Does psoriasis cause pruritus (itching)?

From the Guidelines

Yes, psoriasis commonly causes pruritus (itching), as stated in the joint AAD-NPF guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures 1. About 60-90% of people with psoriasis experience itching, which can range from mild to severe. The itching occurs because psoriasis is an inflammatory skin condition where the immune system triggers rapid skin cell turnover, leading to inflammation and the formation of thick, scaly plaques. This inflammation activates nerve endings in the skin and releases itch-inducing chemicals like histamine and cytokines. The severity of itching often correlates with the extent of psoriasis, but even mild cases can cause significant discomfort. Scratching due to pruritus can worsen psoriasis through the Koebner phenomenon, where skin trauma triggers new psoriatic lesions. Managing psoriasis with appropriate treatments like topical corticosteroids, vitamin D analogs, oral medications, or biologics typically helps reduce both the skin lesions and associated itching. For immediate itch relief, patients can use moisturizers, cold compresses, antihistamines, and avoiding triggers like hot showers, stress, and certain fabrics that can exacerbate itching. It is essential to assess the degree of pruritus when present, as recommended in the guidelines 1. Additionally, the guidelines emphasize the importance of considering the patient's goals and expectations when developing a treatment strategy, which may include reducing pruritus 1. Other studies have also discussed the management of psoriasis and pruritus, including the use of topical calcineurin inhibitors like tacrolimus and pimecrolimus for facial and intertriginous psoriasis 1. However, the most recent and highest-quality study, the joint AAD-NPF guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures 1, provides the strongest evidence for the relationship between psoriasis and pruritus. Therefore, pruritus assessment is a crucial aspect of psoriasis management, and healthcare providers should prioritize this symptom when treating patients with psoriasis. Some key points to consider in the management of psoriasis and pruritus include:

• Assessing the degree of pruritus when present
• Developing a treatment strategy that considers the patient's goals and expectations
• Using topical corticosteroids, vitamin D analogs, oral medications, or biologics to reduce skin lesions and associated itching
• Providing immediate itch relief with moisturizers, cold compresses, antihistamines, and avoiding triggers
• Considering the use of topical calcineurin inhibitors for facial and intertriginous psoriasis.

From the FDA Drug Label

In placebo-controlled adult PsO trials, the percentages of patients reporting adverse reactions in the 50 mg twice a week dose group were similar to those observed in the 25 mg twice a week dose group or placebo group. Table 4 summarizes adverse reactions reported in adult PsO patients from Studies I and II. Table 4 Percent of Adult PsO Patients Experiencing Adverse Reactions in Placebo-Controlled Portions of Clinical Trials (Studies I & II) Placebo(N = 359)Enbrel* (N = 876) Adverse ReactionPercent of Patients Pruritus21

Psoriasis is associated with pruritus in some patients, as indicated by the presence of pruritus as an adverse reaction in adult PsO patients treated with Enbrel, with a reported percentage of 21% 2.

From the Research

Psoriasis and Pruritus

• Psoriasis is a chronic inflammatory skin disease that can cause pruritus (dermal itch) in a significant percentage of patients, with studies suggesting that more than 85% of psoriasis patients suffer from pruritus 3.
• The pathogenesis of pruritus in psoriasis is still unknown, but it is believed to be related to neurogenic inflammation, with possible itch mediators including neuropeptides released from dermal nerve endings upon various stimuli 4.
• Pruritus can significantly impact the quality of life of patients with psoriasis, and it is often considered the most bothersome symptom by patients 4.

Prevalence of Pruritus in Psoriasis

• Studies have shown that pruritus affects about 60-90% of patients with psoriasis, making it a common symptom of the disease 4.
• Pruritus can involve the entire body, although it predominantly affects the legs, hands, back, body, and especially the scalp 5.

Treatment of Pruritus in Psoriasis

• Despite the high frequency of pruritus in psoriasis, there is no single antipruritic therapy dedicated specifically to treat itch in this disease 4.
• Treatment of pruritus in patients with psoriasis should be directed towards the resolution of skin lesions, as disease remission usually is linked with pruritus relief 4.
• Recent clinical studies have begun to include itch as a study outcome, and the resulting data have demonstrated concomitant antipruritic benefits and improved Psoriasis Area and Severity Index (PASI) scores with mainstay treatments for psoriasis, such as topical corticosteroids and vitamin D analogs, phototherapies, and various systemics and biologics 5.