Chronic Itch Linked to Doubling in Risk of Fatigue for Many Skin Conditions

Data from a case-control study of more than 100,000 individuals is shedding light on the relationship between pruritus and fatigue among patients with a range of dermatologic conditions.

Leveraging the National Institutes of Health All of Us Research Hub, investigators found patients with pruritus had a more than 50% increase in odds of developing fatigue as matched controls, with a more than 2-fold increase in likelihood of fatigue seen among those with atopic dermatitis and prurigo nodularis.

“While prior studies have been made to determine the relationship between both fatigue and pruritus combined on systematic disease severity, there is limited data on how the prevalence of pruritus directly correlates with the prevalence of fatigue,” wrote investigators.

Led by Gil Yosipovitch, MD, tenured Professor of Dermatology and director of the Miami Itch Center at Miller School of Medicine at University of Miami, and Luis F. Andrade, BSc, a research fellow in the Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery at the Miller School of Medicine at University of Miami, the current study sought to describe the relationship between pruritus and fatigue with the intent of improving care and clinical decision-making. Pooling data from more than 800 registered institutions, the All of Us Research Hub contains electronic health record data from more than 1.2 million patients dating back to 2015.

In the current study, investigators used the database to identify patients with chronic pruritus, chronic pruritus of unknown origin (CPUO), prurigo nodularis, psoriasis, and atopic dermatitis. Once identified, investigators matched each of these patients to 4 controls using nearest neighbor propensity-score matching, with sex, age, and race/ethnicity as factors of interest. Presented at the Revolutionizing Atopic Dermatitis (RAD) 2024 annual meeting, the study included 91,212 controls and 22,803 cases of pruritus. These groups had a mean age of 59.91 [standard deviation: 15.95] years and 63.57% were female.

For the purpose of analysis, investigators used logistic regression models to estimates of odds ratio (OR) for having pruritus and developing fatigue, with adjustment for age, race/ethnicity, sex, income, education, anxiety, and depression as covariates. Investigators noted presence of pruritus and fatigue were identified using SNOMED/ICD diagnostic codes.¹

Upon analysis, results suggested fatigue was nearly twice as common among patients with pruritus as the matched control groups (40.81% vs 22.06%). In multivariable-adjusted analyses, investigators observed a statistically significant association between pruritus and fatigue (aOR, 1.5; 95% Confidence Interval [CI], 1.16 to 2.07). Further analysis demonstrated certain conditions exhibited a stronger association with fatigue, with the greatest magnitude of risk for developing fatigue observed with CPOU (aOR, 2.27; 95% CI, 1.35 to 3.82; P = .002), prurigo nodularis (aOR, 2.21; 95% CI, 1.87 to 2.61; P <.001), and atopic dermatitis (aOR, 2.05; 95% CI, 1.97 to 2.13; P <.001).¹

“Our study provides a quantitative measure of pruritus’ impact on the prevalence of patient-reported fatigue across many pruritic conditions, including atopic dermatitis. This two-fold increase in fatigue in patients with itch further emphasizes the clinical importance of understanding the impact of pruritus on patient quality of life,” wrote investigators.¹

References:

1. ^{Andrade LF, Haq Z, Abdi P, Diaz MJ, Yosipovitch G. Impact of pruritus on patient fatigue: a case-control study. Abstract presented at Revolutionizing Atopic Dermatitis 2024. Chicago, Il. June 08-10, 2024.}
2. ^{National Institutes of Health. Registered institutions. All of Us Research Hub. Accessed June 9, 2024. https://www.researchallofus.org/institutional-agreements/.}
3. ^{National Institutes of Health. Data Snapshots. All of Us Research Hub. Accessed June 9, 2024. https://www.researchallofus.org/data-tools/data-snapshots/.}