Chronic Pruritus as a Psychosomatic Phenomenon in Primary Cutaneous T-cell Lymphomas
D. E. Vybornykh,
L. G. Gorenkova,
D. V. Romanov,
L. V. Esina,
A. V. Michenko,
Y. A. Chabaeva,
S. M. Kulikov https://doi.org/10.35754/0234-5730-2026-71-1-60-74
Abstract
Introduction. Chronic pruritus (CP) is one of the symptoms of cutaneous T-cell lymphomas (CTCL), which significantly reduces the quality of life of patients.
Aim: to identify the factors associated with CP and describe the phenotypes of CP in patients with CTCL to determine the factors associated with CP and describe the phenotypes of CP in patients with CTCL.
Material and Methods. A total of 58 CTCL patients were examined. The assessment included psychiatric evaluation according to ICD-10 and psychometric instruments: the Eppendorf Itch Questionnaire, Beck Anxiety and Depression Inventories, Toronto Alexithymia Scale (TAS-26), and Symptom Checklist-90-R (SCL-90-R).
Results. CP was found in 84.5 % of patients. CP severity correlated with lymphoma stage and depressive symptoms (p < 0.05). Psychiatric disorders were diagnosed in 39.7 %, mainly affective and cognitive. Gender, age, and education had no effect on itch occurrence, whereas longer disease duration was observed in patients without CP. In 58.8 % of cases, CP was accompanied by pleasure during scratching, indicating ambivalent affective regulation. One-third of patients exhibited formication phenomena, and almost half showed social phobia associated with shame and self-stigmatization due to visible skin lesions.
Conclusion. CP in CTCL patients is a dermatological and psychoneuroimmune phenomenon Treatment should include psychiatric evaluation, correction of depression and anxiety, and psychotherapeutic support.
About the Authors
D. E. Vybornykh
National Medical Research Center of Hematology
Russian Federation
Russian Federation
Dmitry E. Vybornykh, Dr. Sci. (Med.) Head of the Laboratory for the Study of Mental and Neurological Disorders in Diseases of the Blood System
125167, Moscow
L. G. Gorenkova
National Medical Research Center of Hematology
Russian Federation
Russian Federation
Liliya G Gorenkova, Cand. Sci. (Med.), Head of the Department of Hematology and Chemotherapy of Acute Leukemia and Lymphoma with the Bone Marrow and Hematopoietic Stem Cell Transplantation Unit
125167, Moscow
D. V. Romanov
Scientific Center for Mental Health (NCMH) ; I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Dmitry V. Romanov, Dr. Sci. (Med.) Associate Professor, Head of the Department of Clinical Epidemiology; Professor of the Department of Psychiatry, Psychotherapy and Psychosomatics, ICM
115522, Moscow
119991, Moscow
L. V. Esina
National Medical Research Center of Hematology ; I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Liubov V. Esina, medical psychologist of the Laboratory for the Study of Mental and Neurological Disorders in Diseases of the Blood System; assistant of the Department of Pedagogy and Medical Psychology
125167, Moscow
119991, Moscow
A. V. Michenko
Central State Medical Academy of the Administrative Department of the President of the Russian Federation ; Medical Scientific and Educational Center of Moscow State University named after M.V. Lomonosov ; International Institute of Psychosomatic Health ; Institute of Plastic Surgery and Cosmetology
Russian Federation
Russian Federation
Anna V. Michenko, Cand. Sci. (Med.), Associate Professor of the Department of Dermatovenereology and Cosmetology; dermatovenereologist
121359, Moscow
119192, Moscow
107031, Moscow
105066, Moscow
Y. A. Chabaeva
National Medical Research Center of Hematology
Russian Federation
Russian Federation
Yulia A. Chabaeva, Cand. Sci. (Tech), Deputy Head of the Informational Analytical Department
125167, Moscow
S. M. Kulikov
National Medical Research Center of Hematology
Russian Federation
Russian Federation
Sergey M. Kulikov, Cand. Sci. (Tech.), Head of the Informational Analytical Department
125167, Moscow
References
1. Rowe B., Yosipovitch G. Malignancy-associated pruritus. Eur J Pain. 2016;20(1):19–23. DOI: 10.1002/ejp.760.
2. Sheahan T.D., Warwick C.A., Cui A.Y., et al. Kappa opioids inhibit spinal output neurons to suppress itch. Sci Adv. 2024;10(39):eadp6038. DOI: 10.1126/sciadv.adp6038.
3. Hashimoto T., Okuno S. Practical guide for the diagnosis and treatment of localized and generalized cutaneous pruritus (chronic itch with no underlying pruritic dermatosis). J Dermatol. 2025;52(2):204–20. DOI: 10.1111/1346-8138.17565.
4. Coscarella G., Edwards E., Yosipovitch G. Basic mechanisms of itch and advances in clinical management. Ann Allergy Asthma Immunol. 2026;136(2):131–40. DOI: 10.1016/j.anai.2025.09.014.
5. Criado P.R., Jardim Criado R.F., Ianhez M., Miot H.A. Chronic pruritus: a narrative review. An Bras Dermatol. 2025;100(3):487–19. DOI: 10.1016/j.abd.2024.09.008.
6. Kovalenko Yu.A., Kruglova L.S., Shatokhina E.A. Modern concepts of the mechanisms of development and pharmacotherapy of pruritus. Klinicheskaya dermatologiya i venerologiya. 2021;20(1):90–6 (In Russian). DOI: 10.17116/klinderma20212001190.
7. Mahmoud O., Oladipo O., Mahmoud R.H., Yosipovitch G. Itch: from the skin to the brain — peripheral and central neural sensitization in chronic itch. Front Molecular Neurosci. 2023;16:1272230. DOI: 10.3389/fnmol.2023.1272230.
8. Michenko A.V., Lvov A.N., Kruglova L.S., et al. Clinical and psychometric rationale for pruritus typology considering quality-of-life impact: results of a crosssectional observational study. Effektivnaya farmakoterapiya. 2025;21(12):24–31 (In Russian). DOI: 10.33978/2307-3586-2025-21-12-24-31.
9. Weisshaar E., Müller S., Szepietowski J.C., et al. European S2k Guideline on Chronic Pruritus. Acta Derm Venereol. 2025;105:adv44220. DOI: 10.2340/actadv.v105.44220.
10. Damiani G., Tacastacas J.D., Wuerz T., et al. Cognition/Psychological Burden and Resilience in Cutaneous T-Cell Lymphoma and Psoriasis Patients: Real-Life Data and Implications for the Treatment. BioMed Res Inter. 2022;2022:8802469:1– 10. DOI: 10.1155/2022/8802469.
11. Hodak E., Lessin S., Friedland R., et al. New insights into associated co-morbidities in patients with cutaneous T-cell lymphoma (Mycosis Fungoides). Acta Derm Venereol. 2013;93(4):451–5. DOI: 10.2340/00015555-1496.
12. Hu M., Scheffel J., Frischbutter S., et al. Characterization of cells and mediators associated with pruritus in primary cutaneous T-cell lymphomas. Clin Exp Med. 2024;24(1):171. DOI: 10.1007/s10238-024-01407-y.
13. Macagno N., Mastorino L., Rubatto M., et al. Primary cutaneous lymphoma patients seen at a referral dermatological centre in 1 year: a singlecentre observational retrospective cohort study of the diagnoses and staging, comorbidities and associated symptoms, treatment performed and clinical course. J Eur Acad Dermatol Venereol. 2022;36(12):2388–92. DOI: 10.1111/jdv.18469.
14. Kim J.J., Day M.A. The neuroscience of itch in relation to transdiagnostic psychological approaches. Sci Rep. 2024;14:21476. DOI: 10.1038/s41598-024-69973-5.
15. Ferreira B.R., Misery L. Psychopathology Associated with Chronic Pruritus: A Systematic Review. Acta Derm Venereol. 2023;103:adv8488. DOI: 10.2340/actadv.v103.8488.
16. Weisshaar E., Szepietowski J.C., Darsow U., et al. European guideline on chronic pruritus. Ac Acta Derm Venereol. 2012;92(5):563–81. DOI: 10.2340/00015555-1400.
17. Darsow U., Scharein E., Simon D., et al. The Eppendorf Pruritus Questionnaire. Hautarzt. 1997;48(10):730–3. DOI: 10.1007/s001050050651.
18. Weng H.J., Shih M.H., Tsai T.F., et al. Clinical validation and utility of Chinese Eppendorf Itch Questionnaire in adults with chronic pruritus symptoms. J Formos Med Assoc. 2021;120(1 Pt 2):492–500. DOI: 10.1016/j.jfma.2020.06.022.
19. Wu R.Y., Ge L.F., Zhong B.L. Prevalence of psychological symptoms among Chinese land-lost farmers: a systematic review and meta-analysis of cross-sectional studies by using the SCL-90-R. Curr Opin Psychiatry. 2025;38(3):200–8. DOI: 10.1097/YCO.0000000000000988.
20. Snodgrass M.A., Bieu R.K., Schroeder R.W. Development of a Symptom Validity Index for the Beck Anxiety Inventory. Clin Neuropsychol. 2025;39(7):1944– 59. DOI: 10.1080/13854046.2024.2429162.
21. Shura R.D., Schroeder R.W., Ord A.S., et al. Symptom validity indices for the Beck Depression Inventory-II: Development and cross-validation in research and clinical samples. Clin Neuropsychol. 2025;39(7):1960–78. DOI: 10.1080/13854046.2024.24320.
22. Taylor G.J., Bagby R.M., Ryan D.P., et al. Criterion validity of the Toronto Alexithymia Scale. Psychosom Med. 1988;50(5):500–9. DOI: 10.1097/00006842-198809000-00006.
23. Gupta M.A., Gupta A.K., Schork N.J., Ellis C.N. Depression modulates pruritus perception: a study of pruritus in psoriasis, atopic dermatitis, and chronic idiopathic urticaria. Psychosom Med. 1994;56(1):36–40. DOI: 10.1097/00006842-199401000-00005.
24. Zhang X.J., Wang A.P., Shi T.Y., et al. The psychosocial adaptation of patients with skin disease: a scoping review. BMC Public Health. 2019;19(1):1404. DOI: 10.1186/s12889-019-7775-0.
25. Zhang L, Zhou S, Yan L, et al. Supraspinal kappa-opioid receptors: new therapeutic strategies for pain, pruritus, and negative emotions. Exp Brain Res. 2025;243(5):116. DOI: 10.1007/s00221-025-07066-z.
26. Misery L., Taïeb C., Schollhammer M., et al. Psychological Consequences of the Most Common Dermatoses: Data from the Objectifs Peau Study. Acta Derm Venereol. 2020;100(13):adv00175. DOI: 10.2340/00015555-3531.
27. Engin B., Keçici A.S., Uzun A.Ö., Yalçın M. Psychiatric comorbidity, depression, and anxiety levels and quality of life of the patients with mycosis fungoides. Dermatol Ther. 2020;33(6):e13922. DOI: 10.1111/dth.13922.
28. Molloy K., Jonak C., Woei-A-Jin F.J.S.H., et al. Characteristics associated with significantly worse quality of life in mycosis fungoides/Sézary syndrome from the PROCLIPI study. Br J Dermatol. 2020;182(3):770–9. DOI: 10.1111/bjd.18089.
29. Ferreira B.R., Katamanin O.M., Jafferany M., Misery L. Psychodermatology of Chronic Pruritus: An Overview of the Link Between Itch and Distress. Dermatol Ther (Heidelb). 2024;14(7):1799–809. DOI: 10.1007/s13555-024-01214-z.
30. Howell J.N., Mark B., Wada D.A., et al. Mental Health Diagnoses in Patients With Mycosis Fungoides and Potential Impact on Oncologic Outcomes. Cancer Med. 2025;14(5):e70577. DOI: 10.1002/cam4.70577.
31. Zhang Y., Kesler S.R., Dietrich J., Chao H.H. Cancer-Related Cognitive Impairment: A Practical Guide for Oncologists. JCO Oncol Pract. 2025;21(10):1377– 81. DOI: 10.1200/OP-24-00953.
32. Spitzer C., Lübke L., Wülfing C., et al. Facets of shame and their impact on quality of life in patients with atopic dermatitis and psoriasis. Sci Rep. 2025;15(1):13753. DOI: 10.1038/s41598-025-98353-w.
33. Kimyai-Asadi A., Usman A. The role of psychological stress in skin disease. J Cutan Med Surg. 2001;5(2):140–5. DOI: 10.1007/BF02737869.
34. Umezaki Y., Motomura H., Nagamachi S., et al. Alleviation of symptoms and paradoxical brain perfusion shift in oral cenesthopathy: A retrospective neuroimaging study. Front Psychiatry. 202;16:1653444. DOI: 10.3389/fpsyt.2025.1653444.
35. Baptista Gonçalves R., Goulding J.M., Mughal F. Delusional infestation: an evidence-informed approach for general practice. Br J Gen Pract. 2025;75(759):485–7. DOI: 10.3399/BJGP.2025.0288.
36. Ständer S., Sun Y.G., Schmelz M. Editorial: Pruritus Medicine. Front Med. 2021;8:763667. DOI: 10.3389/fmed.2021.763667.
37. Preece D.A., Mehta A., Petrova K., et al. Alexithymia and emotion regulation. J Affect Disord. 2023;324:232–8. DOI: 10.1016/j.jad.2022.12.065.
38. Alexander F. Psychosomatic Medicine: Its Principles and Applications. New York: W.W.Norton & Compane, 1950.
39. Berridge K.C., Kringelbach M.L. Pleasure systems in the brain. Neuron. 2015;86(3):646–64. DOI: 10.1016/j.neuron.2015.02.018.
40. Yosipovitch G., Samuel L.S. Neuropathic and psychogenic itch. Dermatol Ther. 2008;21(1):32–41. DOI: 10.1111/j.1529-8019.2008.00167.x.
41. Stumpf A., Schneider G., Ständer S. Psychosomatic and psychiatric disorders and psychologic factors in pruritus. Clin Dermatol. 2018;36(6):704–08. DOI: 10.1016/j.clindermatol.2018.08.015.
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For citations:
Vybornykh D.E., Gorenkova L.G., Romanov D.V., Esina L.V., Michenko A.V., Chabaeva Y.A., Kulikov S.M. Chronic Pruritus as a Psychosomatic Phenomenon in Primary Cutaneous T-cell Lymphomas. Russian journal of hematology and transfusiology. 2026;71(1):60-74. (In Russ.) https://doi.org/10.35754/0234-5730-2026-71-1-60-74
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