Pruritus assessment scale1*
1. Duration: During the last 2 weeks, how many hours a day have you experienced itching? |
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2. Intensity: Please rate the intensity of your itching over the past 2 weeks. |
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3. Tendency: Over the past 2 weeks, has your itching gotten better or worse compared to the previous months? |
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4. Impact: Rate the impact of your itching on the following activities over the last 2 weeks. | |||||
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Sleep |
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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Leisure/ Social |
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Housework/ Errands |
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Work/ School |
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. | ||
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Your Score
4

*Based on the 5-D pruritus scale. Scores range from 5 to 35.
REFERENCES:
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Elman et al. The 5-D itch scale: a new measure of pruritus. Brit J Dermatol 2010;162;587-593.