Itch is a common symptom among psoriasis patients, affecting up to 80% of patients. This article reviews recent advances in the pathophysiology, clinical presentation, and treatment options for psoriatic itch. English articles between 2003 and 2012, using the key words “psoriasis,” “pruritus,” and “itch,” were searched in Medline and PubMed and reviewed.
KruegerG., KooJ., LebwohlM., MenterA., SternR.S., RolstadT.The impact of psoriasis on quality of life: Results of a 1998 National Psoriasis Foundation patient-membership survey. Arch Dermatol.2001; 137: 280–4.
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KouK., NakamuraF., AiharaM., ChenH., SetoK., Komori-YamaguchiJ.Decreased expression of semaphorin-3A, a neurite collapsing factor, is associated with itch in psoriatic skin. Acta Derm Venereol.2012 May 8 [Epub ahead of print].
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YosipovitchG., GoonA., WeeJ., ChanY.H., GohC.L.The prevalence and clinical characteristics of pruritus among patients with extensive psoriasis. Br J Dermatol.2000; 143: 969–73.
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ReichA., SzepietowskiJ.C.Mediators of pruritus in psoriasis. Mediators Inflamm.2007; 2007: 64727.
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GowdaS., GoldblumO.M., McCallW.V., FeldmanS.R.Factors affecting sleep quality in patients with psoriasis. J Am Acad Dermatol.2010; 63: 114–23.
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DawnA., YosipovitchG.Treating itch in psoriasis. Dermatol Nurs.2006; 18: 227–33.
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YosipovitchG.The pruritus receptor unit: a target for novel therapies. J Invest Dermatol.2007; 127: 1857–9.
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ChangS.E., HanS.S., JungH.J., ChoiJ.H.Neuropeptides and their receptors in psoriatic skin in relation to pruritus. Br J Dermatol.2007; 156: 1272–7.
9.
CoimbraS., FigueiredoA., CastroE., Rocha-PereiraP., Santos-SilvaA.The roles of cells and cytokines in the pathogenesis of psoriasis. Int J Dermatol.2012; 51: 389–95.
10.
SaracenoR., KleynC.E., TerenghiG., GriffithsC.E.The role of neuropeptides in psoriasis. Br J Dermatol.2006; 155: 876–82.
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EedyD.J., JohnstonC.F., ShawC., BuchananK.D.Neuropeptides in psoriasis: an immunocytochemical and radioimmunoassay study. J Invest Dermatol.1991; 96: 434–8.
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AmatyaB., El-NourH., HolstM., TheodorssonE., NordlindK.Expression of tachykinins and their receptors in plaque psoriasis with pruritus. Br J Dermatol.2011; 164: 1023–9.
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YosipovitchG., ChanY.H., TayY.K., GohC.L.Thermosensory abnormalities and blood flow dysfunction in psoriatic skin. Br J Dermatol.2003; 149: 492–7.
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TanedaK., TominagaM., NegiO., TengaraS., KamoA., OgawaH.Evaluation of epidermal nerve density and opioid receptor levels in psoriatic itch. Br J Dermatol.2011; 165: 277–84.
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TominagaM., OgawaH., TakamoriK.Decreased production of semaphorin 3A in the lesional skin of atopic dermatitis. Br J Dermatol.2008; 158: 842–4.
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NakamuraM., ToyodaM., MorohashiM.Pruritogenic mediators in psoriasis vulgaris: comparative evaluation of itch-associated cutaneous factors. Br J Dermatol.2003; 149: 718–30.
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NobbeS., DziunyczP., MühleisenB., BilsboroughJ., DillonS.R., FrenchL.E.IL-31 expression by inflammatory cells is preferentially elevated in atopic dermatitis. Acta Derm Venereol.2012; 92: 24–8.
18.
TóthB.I., DobrosiN., DajnokiA., CzifraG., OláhA., SzöllosiA.G.Endocannabinoids modulate human epidermal keratinocyte proliferation and survival via the sequential engagement of cannabinoid receptor-1 and transient receptor potential vanilloid-1. J Invest Dermatol.2011; 131: 1095–104.
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BíróT., TóthB.I., MarincsákR., DobrosiN., GéczyT., PausR.TRP channels as novel players in the pathogenesis and therapy of itch. Biochim Biophys Acta.2007; 1772: 1004–21.
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SteinhoffM., BíróT.A TR(I)P to pruritus research: role of TRPV3 in inflammation and itch. J Invest Dermatol.2009; 129: 531–5.
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StänderS., SteinhoffM., SchmelzM., WeisshaarE., MetzeD., LugerT.Neurophysiology of pruritus: cutaneous elicitation of itch. Arch Dermatol.2003; 139: 1463–70.
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ReddyV.B., ShimadaS.G., SikandP., LamotteR.H., LernerE.A.Cathepsin S elicits itch and signals via protease-activated receptors. J Invest Dermatol.2010; 130: 1468–70.
O'NeillJ.L., ChanY.H., RappS.R., YosipovitchG.Differences in itch characteristics between psoriasis and atopic dermatitis patients: results of a web-based questionnaire. Acta Derm Venereol.2011; 91: 537–40.
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ReichA., Welz-KubiakK., SzepietowskiJ.C.Pruritus differences between psoriasis and lichen planus. Acta Derm Venereol.2011; 91: 605–6.
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MeeuwisK.A., van de KerkhofP.C., MassugerL.F., de HulluJ.A., van RossumM.M.Patients' Experience of Psoriasis in the Genital Area. Dermatology.2012; 224: 271–6.
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SzepietowskiJ.C., ReichA., WiśnickaB.Itching in patients suffering from psoriasis. Acta Dermatovenerol Croat.2002; 10: 221–6.
28.
PapoiuA.D., YosipovitchG.Topical capsaicin. The fire of a ‘hot’ medicine is reignited. Expert Opin Pharmacother.2010; 11: 1359–71.
29.
KürkçüoğluN., AlaybeyiF.Topical capsaicin for psoriasis. Br J Dermatol.1990; 123: 549–50.
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EllisC.N., BerberianB., SulicaV.I., DoddW.A., JarrattM.T., KatzH.I.A double-blind evaluation of topical capsaicin in pruritic psoriasis. J Am Acad Dermatol.1993; 29: 438–42.
KircikL.H.Efficacy and onset of action of hydrocortisone acetate 2.5% and pramoxine hydrochloride 1% lotion for the management of pruritus: results of a pilot study. J Clin Aesthet Dermatol.2011; 4: 48–50.
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YoungT.A., PatelT.S., CamachoF., ClarkA., FreedmanB.I., KaurM.A pramoxine-based anti-itch lotion is more effective than a control lotion for the treatment of uremic pruritus in adult hemodialysis patients. J Dermatolog Treat.2009; 20: 76–81.
34.
GarcíaF., IparraguirreA., BlancoJ., AllozaP., VicenteJ., BásconesO.Contact dermatitis from prilocaine with cross-sensitivity to pramocaine and bupivacaine. Contact Dermatitis.2007; 56: 120–1.
35.
LebwohlM.The role of salicylic acid in the treatment of psoriasis. Int J Dermatol.1999; 38: 16–24.
36.
KircikL.Salicylic Acid 6% in an ammonium lactate emollient foam vehicle in the treatment of mild-to-moderate scalp psoriasis. J Drugs Dermatol.2011; 10: 270–3.
37.
YosipovitchG., SugengM.W., ChanY.H., GoonA., NgimS., GohC.L.The effect of topically applied aspirin on localized circumscribed neurodermatitis. J Am Acad Dermatol.2001; 45: 910–3.
38.
HendriksA.G., KeijsersR.R., de JongE.M., SeygerM.M., van de KerkhofP.C.Combinations of classical time-honoured topicals in plaque psoriasis: a systematic review. J Eur Acad Dermatol Venereol.2012 Jul 11 [Epub ahead of print].
39.
SchwarbF.P., GabardB., RufliT., SurberC.Percutaneous absorption of salicylic acid in man after topical administration of three different formulations. Dermatology.1999; 198: 44–51.
BreuerK., WerfelT., KappA.Safety and efficacy of topical calcineurin inhibitors in the treatment of childhood atopic dermatitis. Am J Clin Dermatol.2005; 6: 65–77.
42.
StänderS., LugerT.A.Antipruritic effects of pimecrolimus and tacrolimus. Hautarzt.2003; 54: 413–7.
43.
AndersonT.F., WaldingerT.P., VoorheesJ.J.UV-B phototherapy. An overview. Arch Dermatol.1984; 120: 1502–7.
44.
GuptaG., LongJ., TillmanD.M.The efficacy of narrowband ultraviolet B phototherapy in psoriasis using objective and subjective outcome measures. Br J Dermatol.1999; 140: 887–90.
45.
EversA.W., KleinpenningM.M., SmitsT., BoezemanJ., van de KerkhofP.C., KraaimaatF.W.Itch and scratching as predictors of time to clearance of psoriasis with narrow-band ultraviolet B therapy. Br J Dermatol.2009; 161: 542–6.
46.
KuijpersA.L., van de KerkhofP.C.Risk-benefit assessment of methotrexate in the treatment of severe psoriasis. Am J Clin Dermatol.2000; 1: 27–39.
47.
WeatherheadS.C., WahieS., ReynoldsN.J., MeggittS.J.An open-label, dose-ranging study of methotrexate for moderate-to-severe adult atopic eczema. Br J Dermatol.2007; 156: 346–51.
48.
AmorK.T., RyanC., MenterA.The use of cyclosporine in dermatology: part I. J Am Acad Dermatol.2010; 63: 925–46.
49.
OkuboY., NatsumeS., UsuiK., AmayaM., TsuboiR.Low-dose, short-term ciclosporin (Neoral®) therapy is effective in improving patients' quality of life as assessed by Skindex-16 and GHQ-28 in mild to severe psoriasis patients. J Dermatol.2011; 38: 465–72.
50.
SchopfR.E., HultschT., LotzJ., BräutigamM.Eosinophils, pruritus and psoriasis: effects of treatment with etretinate or cyclosporin-A. J Eur Acad Dermatol Venereol.1998; 11: 234–9.
51.
OtsukaA., TaniokaM., NakagawaY., HondaT., IkomaA., MiyachiY.Effects of cyclosporine on pruritus and serum IL-31 levels in patients with atopic dermatitis. Eur J Dermatol.2011; 21: 816–7.
52.
McClureS.L., ValentineJ., GordonK.B.Comparative tolerability of systemic treatments for plaque-type psoriasis. Drug Saf.2002; 25: 913–27.
53.
GottliebA., FengJ., HarrisonD.J., GlobeD.Validation and response to treatment of a pruritus self-assessment tool in patients with moderate to severe psoriasis. J Am Acad Dermatol.2010; 63: 580–6.
54.
SchopfR.E., AustH., KnopJ.Treatment of psoriasis with the chimeric monoclonal antibody against tumor necrosis factor alpha, infliximab. J Am Acad Dermatol.2002; 46: 886–91.
55.
RevickiD.A., WillianM.K., MenterA., GordonK.B., KimballA.B., LeonardiC.L.Impact of adalimumab treatment on patient-reported outcomes: results from a phase III clinical trial in patients with moderate to severe plaque psoriasis. J Dermatolog Treat.2007; 18: 341–50.
56.
VerhoevenE.W., KraaimaatF.W., de JongE.M., SchalkwijkJ., van de KerkhofP.C., EversA.W.Individual differences in the effect of daily stressors on psoriasis: a prospective study. Br J Dermatol.2009; 161: 295–9.
57.
ReichA., HrehorówE., SzepietowskiJ.C.Pruritus is an important factor negatively influencing the well-being of psoriatic patients. Acta Derm Venereol.2010; 90: 257–63.
58.
HundleyJ.L., YosipovitchG.Mirtazapine for reducing nocturnal itch in patients with chronic pruritus: a pilot study. J Am Acad Dermatol.2004; 50: 889–91.
59.
StänderS., BöckenholtB., Schürmeyer-HorstF., WeishauptC., HeuftG., LugerT.A.Treatment of chronic pruritus with the selective serotonin re-uptake inhibitors paroxetine and fluvoxamine: results of an open-labelled, two-arm proof-of-concept study. Acta Derm Venereol.2009; 89: 45–51.
60.
YesudianP.D., WilsonN.J.Efficacy of gabapentin in the management of pruritus of unknown origin. Arch Dermatol.2005; 141: 1507–9.
61.
WinhovenS.M., CoulsonI.H., BottomleyW.W.Brachioradial pruritus: response to treatment with gabapentin. Br J Dermatol.2004; 150: 786–7.
62.
BockbraderH.N., WescheD., MillerR., ChapelS., JaniczekN., BurgerP.A comparison of the pharmacokinetics and pharmacodynamics of pregabalin and gabapentin. Clin Pharmacokinet.2010; 49: 661–9.
63.
DawnA.G., YosipovitchG.Butorphanol for treatment of intractable pruritus. J Am Acad Dermatol.2006; 54: 527–31.
64.
MetzeD., ReimannS., BeissertS., LugerT.Efficacy and safety of naltrexone, an oral opiate receptor antagonist, in the treatment of pruritus in internal and dermatological diseases. J Am Acad Dermatol.1999; 41: 533–9.
65.
TorresT., FernandesI., SeloresM., AlvesR., LimaM.Aprepitant: Evidence of its effectiveness in patients with refractory pruritus continues. J Am Acad Dermatol.2012; 66: e14–5.
66.
StänderS., SiepmannD., HerrgottI., SunderkötterC., LugerT.A.Targeting the neurokinin receptor 1 with aprepitant: A novel antipruritic strategy. PLoS One.2010; 5: e10968.
67.
BinghamL.G., NobleJ.W., DavisM.D.Wet dressings used with topical corticosteroids for pruritic dermatoses: A retrospective study. J Am Acad Dermatol.2009; 60: 792–800.
68.
DemierreM.F., TavernaJ.Mirtazapine and gabapentin for reducing pruritus in cutaneous T-cell lymphoma. J Am Acad Dermatol.2006; 55: 543–4.
