Treating Itch in Psoriasis

Aerlyn Dawn; Gil Yosipovitch


Dermatology Nursing. 2006;18(3):227-233. 

In This Article

Abstract and Introduction

Itch is an important, but underestimated symptom in psoriasis. Many therapies are available for pruritus; however, few are effective for psoriatic itch. Antipruritic therapies that are potentially effective in psoriasis include coal tar products, topical corticosteroids, topical salicylates, menthol and pramoxine, capsaicin, phototherapy, vitamin D analogs, topical immunomodulators, methotrexate, oral mirtazapine, and biologics. Using these therapies can benefit psoriasis patients in the outpatient clinical setting.

Itch in psoriasis is a significant but often unrecognized problem in dermatology. A recent study found that itching was the most frequent complaint (64%) among patients hospitalized for psoriasis, (Sampogna et al., 2004) and several other studies confirm that itch is a principal symptom of psoriasis (Van de Kerkhof, De Hoop, de Korte, Cobelens, & Kuipers, 2000; Van de Kerkhof, De Hoop, de Korte, & Kuipers, 1998). In a survey of members of the National Psoriasis Foundation, 79% reported that itch was the second most bothersome symptom after scaling (Krueger et al., 2001). In our previous research, we demonstrated that generalized pruritus was a feature of psoriasis in 84% of patients and appeared on a daily basis in 77% of patients (Yosipovitch, Goon, Wee, Chan, & Goh, 2000). Erythrodermic psoriasis, in particular, is one of the most pruritic dermatoses that clinicians encounter. Further more, itch significantly detracts from psoriasis patients' quality of life. Patients with chronic pruritus often have difficulty sleeping, problems concentrating, lowered sex drive, and depression (Yosipovitch, Ansari, Goon, Chan, & Goh, 2002; Yosipovitch et al., 2000).

Nevertheless, many clinicians underestimate the impact of itch in patients with psoriasis, and this topic has begun to receive significant attention only recently. Itch research has traditionally focused greater attention on atopic dermatitis than psoriasis, and many dermatology textbooks do not identify pruritus as a component of psoriasis. One of the reasons that clinicians have not recognized the important role of itch in psoriasis is due to the way that psoriasis severity is measured. Dermatologists emphasize observable criteria of psoriasis, such as visible lesions. Measures such as the Psoriasis Area and Severity Index (PASI) and Physician Global Assessment are commonly used but fail to measure quality of life and the patient's perception of well-being. In addition, patient-reported itch intensity, as reflected by a visual analogue scale, does not correlate with PASI scores (Yosipovitch et al., 2000). According to a 2002 study in the United Kingdom, psoriasis patients' emphasize subjective concerns, such as skin suppleness, softness, and alleviation of itch (Ersser, Surridge, & Wiles, 2002). Itching frequently occurs in areas of the body where no psoriasis plaques are visible. Scalp itching, in particular, is specific to psoriasis and may require different therapies than pruritus in other areas of the body (Van de Kerkhof et al., 1998). New developments are beginning to enhance the scientific understanding of itch and the role of itch in psoriasis; however, patients with psoriasis often have difficulty finding adequate remedies for their itch. Itch in psoriasis is unresponsive to most available antipruritics (Yosipovitch et al., 2000).

One of the major concerns that dermatologists have in patients with chronic pruritus is the effect of constant scratching on the skin. Scratching leads to increased inflammation, which causes further itching and scratching, known as the itch-scratch cycle. In addition, trauma to healthy appearing skin from scratching can lead to the development of new psoriasis plaques, referred to as the Koebner phenomenon. An optimal treatment regimen will interrupt the itch-scratch cycle while treating the affected areas. In this article, we present potentially effective treatments for itch in psoriasis with particular attention to pruritus of the scalp (see Table 1 ).


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