Pruritus Assessment Scale | ADVANZ PHARMA FOR PATIENTS

Pruritus assessment scale1*

1. Duration: During the last 2 weeks, how many hours a day have you experienced itching?
Less than 6 hours/day
6–12 hours/day
12–18 hours/day
18–23 hours/day
All day

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2. Intensity: Please rate the intensity of your itching over the past 2 weeks.
Not present
Mild
Moderate
Severe
Unbearable

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3. Tendency: Over the past 2 weeks, has your itching gotten better or worse compared to the previous months?
Completely resolved
Much better, but still present
Little bit better, but still present
Unchanged
Getting worse

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4. Impact: Rate the impact of your itching on the following activities over the last 2 weeks.
	Never affects sleep	Occasionally delays falling asleep	Frequently delays falling asleep	Delays falling asleep and occasionally wakes me up at night	Delays falling asleep and frequently wakes me up at night
Sleep

	N/A	Never affects this activity	Rarely affects this activity	Occasionally affects this activity	Frequently affects this activity	Always affects this activity
Leisure/ Social	N/A	Never affects this activity	Rarely affects this activity	Occasionally affects this activity	Frequently affects this activity	Always affects this activity
Housework/ Errands	N/A	Never affects this activity	Rarely affects this activity	Occasionally affects this activity	Frequently affects this activity	Always affects this activity
Work/ School	N/A	Never affects this activity	Rarely affects this activity	Occasionally affects this activity	Frequently affects this activity	Always affects this activity

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5. Location: Mark whether itching has been present in the following parts of your body over the last 2 weeks. If a body part is not listed, choose the one that is closest anatomically. You can also indicate any affected areas on the diagram below.
Head/scalp	Face	Face
Abdomen	Back‎	Buttocks
Thighs	Lower legs	Tops of feet/toes
Soles	Palms	Tops of hands/fingers
Forearms	Upper arms	Groin
Points of contact with clothing (e.g., waistband, undergarment)

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Your Score

4

Pruritus assessment scale

^{*Based on the 5-D pruritus scale. Scores range from 5 to 35.}

REFERENCES:

Elman et al. The 5-D itch scale: a new measure of pruritus. Brit J Dermatol 2010;162;587-593.