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Updated: Jul 8, 2026
Cheek Injection Model for Simultaneous Measurement of Pain and Itch-related Behaviors
Published on: September 27, 2019
Itch, Scratching, and Sleep Mediate the Association between Disease Severity and Quality of Life in Pruritic
Manuel P Pereira1,2, Pascale Salameh1,2,3,4,5, Athanasios Tsianakas6
1Institute of Allergology, Charité - University Medical Center Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Allergology, Berlin, Germany.
Introduction:
Chronic inflammatory skin conditions significantly impact the quality of life (QoL) of those affected. Itch is a cardinal symptom in many of these conditions, contributing decisively to the burden of disease. This cross-sectional study explored how itch and related factors mediate the relationship between disease severity and QoL impairment.
Methods:
Adult patients with chronic pruritus arising from psoriasis, atopic dermatitis, chronic prurigo, or chronic urticaria completed a set of validated questionnaires assessing worst and average itch intensity (worst itch intensity on the numerical rating scale [WI-NRS]/average itch intensity on the numerical rating scale [AI-NRS]), impairment of QoL with the 5-pruritus life quality (5PLQ), daily time with itch, scratching frequency, and sleep disturbance. Disease severity was evaluated using validated disease-specific scales. Spearman's rank correlation was performed to assess intercorrelations between 5PLQ scores, disease severity, and itch-related factors. A linear regression analysis investigated associations of 5PLQ with demographic and clinical factors. Mediation analyses examined whether the link between disease severity and 5PLQ scores was mediated by itch intensity, daily itch duration, scratching frequency, and sleep disturbance.
Results:
A total of 522 patients (282 female, median age: 56.0 years) participated in the study. 5PLQ scores correlated weakly with disease severity (r = 0.201, p < 0.001), and strongly with itch-related factors (r = 515-0.603, p < 0.001). The linear regression analysis revealed a positive association between 5PLQ scores and female sex (β: 0.887, p = 0.003), moderate disease severity (β: 1.552, p = 0.032), scratching frequency (β: 0.370, p < 0.001), and sleep disturbance (β: 0.427, p < 0.001). Mediation analyses showed that the association between disease severity and QoL impairment was partially mediated by average itch intensity (indirect β: 0.168, p = 0.049), daily itch duration (indirect β: 0.270, p < 0.001), scratching frequency (indirect β: 0.205, p = 0.010), and sleep disturbance (indirect β: 0.235, p = 0.006).
Conclusions:
Average itch intensity, daily itch duration, scratching, and sleep disturbance mediate the relationship between disease severity and impairment of QoL. Interventions targeting these aspects of disease may improve patient outcomes.
