Predictors of malignancy development in patients with chronic pruritus

J Dermatol Sci. 2016 May;82(2):123-8. doi: 10.1016/j.jdermsci.2016.01.010. Epub 2016 Jan 28.

Abstract

Background: Patients with pruritus have been shown to have an increased incidence of certain subtypes of malignancy.

Objective: To assess predictors of malignancy in patients with chronic pruritus without prior dermatologic diagnoses.

Methods: Case-control study of 398 patients with chronic pruritus who developed a malignancy were compared with 8346 patients with chronic pruritus who did not develop a malignancy. Primary outcomes were odds of developing incident malignancy.

Results: Age greater than 60 years (OR 4.04, 95% CI 3.08, 5.31), male sex (OR 1.39, 95% CI 1.13, 1.71) and liver disease (OR 2.37, 95% CI 1.00, 5.65) were predictors of malignancy development in patients with chronic pruritus and non-diseased skin. In an exploratory analysis with multiple imputation via chained equations, age greater than 60 years (OR 4.13, 95% CI 3.15, 5.42), male sex (OR 1.26, 95% CI 1.02, 1.55), and current or prior smoking (OR 2.02, 95% CI 1.42, 2.88) were predictors of malignancy development in patients with chronic pruritus and non-diseased skin.

Limitations: Potential for misclassification and detection biases. Missing data.

Conclusions and relevance: In patients with chronic pruritus without concomitant dermatologic diagnoses, older age, male sex, liver disease and tobacco abuse increase the odds of an underlying malignancy.

Keywords: Itch; Malignancy risk factors; Medical dermatology; Pruritus; Pruritus as a sign of systemic disease; Screening for malignancy.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Case-Control Studies
  • Chronic Disease
  • Cohort Studies
  • Early Detection of Cancer
  • Female
  • Humans
  • Incidence
  • Liver Diseases / complications
  • Male
  • Middle Aged
  • Models, Biological
  • Neoplasms / epidemiology*
  • Neoplasms / etiology
  • Pruritus / complications*
  • Risk Assessment
  • Sex Factors
  • Smoking / adverse effects
  • United Kingdom / epidemiology