disturbances in Patients Suffering from Different Clinical Variants of Psoriasis. Journal of Clinical Medicine, 11, Article 5553. https://doi.org/10.3390/jcm11195553
[6]
Pereira, M.P. and Ständer, S. (2017) Assessment of Severity and Burden of Pruritus. Allergology International, 66, 3-7. https://doi.org/10.1016/j.alit.2016.08.009
[7]
Grundmann, S. and Ständer, S. (2011) Chronic Pruritus: Clinics and Treatment. Annals of Dermatology, 23, 1-11.
[8]
Dalgard, F.J., Svensson, Å., Halvorsen, J.A., Gieler, U., Schut, C., Tomas-Aragones, L., et al. (2020) Itch and Mental Health in Dermatological Patients across Europe: A Cross-Sectional Study in 13 Countries. Journal of Investigative Dermatology, 140, 568-573. https://doi.org/10.1016/j.jid.2019.05.034
[9]
Golpanian, R., Lipman, Z., Fourzali, K., Fowler, E., Nattkemper, L., Chan, Y., et al. (2020) Psychiatric Comorbidities in Non-Psychogenic Chronic Itch, a Us-Based Study. ActaDermatoVenereologica, 100, adv00169. https://doi.org/10.2340/00015555-3487
[10]
Frazier, W. and Bhardwaj, N. (2020) Atopic Dermatitis: Diagnosis and Treatment. American Family Physician, 101, 590-598.
[11]
Kim, J., Kim, B.E. and Leung, D.Y.M. (2019) Pathophysiology of Atopic Dermatitis: Clinical Implications. Allergy and Asthma Proceedings, 40, 84-92. https://doi.org/10.2500/aap.2019.40.4202
[12]
Pareek, A., Kumari, L., Pareek, A., Chaudhary, S., Ratan, Y., Janmeda, P., et al. (2024) Unraveling Atopic Dermatitis: Insights into Pathophysiology, Therapeutic Advances, and Future Perspectives. Cells, 13, Article 425. https://doi.org/10.3390/cells13050425
[13]
Silverberg, J.I. (2019) Comorbidities and the Impact of Atopic Dermatitis. Annals of Allergy, Asthma & Immunology, 123, 144-151. https://doi.org/10.1016/j.anai.2019.04.020
[14]
Hon, K.L., Leung, A.K.C., Ng, W.G.G. and Loo, S.K. (2019) Chronic Urticaria: An Overview of Treatment and Recent Patents. Recent Patents on Inflammation & Allergy Drug Discovery, 13, 27-37. https://doi.org/10.2174/1872213x13666190328164931
[15]
Sachdeva, S., Gupta, V., Amin, S. and Tahseen, M. (2011) Chronic Urticaria. Indian Journal of Dermatology, 56, 622-628. https://doi.org/10.4103/0019-5154.91817
[16]
Greaves, M. (2000) Chronic Urticaria. Journal of Allergy and Clinical Immunology, 105, 664-672. https://doi.org/10.1067/mai.2000.105706
[17]
Shao, Y., Wang, D., Zhu, Y., Xiao, Z., Jin, T., Peng, L., et al. (2023) Molecular Mechanisms of Pruritus in Prurigo Nodularis. Frontiers in Immunology, 14, Article 1301817. https://doi.org/10.3389/fimmu.2023.1301817
[18]
Kowalski, E.H., Kneiber, D., Valdebran, M., Patel, U. and Amber, K.T. (2019) Treatment-Resistant Prurigo Nodularis: Challenges and Solutions. Clinical, Cosmeticand Investigational Dermatology, 12, 163-172. https://doi.org/10.2147/ccid.s188070
[19]
Boozalis, E., Tang, O., Patel, S., Semenov, Y.R., Pereira, M.P., Stander, S., et al. (2018) Ethnic Differences and Comorbidities of 909 Prurigo Nodularis Patients. Journal of the American Academy of Dermatology, 79, 714-719.E3. https://doi.org/10.1016/j.jaad.2018.04.047
[20]
Kwon, C.D., Khanna, R., Williams, K.A., Kwatra, M.M. and Kwatra, S.G. (2019) Diagnostic Workup and Evaluation of Patients with Prurigo Nodularis. Medicines, 6, Article 97. https://doi.org/10.3390/medicines6040097
[21]
Larson, V.A., Tang, O., Stander, S., Miller, L.S., Kang, S. and Kwatra, S.G. (2019) Association between Prurigo Nodularis and Malignancy in Middle-Aged Adults. Journal of the American Academy of Dermatology, 81, 1198-1201. https://doi.org/10.1016/j.jaad.2019.03.083
[22]
Wongvibulsin, S., Sutaria, N., Williams, K.A., Huang, A.H., Choi, J., Roh, Y.S., et al. (2021) A Nationwide Study of Prurigo Nodularis: Disease Burden and Healthcare Utilization in the United States. Journal of Investigative Dermatology, 141, 2530-2533.E1. https://doi.org/10.1016/j.jid.2021.02.756
[23]
Rodriguez, D., Kwatra, S.G., Dias-Barbosa, C., Zeng, F., Jabbar Lopez, Z.K., Piketty, C., et al. (2023) Patient Perspectives on Living with Severe Prurigo Nodularis. JAMA Dermatology, 159, 1205-1212. https://doi.org/10.1001/jamadermatol.2023.3251
[24]
Schut, C., Mollanazar, N., Kupfer, J., Gieler, U. and Yosipovitch, G. (2016) Psychological Interventions in the Treatment of Chronic Itch. ActaDermatoVenereologica, 96, 157-161. https://doi.org/10.2340/00015555-2177
[25]
Hedman-Lagerlöf, E., Fust, J., Axelsson, E., Bonnert, M., Lalouni, M., Molander, O., et al. (2021) Internet-Delivered Cognitive Behavior Therapy for Atopic Dermatitis. JAMA Dermatology, 157, 796-804. https://doi.org/10.1001/jamadermatol.2021.1450
[26]
Jafferany, M. and Davari, M.E. (2018) Itch and Psyche: Psychiatric Aspects of Pruritus. International Journal of Dermatology, 58, 3-23. https://doi.org/10.1111/ijd.14081
[27]
Chida, Y., Steptoe, A., Hirakawa, N., Sudo, N. and Kubo, C. (2007) The Effects of Psychological Intervention on Atopic Dermatitis. International Archives of Allergy and Immunology, 144, 1-9. https://doi.org/10.1159/000101940
[28]
Kabat-Zinn, J. (1982) An Outpatient Program in Behavioral Medicine for Chronic Pain Patients Based on the Practice of Mindfulness Meditation: Theoretical Considerations and Preliminary Results. General Hospital Psychiatry, 4, 33-47. https://doi.org/10.1016/0163-8343(82)90026-3
[29]
Kabat-Zinn, J., Wheeler, E., Light, T., Skillings, A., Scharf, M.J., Cropley, T.G., et al. (1998) Influence of a Mindfulness Meditation-Based Stress Reduction Intervention on Rates of Skin Clearing in Patients with Moderate to Severe Psoriasis Undergoing Photo Therapy (UVB) and Photochemotherapy (PUVA). Psychosomatic Medicine, 60, 625-632. https://doi.org/10.1097/00006842-199809000-00020
[30]
Offenbächer, M., Seitlinger, M., Münch, D., Schnopp, C., Darsow, U., Harfensteller, J., et al. (2021) A Pilot Study of a Mindfulness-Based Stress Reduction Programme in Patients Suffering from Atopic Dermatitis. Psychology International, 3, 663-672. https://doi.org/10.3390/psych3040042
[31]
Fordham, B., Griffiths, C.E.M. and Bundy, C. (2014) A Pilot Study Examining Mindfulness-Based Cognitive Therapy in Psoriasis. Psychology, Health & Medicine, 20, 121-127. https://doi.org/10.1080/13548506.2014.902483
[32]
Steinhoff, M., Cevikbas, F., Ikoma, A. and Berger, T.G. (2011) Pruritus: Management Algorithms and Experimental Therapies. Seminars in Cutaneous Medicine and Surgery, 30, 127-137. https://doi.org/10.1016/j.sder.2011.05.001
[33]
Misery, L., Brenaut, E., Pierre, O., Le Garrec, R., Gouin, O., Lebonvallet, N., et al. (2021) Chronic Itch: Emerging Treatments Following New Research Concepts. British Journal of Pharmacology, 178, 4775-4791. https://doi.org/10.1111/bph.15672
[34]
Pereira, M.P. and Ständer, S. (2018) Novel Drugs for the Treatment of Chronic Pruritus. Expert Opinion on Investigational Drugs, 27, 981-988. https://doi.org/10.1080/13543784.2018.1548606
[35]
Reszke, R., Krajewski, P. and Szepietowski, J.C. (2020) Emerging Therapeutic Options for Chronic Pruritus. American Journal of Clinical Dermatology, 21, 601-618. https://doi.org/10.1007/s40257-020-00534-y
[36]
Trinidad, J., Gabel, C.K., Han, J.J., Bonomo, L., Cartron, A., Chand, S., et al. (2022) Telemedicine and Dermatology Hospital Consultations during the COVID‐19 Pandemic: A Multi‐Centre Observational Study on Resource Utilization and Conversion to in‐Person Consultations during the COVID‐19 Pandemic. Journal of the European Academy of Dermatology and Venereology, 36, e323-e325. https://doi.org/10.1111/jdv.17898
[37]
Andersson, G., Cuijpers, P., Carlbring, P., Riper, H. and Hedman, E. (2014) Guided Internet-Based vs. Face-to-Face Cognitive Behavior Therapy for Psychiatric and Somatic Disorders: A Systematic Review and Meta-Analysis. World Psychiatry, 13, 288-295. https://doi.org/10.1002/wps.20151
[38]
Steinhoff, M., Cevikbas, F., Yeh, I., Chong, K., Buddenkotte, J. and Ikoma, A. (2012) Evaluation and Management of a Patient with Chronic Pruritus. Journal of Allergy and Clinical Immunology, 130, 1015-1016.E7. https://doi.org/10.1016/j.jaci.2012.08.006
[39]
Nakashima, C., Yanagihara, S. and Otsuka, A. (2022) Innovation in the Treatment of Atopic Dermatitis: Emerging Topical and Oral Janus Kinase Inhibitors. Allergology International, 71, 40-46. https://doi.org/10.1016/j.alit.2021.10.004
[40]
Ständer, S., Yosipovitch, G., Legat, F.J., Lacour, J., Paul, C., Narbutt, J., et al. (2020) Trial of Nemolizumab in Moderate-to-Severe Prurigo Nodularis. New England Journal of Medicine, 382, 706-716. https://doi.org/10.1056/nejmoa1908316
[41]
Bonchak, J.G. and Lio, P.A. (2020) Nonpharmacologic Interventions for Chronic Pruritus. Itch, 5, e31-e31. https://doi.org/10.1097/itx.0000000000000031
[42]
Connor, C. (2017) Management of the Psychological Comorbidities of Dermatological Conditions: Practitioners’ Guidelines. Clinical, Cosmetic and Investigational Dermatology, 10, 117-132. https://doi.org/10.2147/ccid.s111041
[43]
König, I.R., Fuchs, O., Hansen, G., von Mutius, E. and Kopp, M.V. (2017) What Is Precision Medicine? European Respiratory Journal, 50, Article 1700391. https://doi.org/10.1183/13993003.00391-2017
[44]
Wang, J.Y. and Sarin, K.Y. (2021) Dermatology Advances into an Era of Precision Medicine. JAMA Dermatology, 157, 770-772. https://doi.org/10.1001/jamadermatol.2021.0024
[45]
Bakker, D., de Bruin-Weller, M., Drylewicz, J., van Wijk, F. and Thijs, J. (2023) Biomarkers in Atopic Dermatitis. Journal of Allergy and Clinical Immunology, 151, 1163-1168. https://doi.org/10.1016/j.jaci.2023.01.019
[46]
Pardiñas, A.F., Owen, M.J. and Walters, J.T.R. (2021) Pharmacogenomics: A Road Ahead for Precision Medicine in Psychiatry. Neuron, 109, 3914-3929. https://doi.org/10.1016/j.neuron.2021.09.011
