Prurigo nodularis (nodular prurigo)
Conditions
Interventions
 
EMD-U: 
The EMD protocol for urge has recently been developed and applied and clinical 
results so far have been positive [11, 14]. Working-memory theory offers an 
explanation for how EMDR might work [15, 16]. The theory states that the 
short-term or working memory can perform various tasks at the same time. 
However, the working memory has a limited attention capacity. As a result, by 
performing one task, performance on another task comes under pressure. In 
EMD-U, the patient is asked to focus on the distracting stimulus, but at the 
same time also to focus on the urge to scratch his/her skin. So, the attention, 
which is focused on the urge to scratch, is distracted by the eye movements. 
The hypothesis is that as a result, 'decay' (desensitization) of the urge to 
scratch takes place and the urge loses more and more of its urgency. 
EMD-U consists of two sessions of 60 minutes in the first three weeks. An 
important part of EMD-U consists of homework exercises. These homework 
exercises comprise to practice/apply the intervention as learned during the 
sessions with the therapist, in those situations wherein the urge to scratch 
their skin is present. In the text below, we will explain in more detail what 
the treatment protocol entails. Patients in this condition receive the EMD-U 
treatment in addition to the care as usual. 
Sponsors
Erasmus MC, Universitair Medisch Centrum Rotterdam
Eligibility
Age
18 Years to 99 Years
Inclusion criteria
Inclusion criteria: - Age 18 >= - A confirmed diagnosis of atopic dermatitis or prurigo nodularis - Suffering from persistent and frequent scratching behaviour - IGA-CPG activity score >= 3 OR Skindex-29 symptoms subscale score >= 42 - Stable course of treatment in the two weeks prior to the study (no medication change, etc.) - Sufficiently motivated to take part in a new intervention aimed at behaviour change
Exclusion criteria
Exclusion criteria: - Insufficient understanding of Dutch language - Severe psychiatric disorders that require treatment first, such as delusional disorder or major depression - If medication is changed during the course of the study, the participant will be considered a drop-out from the moment the medication has changed.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| The main study outcome is the dermatology-specific health-related quality of life (HRQOL), measured at the start of the study (T0), in week 4 (T1), in week 8 (T2), and during follow-up, in week 12 (T3) and six months after T0 (T4). The SKINDEX-29 is used to measure this outcome. It consists of 30 items to be scored on a 5-point response scale. The instrument has three subscales: symptoms, emotions, and functioning [17]. 17. Chren, M.-M., et al., Improved discriminative and evaluative capability of a refined version of Skindex, a quality-of-life instrument for patients with skin diseases. Archives of dermatology, 1997. 133(11): p. 1433-1440. | — |
Secondary
| Measure | Time frame |
|---|---|
| Secondary outcomes are several commonly used measures for disease activity, health-related quality of life, self-control, depression and anxiety, and skin picking. All standardized measures are administered at four time points: at the start of the study (T0), in week 4 (T1), in week 8 (T2), and during follow-up, in week 12 (T3) and six months after T0 (T4). The standardized measures used are: Disease activity, measures to be filled out by dermatologist or dermatology resident: The disease activity of patients with atopic dermatitis is scored using the Eczema Area and Severity Index (EASI) [18]. This is a validated scoring system that grades the physical signs of atopic dermatitis/eczema. For patients with prurigo nodularis and excoriation disorder, the Investigator Global Assessment (IGA) is used. The IGA is a 5-point tool for the objective assessment of chronic prurigo. The IGA for stage of chronic nodular prurigo (CNPG) and signs of activity in chronic prurigo are used [19]. Health-related Quality of Life measure, to be filled out by the patient: The EQ-5D-5L measures health-related quality of life. It is a generic instrument that can be used in a wide range of health conditions and treatments. The EQ-5D-5L consists of a descriptive system and the EQ VAS. The descriptive system comprises five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. The EQ VAS records the patient*s self-rated health on a vertical visual analogue scale [20]. Self-Control, measures to be filled out by the patient: The Self-Control Cognition Questionnaire, Dutch: Zelfcontrole Cognitie Vragenlijst (ZCCL). The ZCCL is an 11-item self-report questionnaire measuring perceived self-control. There are two subscales: *positive reward* (of the unwanted behaviour) and *difficulty resisting*. Each item is scored on a 5-point Likert scale [21]. Depression and anxiety, measures to be filled out by the patient: The four item Patient Health Questionnaire for | — |
Countries
Netherlands
Contacts
Public ContactR. Waalboer-Spuij
Erasmus MC, Universitair Medisch Centrum Rotterdam
Outcome results
None listed