Analysis of correlated factors of skin pruritus in type 2 diabetes mellitus.

BACKGROUND

This investigation employed a prospective observational design to examine pruritus, a common dermatological manifestation in type 2 diabetes mellitus (T2DM) patients that significantly impacts both physical health and psychological status. The primary aim was to elucidate potential risk factors contributing to pruritic symptoms in this patient population.

METHODS

We consecutively enrolled T2DM patients presenting to our endocrinology department from April to December 2023. Comprehensive data collection included demographic characteristics, pruritus symptom profiles, and standard biochemical parameters through structured questionnaires. Non-invasive cutaneous assessments measured transepidermal water loss (TEWL) and stratum corneum hydration (SCH). Flow cytometric analysis quantified Th1/Th2 cell populations, while serum concentrations of IL-4 and IFN-γ were determined via ELISA.

RESULTS

Among 110 participants (26 non-pruritic, 84 pruritic), multivariate analysis identified several significant associations (P < 0.05). Key correlates included fasting plasma glucose (FPG), diabetes duration, presence of diabetic peripheral neuropathy (DPN) or nephropathy, hyperuricemia, IL-4 and IFN-γ levels, and SCH in both upper and lower limbs. Logistic regression showed that FPG, diabetes duration, presence of hyperuricemia, IL-4, and SCH measurements inl ower limbs were the risk factor of pruritus combined T2DM. In chronic pruritus cases, severe symptoms correlated with elevated FPG, increased DPN prevalence, and reduced lower limb SCH compared to milder cases (P < 0.05). Acute pruritus severity showed similar FPG associations, with additional significant SCH reductions in both extremities compared to moderate cases (P < 0.05).

CONCLUSION

Our findings suggest that FPG, diabetes duration, presence of hyperuricemia, IL-4, and SCH measurements in lower limbs were the risk factor of pruritus combined T2DM. Chronic pruritus severity appears related to metabolic control, neurological involvement, immune inflammation and skin hydration, while acute cases primarily associate with metabolic, immune inflammation and skin hydration. The observed Th1/Th2 imbalance, with progressive ratio decline accompanying symptom worsening, potentially indicates type 2 inflammatory pathway activation in diabetic patients experiencing pruritus.