Evaluation of Itch Intensity Scales in Atopic Dermatitis: Differential Measurement Properties and Associations with Relevant Cytokines

Witte F, Wiegmann H, Teitge E et al. J Invest Dermatol. 2026 Apr 20:S0022-202X(26)01046-8. doi: 10.1016/j.jid.2026.04.005.

Abstract

Improvement and comparison of itch intensity scales.
Worst itch intensity scales demonstrated significant improvement in itch after dupilumab
therapy in ADpatients (left: initial assessment/IA, right: follow up/FU, respectively).
The worst itch numerical rating scale/24h and visual analogue scale/4 weeks
reached significantly higher ratings than the visual analogue scale/24h at IA and FU.

Itch is the cardinal symptom contributing to patient burden in atopic dermatitis (AD). Multiple validated itch scales are used in clinical trials, generating heterogeneous data sets. In addition, recent studies suggest an association between cytokine levels and disease severity in AD. This study aimed to compare the performance of different validated itch instruments and their relationship to blood cytokine profiles. 49 adults with severe AD and severe itch were treated with dupilumab 300mg for 16 weeks. At initial assessment and after treatment, itch intensity and quality of life were evaluated using various assessment tools.

Peripheral blood samples were collected at both time points for cytokine profiling. All itch intensity scales demonstrated comparable responsiveness, irrespective of their dimension; however, the numerical rating scale consistently yielded higher scores than the visual analogue scale. MDC, CCL26, BAFF and IL-2R levels were significantly reduced following treatment and correlated with all (MDC, BAFF) or subsets (CCL26, IL-2R) of itch intensity and quality of life scores. In conclusion, all validated itch intensity scales are suitable for routine clinical use; however, adhering to one instrument is recommended. The observed correlations between cytokine levels and itch scales suggest their potential as new markers of disease burden in AD.

PDF