{"title":"Habitual Scratching in Atopic Dermatitis and Its Association with Disease Severity: Findings from Japanese Health Insurance Claims and App-Based Data.","authors":"Takeshi Nakahara, Shinichi Noto, Miyuki Matsukawa, Yasuhito Konishi, Rikiya Toda, Daisaku Michikami, Hiroyuki Murota","doi":"10.1007/s13555-025-01525-9","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>In atopic dermatitis (AD), scratching sustains inflammation and impairs the skin barrier. Beyond scratching driven by itch, affected individuals may engage in habitual scratching, defined as repetitive, unconscious scratching that occurs without itch. The extent and clinical significance of habitual scratching in Japanese patients remain unclear. This study aimed to assess the frequency of habitual scratching and its association with AD severity in the Japanese population.</p><p><strong>Methods: </strong>This cross-sectional study was conducted in Japan using data from anonymized health insurance claims and a nationwide app-based questionnaire administered in October 2022. Included individuals were adults (aged 19-74 years) and children (aged ≤ 18 years) with a self-reported diagnosis of AD and either symptoms or treatment within the previous 6 months. Habitual scratching was assessed using two yes/no questions. Disease severity was measured using the Patient-Oriented Eczema Measure (POEM), and associations were tested using the Cochran-Armitage trend test.</p><p><strong>Results: </strong>A total of 1507 adults and 525 children were included. Among adults, 44.5% reported scratching without feeling itchy, and 30.0% reported only noticing scratching when it was pointed out; among children, these proportions were 57.5% and 53.3%, respectively. The proportion of patients exhibiting both behaviors increased significantly with POEM severity. For scratching without itch, rates ranged from 35.1% to 62.9% in adults and from 44.5% to 82.6% in children (p < 0.001 for both). For unnoticed scratching, rates ranged from 19.0% to 50.3% in adults and from 41.2% to 69.6% in children (p < 0.001 for both).</p><p><strong>Conclusions: </strong>Habitual scratching was commonly reported across all severity levels of AD in Japan and was associated with greater disease severity. These findings highlight the importance of recognizing/noticing and actively managing unconscious scratching behaviors as part of comprehensive AD care.</p>","PeriodicalId":11186,"journal":{"name":"Dermatology and Therapy","volume":" ","pages":""},"PeriodicalIF":4.2000,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Dermatology and Therapy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s13555-025-01525-9","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"DERMATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: In atopic dermatitis (AD), scratching sustains inflammation and impairs the skin barrier. Beyond scratching driven by itch, affected individuals may engage in habitual scratching, defined as repetitive, unconscious scratching that occurs without itch. The extent and clinical significance of habitual scratching in Japanese patients remain unclear. This study aimed to assess the frequency of habitual scratching and its association with AD severity in the Japanese population.
Methods: This cross-sectional study was conducted in Japan using data from anonymized health insurance claims and a nationwide app-based questionnaire administered in October 2022. Included individuals were adults (aged 19-74 years) and children (aged ≤ 18 years) with a self-reported diagnosis of AD and either symptoms or treatment within the previous 6 months. Habitual scratching was assessed using two yes/no questions. Disease severity was measured using the Patient-Oriented Eczema Measure (POEM), and associations were tested using the Cochran-Armitage trend test.
Results: A total of 1507 adults and 525 children were included. Among adults, 44.5% reported scratching without feeling itchy, and 30.0% reported only noticing scratching when it was pointed out; among children, these proportions were 57.5% and 53.3%, respectively. The proportion of patients exhibiting both behaviors increased significantly with POEM severity. For scratching without itch, rates ranged from 35.1% to 62.9% in adults and from 44.5% to 82.6% in children (p < 0.001 for both). For unnoticed scratching, rates ranged from 19.0% to 50.3% in adults and from 41.2% to 69.6% in children (p < 0.001 for both).
Conclusions: Habitual scratching was commonly reported across all severity levels of AD in Japan and was associated with greater disease severity. These findings highlight the importance of recognizing/noticing and actively managing unconscious scratching behaviors as part of comprehensive AD care.
期刊介绍:
Dermatology and Therapy is an international, open access, peer-reviewed, rapid publication journal (peer review in 2 weeks, published 3–4 weeks from acceptance). The journal is dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of dermatological therapies. Studies relating to diagnosis, pharmacoeconomics, public health and epidemiology, quality of life, and patient care, management, and education are also encouraged.
Areas of focus include, but are not limited to all clinical aspects of dermatology, such as skin pharmacology; skin development and aging; prevention, diagnosis, and management of skin disorders and melanomas; research into dermal structures and pathology; and all areas of aesthetic dermatology, including skin maintenance, dermatological surgery, and lasers.
The journal is of interest to a broad audience of pharmaceutical and healthcare professionals and publishes original research, reviews, case reports/case series, trial protocols, and short communications. Dermatology and Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an International and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of quality research, which may be considered of insufficient interest by other journals. The journal appeals to a global audience and receives submissions from all over the world.