TY - JOUR
T1 - Five-year malignancy incidence in patients with chronic pruritus
T2 - A population-based cohort study aimed at limiting unnecessary screening practices
AU - Fett, Nicole
AU - Haynes, Kevin
AU - Propert, Kathleen Joy
AU - Margolis, David J.
PY - 2014/4
Y1 - 2014/4
N2 - Background: The incidence of malignancy in patients with chronic pruritus and nondiseased skin is unknown. Objective: We sought to assess the hazard ratio (HR) of incident overall malignancy and incident malignancy by subtype in patients with chronic pruritus during the 5 years after diagnosis. Methods: A population-based cohort study was performed in the Health Improvement Network. In all, 8744 patients with chronic pruritus were matched with 31,580 patients without chronic pruritus based on sex, age, and practice. Primary outcomes were HR of incident malignancy and HR of malignancy subtypes. Results: The fully adjusted HR for incident malignancy in patients with chronic pruritus was 1.14 (95% confidence interval 0.98-1.33). The fully adjusted HR for incident hematologic malignancy and incident bile duct malignancy in patients with chronic pruritus was 2.02 (95% confidence interval 1.48-2.75) and 3.73 (95% confidence interval 1.55-8.97), respectively. The incidence of hematologic malignancy and cholangiocarcinoma in patients with chronic pruritus was 0.0016 and 0.0003 per person-year, respectively. Limitations: Potential for misclassification and detection biases is a limitation. Conclusions: Chronic pruritus without concomitant skin changes is a risk factor for having undiagnosed hematologic and bile duct malignancies, but not other malignancies. The overall incidence of these malignancies in patients with chronic pruritus is very low.
AB - Background: The incidence of malignancy in patients with chronic pruritus and nondiseased skin is unknown. Objective: We sought to assess the hazard ratio (HR) of incident overall malignancy and incident malignancy by subtype in patients with chronic pruritus during the 5 years after diagnosis. Methods: A population-based cohort study was performed in the Health Improvement Network. In all, 8744 patients with chronic pruritus were matched with 31,580 patients without chronic pruritus based on sex, age, and practice. Primary outcomes were HR of incident malignancy and HR of malignancy subtypes. Results: The fully adjusted HR for incident malignancy in patients with chronic pruritus was 1.14 (95% confidence interval 0.98-1.33). The fully adjusted HR for incident hematologic malignancy and incident bile duct malignancy in patients with chronic pruritus was 2.02 (95% confidence interval 1.48-2.75) and 3.73 (95% confidence interval 1.55-8.97), respectively. The incidence of hematologic malignancy and cholangiocarcinoma in patients with chronic pruritus was 0.0016 and 0.0003 per person-year, respectively. Limitations: Potential for misclassification and detection biases is a limitation. Conclusions: Chronic pruritus without concomitant skin changes is a risk factor for having undiagnosed hematologic and bile duct malignancies, but not other malignancies. The overall incidence of these malignancies in patients with chronic pruritus is very low.
KW - chronic pruritus
KW - generalized pruritus
KW - itch
KW - paraneoplastic signs
KW - pruritus
KW - skin signs of systemic disease
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U2 - 10.1016/j.jaad.2013.11.045
DO - 10.1016/j.jaad.2013.11.045
M3 - Article
C2 - 24485529
AN - SCOPUS:84896097618
SN - 0190-9622
VL - 70
SP - 651
EP - 658
JO - Journal of the American Academy of Dermatology
JF - Journal of the American Academy of Dermatology
IS - 4
ER -