1. Impact of Acute Stress on Itch Sensation and Scratching Behavior in Atopic Dermatitis Patients and Healthy Controls
H. Mochizuki1, 2, M. J. Lavery2, L. A. Nattkemper1, C. Albornoz2, R. Valdes Rodriguez2, C. Stull2, L. Weaver2, J. Hamsher2, K. M. Sanders1, Y.H. Chan3, G. Yosipovitch1.
1Miami Itch Center and Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
2Department of Dermatology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
3Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
British Journal of Dermatology. DOI: /bjd.16921

2. Lead researcher: Hideki Mochizuki Ph.D.

3. Introduction What’s already known?
An imbalance of immune function is associated with stress- induced exacerbation of itch in atopic dermatitis (AD) patients.
No study has investigated if and how acute stress influences itch sensation and scratching behavior in AD patients.

4. Objective
We evaluated the impact of acute stress on experimentally- induced itch and scratching behavior in 16 healthy subjects and 15 AD patients.

5. Methods
The Trier Social Stress Test (TSST) was used to induce acute stress.
The itch sensation, provoked by applying cowhage to the forearms, and off-site scratching behavior (not directed at the cowhage application site) were compared before and after performing TSST or the control condition (watching a video of landscape scenes).

6. TSST-induced change of
Results (1)
TSST induced acute stress in both groups
AD patients who were more sensitive to stress also had higher eczema severity. * * * *
r = 0.57
(p = 0.025)
Task induced change
of NRS rating of stress
EASI score
: p <
TSST Control
TSST Control
TSST-induced change of
NRS rating of stress
Patients
Healthy

7. Results (2)
AD patients reported less itch from cowhage and less urge to scratch when they had been stressed by the TSST.
(a) Itch intensity
(b) Urge to scratch
Time course of VAS rating
Time (min)
Significant difference
AD TSST ( ) vs. AD control ( ), p <
vs. Healthy TSST ( ), p <
vs. Healthy control ( ), p <
Significant difference
AD TSST ( ) vs. AD control ( ), p <
vs. Healthy TSST ( ), p <
vs. Healthy control ( ), p <

8. Results (3)
Despite reporting less itch, AD patients actually scratched their limbs significantly more when they were stressed.

9. Discussion
This study shows that acute stress can affect itch and scratching differently in AD patients compared to healthy individuals.
Stress led to more scratching in those with atopic dermatitis.
Over time, this response to stress could lead to increased skin damage from scratching and therefore worsen eczema and itch.

10. Conclusions What does this study add?
Acute stress increases spontaneous scratching behavior in AD patients.
Acute stress reduces itch sensation in AD patients.
AD patients who are more sensitive to acute stress display more severe skin eczema.

11. Research team of the study
Hideki Mochizuki
Michael Lavery
Leigh A. Nattkemper
Christian Albornoz
Rodrigo Valdes Rodriguez
Joshua Hamsher
Kristen M. Sanders
Chan Yiong Huak
Gil Yosipovitch
Carolyn Stull
Leslie Weaver
Acknowledgement
This study was funded by
the National Eczema Association

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