Itch is a major symptom of skin disease and remains poorly studied. We have used limb worn digital accelerometers, and infrared videoing of subjects as a gold standard, on children with atopic dermatitis and control children in their own homes at night. Video analysis shows that nocturnal scratching and restlessness are more complex than we first thought, with many movements that potentially damage the skin not conforming to stereotypical scratch movements.
Children with atopic dermatitis spent a mean of 46 minutes less time motionless or sleeping at night than controls (468± 3 (SEM) versus 422± 37 (SEM), p<0.001). Atopics showed 2-3 times as much scratching or restlessness activity as controls, with little overlap between groups (p<0.01). Scratching and restlessness were highly correlated with each other (0.94, p<0.01). Individual limb scores were highly correlated with each other (0.87 - 0.98) suggesting that little information would be lost if only one limb were measured.
There was little relation between parental assessment of scratch and objective measured scratch. Accelerometers provide a valid and practical way of assessing scratching at night in the patients own home and should be utilised as an objective measure of disease activity in clinical trials for atopic dermatitis and other pruritic conditions.
Benjamin K, Waterston K, Russell M, Schofield O, Diffey BL, Rees JL. The development of an objective method for measuring scratch in children with atopic dermatitis suitable for clinical use. Journal of the American Academy of Dermatology 2004; 50: 33-40.
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