Correlation between pruritus score and grossly visible erythema in dogs

The severity of pruritus and the extent and severity of erythema were quantified in 107 dogs presenting with various dermatoses. Pruritus was assessed using a previously validated scale, and erythema was quantified by assessing severity at 72 different body sites. Pruritus scores were either 0, or followed a normal type of distribution, with most dogs having a score in the middle of the range and a few dogs having low or high scores. The median pruritus score was 6.3/10. Erythema scores were heavily skewed towards lower values, with only a few dogs having high scores. The median diffuse erythema score was 6.0/216 and the median score for maculo-papular/pustular erythema was 0/1080. Pruritus and erythema scores were significantly correlated with a Spearman rank correlation coefficient of 0.4062 (P<0.001). However, visual assessment of the data representing the two variables revealed that this was not a consistent biological or clinically relevant correlation. Individual dogs could have a high pruritus score with low erythema score or vice versa. This study raises questions about the use of erythema scoring systems as a primary outcome measure in clinical trials, and also about the role of various inflammatory mediators in the pathogenesis of canine pruritus.