Itch in Chronic Wounds: Pathophysiology, Impact, and Management
Abstract
:1. Introduction
2. Methods
Literature Search
3. Results
3.1. Characteristics and Pathophysiological Mechanisms of Itch
3.2. Impact on QoL
3.3. Prevention of Itch in Chronic Wounds
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Authors | Year | Country | Type of Article | Purpose of Study | Findings |
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Hareendran A. et al. [2] | 2005 | United Kingdom | Qualitative and quantitative methods were used to explore health related quality of life (HRQoL) issues in 38 patients | Identify HRQoL issues in patients with venous leg ulcers | Itching was reported in 69.4% of patients but no influence on sleep and functional limitations were found |
Hareendran A. et al. [3] | 2007 | United Kingdom | In-depth interviews with focus group of 36 patients | To develop and validate a disease-specific quality of life (QoL) measure, based on the conceptual model of the Skin Disease impact on quality of life Index (SKINDEX-29) for patients with chronic venous leg ulcers | Itch was ranked 4th among ten symptoms causing distress in chronic venous ulcers |
Paul J.C. et al. [4] | 2011 | Michigan (USA) | Cross sectional study on 161 patients | Investigate itch related to chronic venous disease, pain, and QoL | Positive correlation between intensity of itch and severity of venous disease with lower QoL |
Paul J. [5] | 2013 | Michigan (USA) | Cross sectional study on 199 patients with chronic wounds of different etiologies | Comparing pain and itch in chronic wounds | Wound-related itch was significantly associated with age, xerosis, employment status, and with venous wounds. Itch was rated higher on the perilesional skin, while pain was rated higher on the wound bed. |
Paul J. [6] | 2013 | Michigan (USA) | Observational study on 200 patients with chronic wounds of different etiologies | Explore characteristics of wound-related itch | Itch characterizes more severe wounds with larger size, more tissue edema, and granulation issue and was also associated with moderate exudate amount or necrotic tissue |
Upton D. et al. [7] | 2013 | United Kingdom | Literature review | Overview of the physiological mechanisms of itch and comorbidities in acute and chronic wounds | The itch causes a range of physical and psychological problems, reducing QoL and delaying healing. There are no specific guidelines on itch management in chronic wounds and further studies are needed. |
Upton D. et al. [8] | 2013 | Australia | Literature review | Overview on psychological itch treatment in wounds | Unconventional treatments such as habit reversal training, relaxation, massage, and itch coping programs showed a potential role in reducing itch in association with standard treatments, but current literature evidence is limited. |
D’Erme A.M. et al. [9] | 2016 | Italy | Literature review | Overview on contact allergy and polysensitization in patients with chronic wounds | Advanced dressings can cause allergic contact dermatitis. The most frequent was hydrogel, followed by hydrocolloid and by silver wound dressings. Primary prevention is required, avoiding sensitizers and irritant products, along with secondary prevention using patch tests in all patients with non-healing wounds. |
Paul J. [10] | 2018 | Michigan (USA) | Structured interviews of 199 patients with chronic wounds | Identify descriptors for wound-related itch | 15 descriptors identified (annoying, bothersome, just want itching to go away, unpleasant, stubborn, disturbing sleep, insistent, disgusting, severe, awful, prickly, warm, worrisome, unbearable, uncontrollable) |
Parnell L.K.S. et al. [11] | 2018 | Texas (USA) | Literature review | Overview on itch research focusing on itch in wound care | Importance of multidimensional questionnaires to characterize itch. The authors described sensory, affective dimensions of itch, the itch trigger, and itch receptors and pathways. They highlighted both conventional and unconventional pharmacological therapies. |
Lerner E. [12] | 2018 | South Carolina (USA) | Literature review | Overview of current understanding on the physiology of itch in wounds | Proposal for unconventional therapeutic approaches based on physiology |
Take-Home Messages |
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✓ Itch in wounds is a very frequent symptom and should never be underestimated. The underlying mechanisms are very complex, including those of a subjective and multidimensional nature, which make investigations a real challenge for clinicians. |
✓ The application of the tissue debridement, inflammation/infection, moisture imbalance, epithelial edge advancement (TIME) principles of wound bed preparation, the topical management of perilesional skin, and a stepwise therapeutic approach based on European S2k Guideline on chronic itch (if causative treatment fails) seem to be the best management strategies to date. |
✓ Further studies are needed to better characterize and develop targeted therapies for itch in chronic wounds, adopting a tailored-based approach and drawing up practical guidelines. |
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Iannone, M.; Janowska, A.; Dini, V.; Tonini, G.; Oranges, T.; Romanelli, M. Itch in Chronic Wounds: Pathophysiology, Impact, and Management. Medicines 2019, 6, 112. https://doi.org/10.3390/medicines6040112
Iannone M, Janowska A, Dini V, Tonini G, Oranges T, Romanelli M. Itch in Chronic Wounds: Pathophysiology, Impact, and Management. Medicines. 2019; 6(4):112. https://doi.org/10.3390/medicines6040112
Chicago/Turabian StyleIannone, Michela, Agata Janowska, Valentina Dini, Giulia Tonini, Teresa Oranges, and Marco Romanelli. 2019. "Itch in Chronic Wounds: Pathophysiology, Impact, and Management" Medicines 6, no. 4: 112. https://doi.org/10.3390/medicines6040112
APA StyleIannone, M., Janowska, A., Dini, V., Tonini, G., Oranges, T., & Romanelli, M. (2019). Itch in Chronic Wounds: Pathophysiology, Impact, and Management. Medicines, 6(4), 112. https://doi.org/10.3390/medicines6040112