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Pruritus and Psyche: An Update on Clinical Management
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Pruritus and Psyche: An Update on Clinical Management

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Dermatology".

Deadline for manuscript submissions: 30 May 2025 | Viewed by 8179

Special Issue Editors

Dr. Simon M. Mueller

E-Mail Website
Guest Editor
Department of Dermatology, University Hospital Basel, University of Basel, 4056 Basel, Switzerland
Interests: pruritus; itch; inflammatory dermatoses; graft-versus-host disease; psychodermatology
Dr. Antonios Kolios

E-Mail Website
Guest Editor
Department of Dermatology, University of Zurich, Zurich, Switzerland
Interests: dermatology; immunology; immune tolerance; autoimmunity; lupus; vitiligo; hidradenitis suppurativa; psoriasis

Special Issue Information

Dear Colleagues,

Pruritus is the most common cutaneous symptom, caused by numerous dermatological and non-dermatological conditions. Based on the neurocutaneous axis, the experience of pruritus and emotions are closely linked. Chronic itchy conditions can lead to stress reactions, depression, and anxiety; these and other psychiatric conditions (e.g., delusional infestation) may also result in pruritus. In recent years, a remarkable number of novel drugs to treat itchy conditions (such as atopic dermatitis, psoriasis, prurigo nodularis, or uremic pruritus) have been developed, primarily to treat the somatic complaints of affected patients. When managing these patients, however, their psychological condition should also be addressed and treated. In this Special Issue, we therefore aim to gather novel insights into psychodermatological aspects of patients suffering from pruritus to improve their clinical management. Both clinicians and researchers are encouraged to submit their original works, reviews, commentaries, and perspectives to this Special Issue.

Dr. Simon M. Mueller
Dr. Antonios Kolios
Guest Editors

Manuscript Submission Information

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pruritus
  • itching
  • psyche
  • psychodermatology
  • psychopharmacology
  • modern treatment
  • burden of disease
  • depression
  • anxiety
  • stress
  • delusional infestation
  • skin–brain axis

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Published Papers (6 papers)

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Research

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11 pages, 218 KiB  
Article
From Itch to Access: Psychodermatological Care Challenges and the Promise of Telehealth
by Julia Rümmelein, Christiane Brockes and Christian Greis
J. Clin. Med. 2025, 14(6), 1993; https://doi.org/10.3390/jcm14061993 - 15 Mar 2025
Viewed by 520
Abstract
Background/Objectives: Pruritus is a prominent symptom of chronic inflammatory skin diseases and significantly affects quality of life. Psychological stress can exacerbate pruritus and worsen skin conditions, yet psychological aspects are often insufficiently addressed in clinical routine. While psychodermatological treatments are becoming more available [...] Read more.
Background/Objectives: Pruritus is a prominent symptom of chronic inflammatory skin diseases and significantly affects quality of life. Psychological stress can exacerbate pruritus and worsen skin conditions, yet psychological aspects are often insufficiently addressed in clinical routine. While psychodermatological treatments are becoming more available in German-speaking countries, they are mostly confined to specialized clinics, limiting access for many patients. This study aims to explore the unmet needs of patients with chronic inflammatory skin diseases in German-speaking regions and assess the potential role of telemedicine in bridging existing psychodermatological care gaps. Methods: Patients with chronic inflammatory skin diseases were invited via the Network of People with Autoimmune Diseases to participate in free video consultations with a licensed psychotherapist. Quantitative data on disease, pruritus, and distress were analyzed alongside qualitative feedback from consultations and surveys. Results: Of 174 individuals who received the newsletter, 124 opened it, and 16 engaged with the scheduling link. Over one month, five patients (mean age 40.4 years, all female) participated in psychodermatological video consultations. All had chronic inflammatory skin diseases and were under dermatological care but felt insufficiently treated by dermatological approaches alone. Barriers to multimodal care included lack of awareness, distance to specialized clinics, and long waiting times. Three participants reported pruritus with an average intensity of 75/100 on a Visual Analog Scale (VAS). Psychological factors were identified as significant contributors to pruritus by all participants. Post-consultation, 4/5 of participants completed a survey, reporting high levels of distress (average 74/100 VAS) and favoring online or hybrid treatment options. Conclusions: Dermatological treatment alone often fails to address psychological aspects in patients with chronic inflammatory skin diseases. These findings emphasize the need for integrated dermatological and psychological treatment, with telemedicine offering a valuable avenue to improve access and foster interdisciplinary collaboration. Full article
(This article belongs to the Special Issue Pruritus and Psyche: An Update on Clinical Management)
14 pages, 941 KiB  
Article
Pruritus and Neuropsychiatric Symptoms Among Patients with Darier Disease—An Overlooked and Interconnected Challenge
by Grace Xiong, Muskaan Sachdeva, Gil Yosipovitch, Michael Ziv and Roni P. Dodiuk-Gad
J. Clin. Med. 2025, 14(6), 1818; https://doi.org/10.3390/jcm14061818 - 8 Mar 2025
Viewed by 612
Abstract
(1) Background: Darier disease (DD) is a rare autosomal dominant disorder caused by mutations in ATP2A2, a gene that encodes the sarco(endo)plasmic reticulum calcium-ATPase 2 enzyme, which disrupts calcium homeostasis in keratinocytes. Pruritus, a frequently overlooked symptom in DD, can lead to physical [...] Read more.
(1) Background: Darier disease (DD) is a rare autosomal dominant disorder caused by mutations in ATP2A2, a gene that encodes the sarco(endo)plasmic reticulum calcium-ATPase 2 enzyme, which disrupts calcium homeostasis in keratinocytes. Pruritus, a frequently overlooked symptom in DD, can lead to physical and emotional complications, especially in patients with DD who are genetically predisposed to psychiatric comorbidities. (2) Methods: This study aimed to analyze pruritus and other related symptoms in patients with DD and explore their correlation with neuropsychiatric conditions, psychological challenges, disease severity, and body surface area (BSA) involvement through a retrospective review of a tertiary center. (3) Results: Data from 76 patients (equal gender distribution, mean age 44 years) revealed a prevalence of pruritus of 90.8%, surpassing symptoms such as pain (34.3%) and malodor (43.4%). Burning sensations due to DD lesions were significantly correlated with the diagnosis of comorbid neuropsychiatric conditions (p = 0.047) and psychiatric medication use (p = 0.019). While pruritus correlated with disease severity and %BSA involvement, the findings were not statistically significant. Patients reporting pruritus had a significantly higher Dermatology Life Quality Index symptom score (2.4 ± 1.0), which is defined as the presence of itch, soreness, pain, or stinging, than those who did not (1.5 ± 0.6), indicating accurate symptom reporting. (4) Conclusions: In conclusion, a striking majority of patients with DD experience pruritus, with higher prevalence among those with neuropsychiatric challenges, severe Darier disease, and greater %BSA skin involvement. Clinicians should recognize pruritus as a key therapeutic target and adopt comprehensive treatment approaches that both address the neuropsychiatric comorbidities and the added psychological burden of pruritus in patients with DD. Full article
(This article belongs to the Special Issue Pruritus and Psyche: An Update on Clinical Management)
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17 pages, 1804 KiB  
Article
Isotretinoin Concerns in Switzerland: A Student-Based Transversal Study
by Anna-Lena U. Jakobi, Andreas J. Bircher, Alberto Pagnamenta and Isabella Terrani
J. Clin. Med. 2025, 14(6), 1801; https://doi.org/10.3390/jcm14061801 - 7 Mar 2025
Viewed by 543
Abstract
Background/Objectives: Concerns about isotretinoin may affect both initiation and adherence in acne patients. We conducted a student-based transversal study including participants with knowledge on isotretinoin to assess related concerns and factors as well as the impact of an isotretinoin fact sheet in [...] Read more.
Background/Objectives: Concerns about isotretinoin may affect both initiation and adherence in acne patients. We conducted a student-based transversal study including participants with knowledge on isotretinoin to assess related concerns and factors as well as the impact of an isotretinoin fact sheet in a before–after design. To our knowledge, no such surveys have been published to evaluate such concerns. Method: An online questionnaire about isotretinoin treatment was distributed by social media. The impact of written information about isotretinoin was assessed. Results: A total of 528 participants had fulfilled inclusion criteria. Most participants (53.8%) reported having concerns about isotretinoin treatment, mainly about xerosis cutis, but also about depression. A total of 49.1% of participants with a history of isotretinoin treatment reported that these concerns affected their adherence to treatment. Participants mostly relied on information from relatives or acquaintances and treating physicians, while reading a text about isotretinoin did not affect their concerns (p = 0.22). Multivariable regression analysis demonstrated that female participants, pharmacy students, and subjects with a history of acne had higher isotretinoin concerns. Conclusions: Students in Switzerland were concerned about an isotretinoin treatment. Written information did not change their existing concerns. This study highlights the importance for more education regarding potential side effects of isotretinoin. Full article
(This article belongs to the Special Issue Pruritus and Psyche: An Update on Clinical Management)
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Review

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15 pages, 835 KiB  
Review
The Relationship Between Chronic Pruritus, Attention-Deficit/Hyperactivity Disorder, and Skin Picking—A Case Series and Narrative Review
by Eva Loos, Suzan Sekar, Christiane Rosin, Alexander A. Navarini, Chrysovalandis Schwale, Rainer Schaefert and Simon Müller
J. Clin. Med. 2025, 14(5), 1774; https://doi.org/10.3390/jcm14051774 - 6 Mar 2025
Viewed by 846
Abstract
Chronic pruritus (CP), attention-deficit/hyperactivity disorder (ADHD), and skin picking disorder (SPD) are medical conditions that involve both somatic and psychosocial dimensions, posing unique challenges in clinical management. While CP and SPD are often observed together, the link between ADHD and these conditions is [...] Read more.
Chronic pruritus (CP), attention-deficit/hyperactivity disorder (ADHD), and skin picking disorder (SPD) are medical conditions that involve both somatic and psychosocial dimensions, posing unique challenges in clinical management. While CP and SPD are often observed together, the link between ADHD and these conditions is less recognized. This conceptual work describes three women who suffered from a complex interplay of CP, ADHD, and SPD treated at our specialized bi-disciplinary psychodermatological pruritus clinic. Based on our clinical observation and a narrative review of the literature, we assume a bidirectional, triangular relationship between CP, ADHD, and SPD. To support this assumption, we propose two hypotheses: (1) a neurodevelopmental hypothesis, emphasizing that an underlying neurodevelopmental disorder, in this case, ADHD, might present with symptoms like dysfunction of sensory processing, impulsivity, and attention deficits as shared features that reinforce CP and SPD, and (2) a neuroinflammatory hypothesis, suggesting that similar neuroinflammatory signatures promote the co-occurrence of CP, ADHD, and SPD. In addition, we provide specific suggestions derived from our clinical experience on how to manage patients with this complex combination of conditions. Elucidating the interplay between CP, ADHD, and SPD might help develop personalized treatment strategies and improve outcomes. Full article
(This article belongs to the Special Issue Pruritus and Psyche: An Update on Clinical Management)
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12 pages, 976 KiB  
Review
A Narrative Review on Stress and Itch: What We Know and What We Would Like to Know
by Nicole B. Khalil, Giulia Coscarella, Firdaus S. Dhabhar and Gil Yosipovitch
J. Clin. Med. 2024, 13(22), 6854; https://doi.org/10.3390/jcm13226854 - 14 Nov 2024
Cited by 3 | Viewed by 1785
Abstract
Itch is one of the most prevalent symptoms experienced by patients with inflammatory skin conditions, yet it is also one of the most debilitating. Patients suffering from chronic itch have been found to have significantly higher stress levels compared with those not experiencing [...] Read more.
Itch is one of the most prevalent symptoms experienced by patients with inflammatory skin conditions, yet it is also one of the most debilitating. Patients suffering from chronic itch have been found to have significantly higher stress levels compared with those not experiencing itch. In fact, recent studies have revealed a bidirectional relationship between stress and itch, where each condition worsens the other. This is thought to be driven by the vicious itch–scratch cycle, which is fueled by underlying inflammation. The precise molecular pathways and mediators involved, however, remain unclear. This narrative review discusses the existing research on the relationship between stress and itch and outlines future research directions that will be necessary to advance our understanding and treatment of these conditions. Given that the effective management of both symptoms often requires a combined treatment approach, further investigation into their shared mechanisms is essential for identifying successful therapies and improving patient outcomes. Full article
(This article belongs to the Special Issue Pruritus and Psyche: An Update on Clinical Management)
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17 pages, 331 KiB  
Review
Integrative Treatment Approaches with Mind–Body Therapies in the Management of Atopic Dermatitis
by Gil Yosipovitch, Ludivine Canchy, Bárbara Roque Ferreira, Claudia C. Aguirre, Therdpong Tempark, Roberto Takaoka, Martin Steinhoff and Laurent Misery
J. Clin. Med. 2024, 13(18), 5368; https://doi.org/10.3390/jcm13185368 - 11 Sep 2024
Cited by 2 | Viewed by 3115
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disease with a complex pathophysiology characterized by intense pruritus, often associated with psychological stress and atopic and non-atopic comorbidities that significantly reduce quality of life. The psychological aspects of AD and the interaction between the [...] Read more.
Atopic dermatitis (AD) is a chronic inflammatory skin disease with a complex pathophysiology characterized by intense pruritus, often associated with psychological stress and atopic and non-atopic comorbidities that significantly reduce quality of life. The psychological aspects of AD and the interaction between the mind and body via the skin–brain axis have led to an interest in mind–body therapies (MBT). The aim of this article is, therefore, to reinforce the importance of psychodermatological care in AD. We performed a focused literature review on holistic practices or integrative MBT in AD, including education, cognitive behavioral therapy, habit reversal, meditation, mindfulness, hypnotherapy, eye movement desensitization and reprocessing, biofeedback, progressive muscle relaxation, autonomous sensory meridian response, music therapy, massage, and touch therapy. A multidisciplinary holistic approach with MBT, in addition to conventional pharmacologic antipruritic therapies, to break the itch–scratch cycle may improve AD outcomes and psychological well-being. Although there is a paucity of rigorously designed trials, evidence shows the potential benefits of an integrative approach on pruritus, pain, psychological stress, anxiety, depressive symptoms, and sleep quality. Relaxation and various behavioral interventions, such as habit reversal therapy for replacing harmful scratching with massaging with emollient ‘plus’, may reduce the urge to scratch, while education may improve adherence to conventional therapies. Full article
(This article belongs to the Special Issue Pruritus and Psyche: An Update on Clinical Management)
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