Skin hypersensitivity in chronic cough patients: symptom profiles and psychosomatic correlates

TL;DR

This study finds that many chronic cough patients also have sensitive skin syndrome, which is linked to heightened cough sensitivity and psychological distress.

Contribution

The study identifies a significant link between chronic cough and sensitive skin syndrome, revealing new insights into their shared neural hypersensitivity mechanisms.

Findings

44.5% of chronic cough patients had sensitive skin syndrome, with higher prevalence in refractory cases.

Patients with sensitive skin syndrome showed increased cough sensitivity and psychological distress.

Neuromodulators improved outcomes more in sensitive skin syndrome patients with refractory chronic cough.

Abstract

Cough hypersensitivity syndrome (CHS) is a characteristic of patients with chronic cough (CC). Sensitive skin syndrome (SSS), which is characterised by cutaneous pain and pruritus, may share neural hypersensitivity mechanisms with CHS. This study aimed to determine the co-morbidities, clinical profiles, and psychosomatic correlates in CC patients.

Two hundred CC patients were enrolled in this prospective cohort study. SSS was diagnosed according to established guidelines, which required the presence of subjective symptoms induced by minimal stimuli with at least one of the following positive criteria: Sensitive Scale-10 score > 13; Sensitive Scale-14 score > 18; lactic acid sting test score ≥ 3; or capsaicin test score ≥ 3. Assessments included cough severity, Visual Analogue Scale (VAS), capsaicin cough sensitivity, cough symptom score, Leicester cough questionnaire (LCQ), and psychological evaluations.

Among CC patients, 44.5% (89/200) had SSS with a higher prevalence in refractory/unexplained CC (RU-CC) patients compared to non-RU-CC patients (63.24% vs. 34.85%; p < 0.001). SSS patients exhibited heightened cough sensitivity (lower C2/C5 thresholds; p = 0.017/0.004), higher VAS scores (p = 0.026), lower LCQ scores, and an elevated psychological burden compared to non-SSS patients. In addition, RU-CC patients with SSS had superior cough responses to neuromodulators than non-SSS patients (LCQ improvement: 2.59 ± 2.36 vs. 1.26 ± 2.53; p = 0.037; response rate: 79.3% vs. 44.4%; p = 0.029).

SSS was identified in a clinically relevant subset of CC patients (especially those with RU-CC) and correlated with neural hypersensitivity and psychological distress. Early recognition of SSS in patients with CC and the early introduction of neuromodulators may offer greater therapeutic benefits and improve patient outcomes.

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