Longitudinal Association Between Polypharmacy and Development of Pruritus Journal of the European Academy of Dermatology and Venereology: JEADV

TAKE-HOME MESSAGE

• In this cohort study, 332 of 3126 patients had polypharmacy or use of ≥5 prescription medications. Patients with polypharmacy were more likely to have severe pruritus at baseline than those not using drugs. Patients with polypharmacy were also more likely to develop severe pruritus at 1 year follow-up compared with those not using drugs.

• Polypharmacy was associated with an increased risk of developing severe pruritus compared with those taking no medications.

–  Kelly B. Scarberry, MD

Written by

 

 

Ashish C. Bhatia MD, FAAD

Written by

 

 

Eliot N. Mostow MD, MPH

Written by

 

 

Robert T. Brodell MD, FAAD

There is little doubt that this study from Japan is generalizable to other countries, including the USA.  This is a great article to share with primary care colleagues, at conferences since they manage many of our patients medications. Of course, there are limitations to this study. Potential confounders include potential for additional medical problems being treated with medications (diabetes, thyroid disease, polycythemia, hepatic and renal disease) representing the true underlying cause of pruritus.  In addition, this data was obtained from a survey of patients rather than medical records.  Still, medications are an important cause of pruritus.  While difficult to pinpoint and often a time consuming process, efforts to eliminate non-essential meds and substitute essential meds with other drugs can lead to prompt resolution of pruritus in many patients. . 

Abstract

BACKGROUND

Although polypharmacy is known to cause side-effects due to drug-drug interactions, dermatological symptoms triggered by polypharmacy are not fully addressed.

OBJECTIVE

To investigate whether polypharmacy is associated with the risk of pruritus.

METHOD

A cohort study was performed to examine cross-sectional and longitudinal relationships between polypharmacy and pruritus in a general population. Data were collected from the Norm Study conducted in 2016 and 2017, which is a nationwide survey based on a self-administered questionnaire with Japanese representative participants aged 16-84 years. Presence of polypharmacy which was defined as concurrent use of ≥5 prescribed drugs. Primary outcomes were the presence of severe pruritus at baseline for the cross-sectional analysis and the development of severe pruritus after one year for the longitudinal analysis. Multivariable modified Poisson regression analyses were performed to estimate risk ratios (RRs) and 95% confidence intervals (95%CIs) with adjustment for potential confounders (age, gender, smoking habits, drinking habits, depressive symptoms, moderate activities based on IPAQ score and presence of 11 comorbid conditions including skin disease).

RESULTS

The study included 3126 participants (mean age, 48.7 years); nearly half (49.8%) were male. In all, 332 participants (10.3%) had polypharmacy in the cross-sectional analysis. Participants with polypharmacy were more likely to present with severe pruritus at baseline than those who were not using drugs (adjusted RR = 1.52 [95%CI 1.15-2.01, P = 0.003]). The longitudinal analysis (n = 1803) was limited to those without severe pruritus at baseline; participants with polypharmacy at baseline were more likely to develop severe pruritus after a one-year follow-up period than those not using drugs (adjusted RR = 1.46 [95%CI 1.14-1.87, P = 0.002]).

CONCLUSION

Polypharmacy was associated with the presence of pruritus at baseline and may predict the future risk of developing pruritus.

Journal of the European Academy of Dermatology and Venereology: JEADV

Longitudinal Association Between Polypharmacy and Development of Pruritus: A Nationwide Cohort Study in a Japanese Population

J Eur Acad Dermatol Venereol 2021 Jun 02;[EPub Ahead of Print], T Kogame, T Kamitani, H Yamazaki, Y Ogawa, S Fukuhara, K Kabashima, Y Yamamoto 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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