Psoriasis: moderate-to-severe forms are much more itchy than previously thought (plaque type)

Pruritus and quality of life in moderate-to-severe plaque psoriasis: post hoc explorative analysis from the PRISTINE study. Mrowietz U. et al. J Eur Acad Dermatol Venereol. 2015 Jun;29(6):1114-20. doi: 10.1111/jdv.12761. Epub 2014 Nov 5.

Psoriasis (plaque-type) being “not itchy” is  classically described during clinics and textbooks, although in reality a lot of patients often complain of scratching.
Itching in psoriasis can impact the quality of life, but in our experience it is not often the chief complaint as it often is in eczema.

This study includes 270 patients with moderate to severe psoriasis with etanercept (Enbrel)
Results show that:
-before therapy, patients had an average pruritus level of 3.6 (0 to 5). Itching (level ≥1) in 96% of patients, severe itching in 62% (level ≥4), maximum itch (level 5) in 26%

-after therapy (50mg injected twice weekly or once weekly):
-patients with clinically meaningful pruritus improvement at week 24 reported greater improvement in Quality of Life scales  than other patients.
-results were achieved faster was faster with the twice weekly regimen and it was significantly higher than the once weekly group 12 weeks after starting the treatment. However there was no difference at week 24.
-Patients with the maximum itch (5) improved reduced the itch score to 1.7 at week 24.

CONCLUSION
Although this study talks about the improvement of pruritus with etanercept it shows the 96% of patients reported pruritus.

COMMENT
Biologics (such as etanercept) are chosen to treat moderate-to-severe psoriasis and thus the itching is for this patient group.Therefore patients with more severe psoriasis should according to this study almost always complain of pruritus
Again, other conditions should be suspected if pruritus is prominent as mild psoriasis is often asymptomatic.

Article selection: Prof Dr Jean-Hilaire Saurat – dermatologist. Geneva, Switzerland