What can sufferers learn about dealing with pruritus in a rehabilitation clinic?
How can I apply for rehabilitation?
These and many other questions were answered by Priv.-Doz. Dr. Athanasios Tsianakas, Head Dermatologist at Fachklinik Bad Bentheim, answered these and many other questions during our lecture series for patients with chronic pruritus.
In the past, rehabilitation was still called a "cure" and was used to keep people healthy or to help them recover, usually in a place with natural healing springs. The focus here was on wellness.
Today, rehabilitation is much more: the current rehabilitation concept is based on a WHO (World Health Organization) model, which takes into account the entire life background of those affected.
The clinical picture of chronic pruritus (itching) is characterized by a duration of more than 6 weeks, is difficult to treat and has various causes.
16.8 % of the working population and 13.5 % of the general population suffers from chronic pruritus - with serious effects on concentration, sleep behavior and ultimately the ability to work of those affected. Pruritus also has an enormous impact on patients' quality of life: obvious skin lesions lead to stigmatization, which is accompanied by the reactive development of psychological symptoms such as anxiety, sleep disorders and depression.
There are many causes of chronic itching: skin diseases, internal diseases, neuropathic or psychosomatic diseases can play a role.
The pillars of the diagnosis and treatment of chronic itching are inpatient or outpatient acute medicine: after diagnosis, an appropriate - usually medicinal - therapy is initiated.
In order to be able to respond to those affected and their entire life background, dermatological rehabilitation offers the opportunity to achieve an improvement in quality of life with more time and targeted additional therapeutic interventions. Those affected can also integrate learned relaxation or exercise therapy techniques into their everyday lives.
Dermatological rehabilitation is a three-week inpatient stay with an intensive program including medication, physical therapy, physiotherapy, relaxation medicine and psychological treatment. The rehabilitation concept at Fachklinik Bad Bentheim was developed jointly with the Chronic Pruritus Competence Center at the Dermatology Clinic of Münster University Hospital. In addition to any drug therapy that may already have been initiated, the specialist clinic offers UV therapy, bath therapies with sulphur mineral water, which have an antipruritic and anti-inflammatory effect. Local therapy in the ointment room is just as much a part of the therapy as all system therapies with, for example, antihistamines, antidepressants, systemic steroids or biologics and JAK inhibitors. Of course, all additional diseases such as diabetes mellitus, arterial hypertension, hyperlipidemia, etc. are also treated.
Psychology with one-to-one sessions and the use of mindfulness and relaxation exercises and physical therapy with exercise programs, massages, equipment training, etc. are particularly important in rehab for persistent itching. Nutritional advice is offered and a social service is available to support those affected with occupational and social-legal issues.
Patient surveys showed clearly measurable positive effects in patients with chronic pruritus after rehabilitation.
How do I apply for rehabilitation?
For inpatients, the hospital's social services department submits the application for follow-up rehabilitation. Rehabilitation must be started no later than 14 days after discharge.
Patients who are not hospitalized should contact their family doctor in confidence. The application and the service provider depend on the employment relationship, pension and entitlement to benefits and private or statutory health insurance.
Patients with chronic inflammatory diseases are entitled to rehabilitation every 4 years, in severe cases every 2 years. If the first application is rejected - which unfortunately happens very often - an appeal against the rejection should definitely be submitted.
The Fachklinik Bad Bentheim has put together a step-by-step guide to the application process on its website: https://www.fk-bentheim.de/fachbereiche/dermatologie/rehabilitation/
The Working Group for Rehabilitation in Dermatology (AReD) has further information on how to apply. https://derma.de/ddg/arbeitsgruppen-kooperationen/arbeitsgruppe/rehabilitation-in-der-dermatologie-ared
Patients have the right to choose their preferred clinic. The desired clinic can be entered in the application under "Remarks". If the request is not granted, an objection is advisable. There are various clinic finder portals on the Internet, here is a small selection:
Many thanks Dr. Tsianakas for the valuable information and the time you took and a big thank you to all participants for your keen interest and questions.
We look forward to the next lecture in January 2024 - for the sake of your skin. ❤️