Pruritus in patients with adverse events of anticancer therapy: relationships with anxiety and depression compared with dermatoses and skin neoplasms and preventive care tactics

Background: Chronic pruritus is a common symptom in dermatology and is often associated with anxiety and depression. The relationship between pruritus and psychological disorders, particularly in patients with dermatoses, melanocytic skin neoplasms, and cutaneous toxic reactions, is poorly understood. Understanding this relationship is important for improving patient care and quality of life.

Objective: Assessment of the prevalence of anxiety and depression symptoms in patients with dermatoses, melanocytic skin neoplasms, and cutaneous toxic reactions and analysis of their relationship with pruritus.

Methods: A cross-sectional, observational, controlled study was conducted in patients with pruritic and non-pruritic dermatoses and melanocytic skin neoplasms. The frequency of pruritus and its relationship with anxiety and depression were assessed. No medical interventions were performed. The study was conducted from February 2021 to January 2025. The primary endpoint of this study was a comparative assessment of the intensity of itching and the level of anxiety-depressive disorders in patients with various dermatological and oncological skin diseases. Itching intensity was assessed using the NRS (0-10 points), GAD-2 (anxiety), PHQ-2 (depression), and PHQ-4 (anxiety and depression).

Results: The main group included patients with itchy (atopic dermatitis, n=106) and non-itchy (psoriasis, n=101, acne, n=104) dermatoses; benign and malignant melanocytic neoplasms (melaniform nevi, n=105, melanoma, n=88); skin toxic reactions associated with antitumor therapy (STR, n=93); the control group included 216 healthy volunteers. Patients with chronic inflammatory dermatoses more often reported suicidal ideation. According to the intergroup comparison, the mean total GAD-2 anxiety and PHQ-2 depression scores differed significantly (p<0.0001). Screening scores for anxiety were highest in patients with acne and atopic dermatitis. Depression was most common in patients with chronic itchy rashes (atopic dermatitis) and lesions of visible skin areas (acne). A significant positive correlation was shown between the intensity of itching and the total PHQ-4 score. Current approaches to the prevention of dermatological adverse events of antitumor therapy are presented.

Conclusion: The study demonstrated a strong association between pruritus and psychological disorders in dermatology patients. These disorders are associated with high levels of anxiety, depression, and suicidal ideation, highlighting the need for a comprehensive approach to patient treatment. An algorithm for preventive dermatological care, taking into account the nature and severity of rashes, is presented. This algorithm forms the basis for dermatological supportive therapy for patients with skin toxic reactions.