Is it legal to scratch Wikipedia

Itching / pruritus / professional article

Epidemiology

Incidence / prevalence [edit]

For many years it was assumed that the sensation of itching represents a sub-form of pain ("the little brother of pain"), since it can be ended by pain stimuli (scratching). We now know that there are some parallels, but also clear differences between the two.[1] Chronic itching (longer than 6 weeks) is not only caused by skin diseases but by a wide variety of diseases. According to the guidelines, pruritus is divided into 6 categories. For more details see table 1.

Table 1. Classification of chronic pruritus according to the European guideline.[2]

category
causes
Examples
I.
Skin disorders Atopic dermatitis

psoriasis
Urticaria

II
Systemic diseases,

drug

Liver disease with / without biliary obstruction

Kidney failure
Cancers
HIV, AIDS
Medication such as B. chloroquine, opioids, HAES (HAES = hydroxyethyl starch, used as blood plasma substitute)

III
Neurological diseases multiple sclerosis

Brain tumor
Notalgia paraesthetica
Polyneuropathy
Brachioradial pruritus
Post-herpetic neuralgia

IV
Psychogenic causesSomatoform disorders

schizophrenia
Mood disorders, e.g. B. Depression
Constraints
eating disorder

V.
Not clear
VI
Multifactorial 2 or more causes

Chronic itching is very common in the general population - almost one in four will experience it in their lifetime.[3] In a study by Ständer et al. it could be shown that slightly more women were affected by chronic itching than men (54.8% versus 46.2%).[4] There were also differences with regard to the underlying underlying disease, the additional diseases or the subtypes of chronic itching (see Table 2):

Table 2. Differences between men and women in terms of itching.

Women> men Men> women
Underlying diseases
Underlying diseases
  • Neurological diseases
  • Multifactorial, i.e. due to several different diseases
  • Mental illness
  • Skin disorders
  • Systemic diseases
Chronic itching subtypesChronic itching subtypes
  • Prurigo nodularis (nodules caused by scratching that make them itch again)
  • Brachioradial pruritus (itching that affects certain areas on the arm is caused by nerve damage in the spine)

Additional illnessesAdditional illnesses
  • Mental illness
  • Rheumatological diseases
  • Cardiovascular disease
  • Diseases of the urinary and genital organs
  • Medication

Risk factors and protective factors

Often those affected suffer very badly from the itching, which not infrequently leads to mental illnesses such as depression or anxiety. Anxiety or depression symptoms affect women more often than men.[5][6] It is not yet known whether anxiety and depression are also risk factors for chronic itching. Individual studies have shown that social support (e.g. from friends or family) has a positive effect on chronic itching.[7][8] Possibly this is because those affected can cope better with stress through social support,[9] which in turn plays an important role in maintaining chronic itching. So far, however, it is completely unknown whether there are gender-specific differences.

Pathophysiology
[To edit]

Gender-specific physical differences in the body outside the brain

Although the itching signaling pathway (see Figure 1) has been intensively researched in recent years, there is only limited knowledge about the differences between men and women. As early as 1990, however, it could be shown that women had a stronger reaction to the pruritic substance histamine than men (stronger sensation of itching, stronger skin reaction).[10] This stronger reaction was probably not caused by the nerve fibers, but by other physical as well as psychological reactions. No gender-specific difference in redness was found in the study by Hartmann et al. found that 15 men and 15 women injected various pruritic substances into the skin.[11] The research group concluded that there were no differences in the nerve fibers and their branches. However, this hypothesis has not been confirmed by skin biopsies. The fact that there are gender-specific differences with regard to the qualities of itching sensation was shown in a study with a large patient collective by Ständer et al. to be shown.[12] Here women described more stinging, warmth and pain when they felt itchy. Men could relieve itching better with warmth, but women with cold. These results suggest that more nerve fibers are affected in women. Due to the different responses to cold and warmth, it also seems likely that the nerve receptors are different in men and women. This is backed up by another study that found that women and men perceive itching on the lower legs and forearms differently.[13] Overall, several studies have shown that women perceive itching more intensely than men.[14][15][16] This coincides with the results of pain studies. Here women also reported higher pain intensities and, in contrast to men, suffered more from painful illnesses.[17][18]


Figure 1: Processing of the stimulus "itching".

Gender-specific differences in the processing of itching sensation in the brain

In addition to possible gender-specific differences in the periphery of the body, a different processing of the sensation of itching in the brain appears to be responsible for differences between men and women. The sensation of itching is caused by the activation of different regions in the brain. According to the knowledge from pain research, it is assumed that the interaction of different areas with different functions enables processing. One area is responsible for deciphering the touch stimuli ("where and how much it itches in the body"), another for the emotional evaluation ("how uncomfortable is the itching") and a third for planning the response to the itching stimulus - scratching (see Figure 1).

So far there is only one study that examined gender-specific differences.[19] In women, an increased activation of the brain regions was found, which are responsible for the decoding of the touch stimuli, the emotional assessment and the planning of actions. In analogy to studies on pain processing, it would be conceivable that women can anticipate the sensation of itching more and perceive it more emotionally and mentally. The increased activation of the brain regions responsible for action planning could also explain why women tend to scratch harder, which leads to larger injuries and scratch marks on the skin.[20]

Clinic [edit]

According to the European guideline, a distinction is made between 3 manifestations of chronic itching:[21]
* Chronic itching on unchanged skin
* Chronic itching with isolated scratching lesions (skin damage from scratching)
* chronic itching with numerous scratch lesions (so-called prurigo nodularis)
So far there is one study that has shown that women suffer more from chronic itching with numerous scratches.[22] It is not yet known why this is so. It is conceivable that women perceive the itching more strongly and process it differently in the brain than men, which could lead to a stronger scratch response (see pathophysiology).

Diagnostics [edit]

With regard to diagnostics, according to the current state of knowledge, no gender-specific differences have been investigated so far.

Management of patients

According to the current state of knowledge, gender-specific differences have not yet been investigated with regard to the management of patients.

Therapy [edit]

Unfortunately, there is so far no knowledge as to whether men and women benefit from different therapies, as studies are lacking.

Interaction between doctor and patient [edit]

Studies that have examined the interaction between doctor and patient do not yet exist. However, there is a study by Stumpf et al.,[23] who investigated whether there are differences when men and women had an itch-inducing substance injected into the skin by a female or a male investigator. Before the substance was injected, neutral or aggravating instructions were read out ("This substance causes enormous itching in most people!"). In this study it could be shown that men and women did not differ in the skin reaction (redness and wheal) or in the intensity of the sensation of itching. However, in contrast to the male investigator, the female investigator caused stronger skin reactions in combination with the aggravating instruction. It is conceivable that the test participants were stressed more by the investigator than by the male. The study by Kiecolt-Glaser et al. to be shown.[24] It may be that an investigator was expected to behave more empathically than an investigator. If this idea was not fulfilled, the test participants may have reacted with increased stress, which could then have led to the increased response. However, this assumption is very speculative, so that further studies would have to be carried out to confirm this assumption.

Treatment success / outcome [edit]

No studies on gender-specific differences have yet been published.

Psychosocial factors

The knowledge about psychosocial factors in pruritus has so far been very poor overall (see also risk factors). Bathe et al. were able to show that patients with chronic pruritus often felt that their doctor did not understand them, which can lead to significant difficulties in adherence, i.e. following treatment recommendations. It is not known whether there are any differences between men and women in this regard.[25]

In addition to biological differences in itching sensation, not only different behavioral patterns (increased scratching in women) seem to play a role, but also how the complaints are dealt with and the resulting psychological consequences. According to the current data, women seem not only to perceive the sensation of itching more strongly, but also seem to suffer more from it, which can increasingly lead to psychological complaints such as anxiety and depression.[26][27] But the size of the affected skin also seemed to play a role. In a study by Stumpf et al. In the statistics for women, connections between an itching all over the body that already existed at the beginning of the symptoms and fears and depression.[28] In men, scratching seemed to play a bigger role. This showed statistical relationships between depression values ​​and the patient group with numerous injuries from scratching. It would therefore be conceivable that feelings of loss of control or helplessness with regard to the frustrated itching in men favor depression symptoms.
However, the itching sensation also seems to have a more lasting effect on the quality of life for women than for men.[29] From studies that have examined patients with other skin diseases, some of which are disfiguring, it is known that young women in particular suffer from these diseases, whereby the desired role and the current ideal of beauty in society are an important factor.[30][31] Further studies should investigate whether this can also be transferred to patients with chronic itching.

Prevention [edit]

No studies can currently be found in the current literature that have investigated this issue.

Integration into clinical care

Open research questions [edit]

So far, some studies with patients as well as experimental studies have shown gender-specific differences. However, many issues have so far been investigated very little or not at all, so that it is urgently necessary to carry out further studies in order to be able to offer those affected a gender-adapted diagnosis and therapy.

External links [edit]

Click on "Expand" to display the references.
  1. Ständer S, Schmelz M. Chronic itch and pain - similarities and differences. Eur J Pain 2006 Jul; 10 (5): 473-8.
  2. Weisshaar E, Szepietowski JC, Darsow U, Misery L, Wallengren J, Mettang T, et al. European guideline on chronic pruritus. Acta Derm Venereol 2012 Oct 10; 92 (5): 563-81.
  3. Stand S, Schafer I, Phan NQ, Blome C, Herberger K, Heigel H, et al. Prevalence of chronic pruritus in Germany: results of a cross-sectional study in a sample working population of 11,730. Dermatology 2010; 221 (3): 229-35.
  4. Ständer S, Stumpf A, Osada N, Wilp S, Chatzigeorgakidis E, Pfleiderer B. Gender differences in chronic pruritus: women present different morbidity, more scratch lesions and higher burden. Br J Dermatol 2013 Jun; 168 (6): 1273-80.
  5. Ständer S, Stumpf A, Osada N, Wilp S, Chatzigeorgakidis E, Pfleiderer B. Gender differences in chronic pruritus: women present different morbidity, more scratch lesions and higher burden. Br J Dermatol 2013 Jun; 168 (6): 1273-80.
  6. Stump A, Stand S, Warlich B, Fritz F, Bruland P, Pfleiderer B, et al. Relations between the characteristics and psychological comorbidities of chronic pruritus differ between men and women: women are more anxious than men. Br J Dermatol 2015 May; 172 (5): 1323-8.
  7. Evers AW, Lu Y, Duller P, van der Valk PG, Kraaimaat FW, van de Kerkhof PC. Common burden of chronic skin diseases? Contributors to psychological distress in adults with psoriasis and atopic dermatitis. Br J Dermatol 2005 Jun; 152 (6): 1275-81.
  8. Dalgard F, Svensson A, Sundby J, Dalgard OS. Self-reported skin morbidity and mental health. A population survey among adults in a Norwegian city. Br J Dermatol 2005 Jul; 153 (1): 145-9.
  9. Evers AW, Lu Y, Duller P, van der Valk PG, Kraaimaat FW, van de Kerkhof PC. Common burden of chronic skin diseases? Contributors to psychological distress in adults with psoriasis and atopic dermatitis. Br J Dermatol 2005 Jun; 152 (6): 1275-81.
  10. Magerl W, Westerman RA, Mohner B, Craftsman HO. Properties of transdermal histamine iontophoresis: differential effects of season, gender, and body region. J Invest Dermatol 1990 Mar; 94 (3): 347-52.
  11. Hartmann EM, Handwerker HO, Forster C. Gender Differences in Itch and Pain-Related Sensations Provoked by Histamine, Cowhage and Capsaicin. Acta Derm Venereol 2014 May 13.
  12. Ständer S, Stumpf A, Osada N, Wilp S, Chatzigeorgakidis E, Pfleiderer B. Gender differences in chronic pruritus: women present different morbidity, more scratch lesions and higher burden. Br J Dermatol 2013 Jun; 168 (6): 1273-80.
  13. Stump A, Burgmer M, Schneider G, Heuft G, Schmelz M, Phan NQ, et al. Sex differences in itch perception and modulation by distraction - an FMRI pilot study in healthy volunteers. PLoS One 2013; 8 (11): e79123.
  14. Ständer S, Stumpf A, Osada N, Wilp S, Chatzigeorgakidis E, Pfleiderer B. Gender differences in chronic pruritus: women present different morbidity, more scratch lesions and higher burden. Br J Dermatol 2013 Jun; 168 (6): 1273-80.
  15. Stump A, Burgmer M, Schneider G, Heuft G, Schmelz M, Phan NQ, et al. Sex differences in itch perception and modulation by distraction - Stumpf A, Burgmer M, Schneider G, Heuft G, Schmelz M, Phan NQ, et al. Sex differences in itch perception and modulation by distraction - an FMRI pilot study in healthy volunteers. PLoS One 2013; 8 (11): e79123. an FMRI pilot study in healthy volunteers. PLoS One 2013; 8 (11): e79123.
  16. Stump A, Stand S, Warlich B, Fritz F, Bruland P, Pfleiderer B, et al. Relations between the characteristics and psychological comorbidities of chronic pruritus differ between men and women: women are more anxious than men. Br J Dermatol 2015 May; 172 (5): 1323-8.
  17. Fillingim RB, King CD, Ribeiro-Dasilva MC, Rahim-Williams B, Riley JL, III. Sex, gender, and pain: a review of recent clinical and experimental findings. J Pain 2009 May; 10 (5): 447-85.
  18. Riley JL, III, Robinson ME, Wise EA, Myers CD, Fillingim RB. Sex differences in the perception of noxious experimental stimuli: a meta-analysis. Pain 1998 Feb; 74 (2-3): 181-7.
  19. Stump A, Burgmer M, Schneider G, Heuft G, Schmelz M, Phan NQ, et al. Sex differences in itch perception and modulation by distraction - an FMRI pilot study in healthy volunteers. PLoS One 2013; 8 (11): e79123.
  20. Ständer S, Stumpf A, Osada N, Wilp S, Chatzigeorgakidis E, Pfleiderer B. Gender differences in chronic pruritus: women present different morbidity, more scratch lesions and higher burden. Br J Dermatol 2013 Jun; 168 (6): 1273-80.
  21. Weisshaar E, Szepietowski JC, Darsow U, Misery L, Wallengren J, Mettang T, et al. European guideline on chronic pruritus. Acta Derm Venereol 2012 Oct 10; 92 (5): 563-81.
  22. Ständer S, Stumpf A, Osada N, Wilp S, Chatzigeorgakidis E, Pfleiderer B. Gender differences in chronic pruritus: women present different morbidity, more scratch lesions and higher burden. Br J Dermatol 2013 Jun; 168 (6): 1273-80.
  23. Stumpf A, Zerey V, Heuft G, Ständer S, Pfleiderer B, Schneider G. Itch Perception and Skin Reactions as Modulated by Verbal Suggestions: Role of Participant's and Investigator's Sex. Acta Derm Venereol 2015 Dec 30.
  24. Ständer S, Stumpf A, Osada N, Wilp S, Chatzigeorgakidis E, Pfleiderer B. Gender differences in chronic pruritus: women present different morbidity, more scratch lesions and higher burden. Br J Dermatol 2013 Jun; 168 (6): 1273-80.
  25. Bathe A, Weisshaar E, Matterne U. Chronic pruritus - more than a symptom: a qualitative investigation into patients' subjective illness perceptions. J Adv Nurs 2013 Feb; 69 (2): 316-26.
  26. Ständer S, Stumpf A, Osada N, Wilp S, Chatzigeorgakidis E, Pfleiderer B. Gender differences in chronic pruritus: women present different morbidity, more scratch lesions and higher burden. Br J Dermatol 2013 Jun; 168 (6): 1273-80.
  27. Stump A, Stand S, Warlich B, Fritz F, Bruland P, Pfleiderer B, et al. Relations between the characteristics and psychological comorbidities of chronic pruritus differ between men and women: women are more anxious than men. Br J Dermatol 2015 May; 172 (5): 1323-8.
  28. Stump A, Stand S, Warlich B, Fritz F, Bruland P, Pfleiderer B, et al. Relations between the characteristics and psychological comorbidities of chronic pruritus differ between men and women: women are more anxious than men. Br J Dermatol 2015 May; 172 (5): 1323-8.
  29. Ständer S, Stumpf A, Osada N, Wilp S, Chatzigeorgakidis E, Pfleiderer B. Gender differences in chronic pruritus: women present different morbidity, more scratch lesions and higher burden. Br J Dermatol 2013 Jun; 168 (6): 1273-80.
  30. Szepietowski JC, Reich A, Wesolowska-Szepietowska E, Baran E. Quality of life in patients suffering from seborrheic dermatitis: influence of age, gender and education level. Mycoses 2009 Jul; 52 (4): 357-63.
  31. Borimnejad L, Parsa YZ, Nikbakht-Nasrabadi A, Firooz A. Quality of life with vitiligo: comparison of male and female muslim patients in Iran. Gend Med 2006 Jun; 3 (2): 124-30.

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Last modified: 2017-09-15 09:46:11