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Erfassung von Pruritus – aktuelle Standards und Implikationen für die Praxis

Konsensuspaper der Initiative Pruritusparameter der Arbeitsgemeinschaft Pruritusforschung (AGP)

Assessment of pruritus – current standards and implications for clinical practice

Consensus paper of the Action Group Pruritus Parameter of the International Working Group on Pruritus Research (AGP)

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An Erratum to this article was published on 08 September 2012

Zusammenfassung

Mit einer Prävalenz von ca. 20% ist chronischer Pruritus als Symptom vieler Erkrankungen von erheblicher gesundheitsökonomischer Relevanz. Der Mangel an spezifischen Therapien macht die Entwicklung neuer Substanzen und deren Überprüfung in klinischen Studien dringend notwendig. Die objektive Messung der Empfindung Pruritus ist derzeit noch nicht möglich. Aus diesem Grund soll Pruritus anhand eines standardisierten Sets an verschiedenen Instrumenten erfasst werden. Die Intensitätsskalen wie die Visuelle Analog Skala (VAS) werden zur Verlaufsdokumentation am häufigsten genutzt. Zur Erfassung der Pruritusintensität ist die VAS kein optimales, aber bisher noch unverzichtbares Instrument. Die VAS sollten in klinischen Studien in Kombination mit weiteren Skalen verwendet werden, um die Daten intern auf Konsistenz prüfen zu können. Weitere Instrumente zur Intensitäts- und Verlaufsdokumentation sind in Entwicklung. Die Kratzaktivität und kratzassoziierte Läsionen können derzeit hauptsächlich deskriptiv in der Praxis erfasst werden. In Studien wurden Geräte zur Erfassung der Kratzaktivität eingesetzt, allerdings fehlen derzeit noch methodische Studien. Der Patienten-Benefit-Index ist ein unverzichtbares Tool in klinischen Studien. Ein Fragebogen zur Erfassung der Anamnese und einiger pruritusspezifischer Parameter ist bereits entwickelt und publiziert. Fragebögen, die die Lebensqualität, Angst und Depression erfassen, dienen dazu, weitere ökonomisch relevante Parameter der Patienten zu erfassen. Die Erfassung der Lebensqualität liefert z. B. wichtige Hinweise zur Einschätzung des individuellen Leidensdrucks. Die Ergebnisse dieser Fragebögen können mit den Daten der Pruritusintensitätsskalen korreliert werden. Die relevanten Fragebögen können z. T. bereits digital erfasst werden und stehen somit unmittelbar bei der Patientenversorgung zur Verfügung. Weitere methodische Entwicklungen und Studien sind notwendig, um ein robustes Set an Messinstrumenten zur Erhebung von Pruritus in der Praxis und in klinischen Studien zu definieren.

Abstract

With a prevalence of 20%, chronic pruritus is a symptom of many diseases with major impact on healthcare costs. The lack of specific therapeutic measures makes the development of new drugs and their testing in clinical trials urgent. It is not possible to measure pruritus in an objective way. For these reasons, it is necessary to have a series of standardized measures to characterize pruritus in a reliable way. Intensity scales such as the visual analog scale (VAS) are most frequently used to document the course of the symptoms. However, for assessing pruritus intensity, VAS is not an optimal instrument, although it cannot be dispensed with. The VAS should be combined with other scales in clinical studies in order to internally test the consistency of data. Other instruments for assessing intensity and course of pruritus are in the process of development. Presently scratch activity and scratch-associated lesions can be documented in a descriptive fashion. There are some studies that have employed devices to document scratch activity; however, methodological studies are not yet available. The patient-benefit index is an indispensable tool in clinical trials. A questionnaire for gathering data on the history and some pruritus-specific parameters has been developed and published. Questionnaires on patient quality of life, anxiety and depression are helpful in obtaining data on other cost-relevant parameters. A questionnaire on the quality of life, for instance, can provide important help in the assessment of the burden of the disease. The results of these questionnaires can be correlated with data on pruritus intensity scales. The relevant questionnaires have been partially digitalized so that they are available immediately as part of patient care. Additional methodological developments and studies are required in order to define a robust set of instruments for measuring pruritus in daily practice and in clinical studies.

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Authors and Affiliations

  1. Klinik für Hautkrankheiten und Kompetenzzentrum Chronischer Pruritus (KCP), Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland

    S. Ständer, N.Q. Phan & S. Steinke

  2. Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen, Universitätsklinikum Hamburg-Eppendorf, Hamburg-Eppendorf, Deutschland

    C. Blome & M. Augustin

  3. Institut für Medizinische Informatik, Universitätsklinikum Münster, Münster, Deutschland

    B. Breil, P. Bruland, M. Dugas & F. Fritz

  4. Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, ZAUM Zentrum für Allergie und Umwelt, Technische Universität München, München, Deutschland

    U. Darsow

  5. Department of Medical Psychology, Radboud University Nijmegen, Medical Centre, Nijmegen, Niederlande

    A. Evers

  6. Klinik für Dermatologie, Venerologie und Allergologie, Allergie-Centrum-Charité, Charité – Universitätsmedizin Berlin, Berlin, Deutschland

    M. Metz

  7. Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover, Hannover, Deutschland

    U. Raap

  8. Department of Dermatology, University of Medicine, Wroclaw, Polen

    A. Reich & J. Szepietowski

  9. Klinik für Psychosomatik und Psychotherapie, Universitätsklinikum Münster, Münster, Deutschland

    G. Schneider

  10. Abt. Klinische Sozialmedizin, Schwerpunkt: Berufs- und Umweltdermatologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    E. Weisshaar

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  1. S. Ständer
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Correspondence to S. Ständer.

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___Teilnehmer der Initiative Pruritusparameter der AGP___

M. Augustin, Hamburg, C. Blome, Hamburg, U. Darsow, München, M. Dugas, Münster, A. Evers, Nijmegen, C. Foster, Erlangen, R. Fölster-Holst, Kiel, F. Fritz, Münster, U. Gieler, Gießen, A. Kremer, Erlangen, U. Matterne, Heidelberg, T. Mettang, Wiesbaden, M. Metz, Berlin, G. Neufang, Hamburg, N.Q. Phan, Münster, U. Raap, Hannover, A. Reich, Wroclaw, G. Schneider, Münster, S. Steinke, Münster, S. Ständer, Münster, P. Staubach-Renz, Mainz, E. Weisshaar, Heidelberg.

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Ständer, S., Blome, C., Breil, B. et al. Erfassung von Pruritus – aktuelle Standards und Implikationen für die Praxis. Hautarzt 63, 521–531 (2012). https://doi.org/10.1007/s00105-011-2318-3

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