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

Michenko A.V., Lvov A.N., Kruglova L.S., Golova A.Yu., Allenova A.S., Romanov D.V.

1) Central State Medical Academy of the Administrative Directorate of the President of the Russian Federation, Moscow, Russia; 2) Medical Research and Educational Center, Lomonosov Moscow State University, Moscow, Russia; 3) International Institute of Psychosomatic Health, Moscow, Russia; 4) Institute of Plastic Surgery and Cosmetology, Moscow, Russia; 5) I.M. Sechenov First Moscow State Medical University, Moscow, Russia; 6) Mental Health Research Center, Moscow, Russia

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.

For citations: Michenko A.V., Lvov A.N., Kruglova L.S., Golova A.Yu., Allenova A.S., Romanov D.V. Pruritus in patients with adverse events of anticancer therapy: relationships with anxiety and depression compared with dermatoses and skin neoplasms and preventive care tactics. Pharmateca. 2025;32(9):158-168. (In Russ.). DOI: https://dx.doi.org/10.18565/pharmateca.2025.9.158-168

Authors’ contribution: A.V. Michenko, A.N. Lvov, L.S. Kruglova, E.A. Kuzma, D.S. Vorobyeva, A.Yu. Golova, and D.V. Romanov – dermatological consultation and psychometric examination of the patient, collection and analysis of literature sources, writing and editing the article.
All authors confirm that their authorship complies with the international ICMJE criteria (all authors made a significant contribution to the development of the concept, conduct of the study, and preparation of the article, and read and approved the final version before publication).
Conflicts of interest: The authors confirm that they have no conflicts of interest to declare.
Funding: This study was not supported by any external sources of funding.
Ethical Approval: The study was approved by the local ethics committee of the Central State Medical Academy of the Administrative Directorate of the President of the Russian Federation (minutes of the local ethics committee meeting dated February 4, 2021).
Patient Consent for Publication: All patients provided informed consent for the publication of their data.
Authors’ Data Sharing Statement: The data supporting the findings of this study are available upon request from the corresponding author after approval from the principal investigator.

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About the Authors

Anna V. Michenko, Cand. Sci. (Med.), Sssociate Professor, Department of Dermatovenereology and Cosmetology, Central State Medical Academy of the Administrative Directorate of the President of the Russian Federation; Dermatovenereologist, Medical Research and Educational Center, Lomonosov Moscow State University; Dermatovenereologist, International Institute of Psychosomatic Health; Dermatovenereologist, Institute of Plastic Surgery and Cosmetology, Moscow, Russia; amichenko@mail.ru, ORCID: https://orcid.org/0000-0002-2985-5729, SPIN: 8375-4620 (corresponding author)
Andrey N. Lvov, Dr. Sci. (Med.), Professor, Head of the Department of Postgraduate Studies and Residency, Professor of the Department of Dermatovenereology and Cosmetology, Central State Medical Academy of the Administrative Directorate of the President of the Russian Federation; Chief Researcher, Medical Research and Education Center, Lomonosov Moscow State University, Moscow, Russia; alvov@mail.ru, ORCID: https://orcid.org/0000-0002-3875-4030, SPIN: 1053-3290
Larisa S. Kruglova, Dr. Sci. (Med.), Professor, Head of the Department of Dermatovenereology and Cosmetology, Rector, Central State Medical Academy of the Administrative Directorate of the President of the Russian Federation, Moscow, Russia; kruglovals@mail.ru, ORCID: https://orcid.org/0000-0002-5044-5265, SPIN: 1107-4372
Anastasia Yu. Golova, Resident Physician, Department of Dermatovenereology and Cosmetology, Central State Medical Academy of the Administrative Directorate of the President of the Russian Federation, Moscow, Russia; nastya75796@mail.ru, ORCID: https://orcid.org/0009-0004-1914-2110, SPIN: 4990-4574
Anastasia S. Allenova, Cand. Sci. (Med.), Senior Researcher, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; allenova_a_s@staff.sechenov.ru, ORCID: https://orcid.org/0000-0003-0751-0073, SPIN: 7765-7631
Dmitry V. Romanov, Dr. Sci. (Med.), Professor, Department of Psychiatry and Psychosomatics, ICM, I.M. Sechenov First Moscow State Medical University (Sechenov University); Leading Researcher, Department for the Study of Borderline Mental Pathology and Psychosomatic Disorders, Scientific Center for Mental Health, Moscow, Russia; newt777@mail.ru, ORCID: https://orcid.org/0000-0002-1822-8973, SPIN: 2412-9077, Scopus Author ID: 25650916200

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