Assessing Pruritus in Hidradenitis Suppurativa: A Cross-Sectional Study

Background Pruritus is still a forgotten aspect of hidradenitis suppurativa (HS) and, to date, has never been adequately studied. Objective The aim of this study was to determine the prevalence, and explore the characteristics, of pruritus in a well-defined cohort of HS patients. Setting An academic hospital-based cross-sectional study in The Netherlands. Methods A numerical rating scale (NRS, 0-10) was used to determine the prevalence of HS-related itch (NRS score >= 3). Candidate predictors for pruritus were subsequently determined using logistic regression models, and the impact of pruritus was assessed using a modified five-dimensional (5-D) itch scale. Associated serological and histological markers of pruritus were (semi-)quantitatively investigated in a subpopulation. Results The prevalence rate of pruritus in 211 HS patients was 57.3%, with a mean NRS score of 6.1 +/- 2.0. Patients with a pruritus NRS score >= 3 had more HS-affected body sites than patients with a score < 3 (p< 0.001). The occurrence of a pruritus NRS score >= 3 was associated with Hurley III disease (odds ratio [OR] 7.73; p = 0.003) and pain (OR 1.34; p< 0.001). Pruritus affected sleep and activities of daily living (ADL) in the majority of cases, with an associated modified 5-D itch score of 13.7 +/- 3.6 (on a scale from 5 to 25) in 52 HS patients. Histological examination showed eosinophilic granulocytes were present in 25% (2/8) of the perilesional skin and 63% (10/16) of the lesional skin, while a perineural infiltrate was found in 25% (2/8) and 69% (11/16) of the perilesional and lesional skin, respectively. Conclusion Pruritus is a frequent but underreported symptom in patients with HS. Its moderate to severe intensity and significant impact on daily activities have great potential to impair patients' quality of life.