Acta Dermato-Venereologica 99-4CompleteContent | Page 17

429 INVESTIGATIVE REPORT Itch in Psoriasis: A New Look at Well-known Subject Radomir RESZKE, Rafał BIAŁYNICKI-BIRULA AND Jacek C. SZEPIETOWSKI Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland Psoriasis is a chronic inflammatory dermatosis, fre- quently presenting with chronic itch. This study in- vestigated the prevalence and detailed clinical cha- racteristics of chronic itch in 143 psoriatic patients, with regard to different age groups, comorbidities and pharmacotherapy. Chronic itch was reported by 72% of subjects. Patients aged 65 years and over presen- ted higher 4-Item Itch Questionnaire (4IIQ) scores (8.6  ±  3.4 vs. 7.4  ±  2.5 points; p  = 0.03) and rarely expe- rienced itching at midday (p  = 0.009). Chronic itch cor- related with aspirin intake and xerosis intensity. 4IIQ scores were higher in patients with asthma/chronic ob- structive pulmonary disease, peptic ulcer disease and those taking insulin. Logistic regression analysis found that chronic itch was positively correlated with the use of antacids, angiotensin receptor blockers, angioten- sin enzyme converting inhibitors, beta-blockers, xero- sis intensity and Physician’s Global Assessment score, whereas psychiatric drugs other than selective seroto- nin reuptake inhibitors, allopurinol, coexistence of ar- terial hypertension and application of emollients acted conversely. Elderly psoriatic patients present several differences in the characteristics of chronic itch, and chronic itch may be associated with comorbidities and pharmacotherapy. To the best of our knowledge, this is the first study to report possible associations bet- ween psoriatic pruritus and co-administration of drugs utilized in various systemic conditions. Key words: itch; psoriasis; elderly; comorbidities; pharmaco ­ therapy. Accepted Feb 7, 2019; E-published Feb 8, 2019 Acta Derm Venereol 2019; 99: 429–434. Corr: Jacek Szepietowski, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, ul. Chalubinskiego 1, PL-50-368, Wroclaw, Poland. E-mail: [email protected] P soriasis is a chronic, inflammatory cutaneous disorder affecting skin, nails and joints, often associated with various comorbidities, and posing a severe psychosocial burden in affected individuals (1, 2). Psoriasis is common in the general population, with an estimated prevalence in the general population of 1–4.4% (3–5). Clinical studies of the elderly population with psoriasis are scarce, al­ though it is the 6 th most common cutaneous disease in this population (6). Studies have determined the prevalence of psoriasis in elderly patients as 2.2–12.5% (7–9), whereas late onset of psoriasis was observed in approximately 3% of psoriatic individuals (6, 10). Itch, classically described as an unpleasant feeling urging a desire to scratch (11), is classified as acute SIGNIFICANCE Psoriasis is a chronic inflammatory cutaneous disease fre- quently encountered in the general population. The majo- rity of psoriatic patients experience chronic itch. The cur- rent study has extensively evaluated the prevalence and clinical characteristics of chronic itch in a cohort of psoriatic subjects. Moreover, we have investigated clinical itch-rela- ted differences between senior and non-senior groups of patients, as well as possible associations between chronic itch, systemic comorbidities and pharmacotherapy. or chronic, with the latter being described as lasting 6 weeks or longer (12). Chronic itch (CI) is a frequent complaint, affecting 64–97% of psoriatic individuals, and its clinical characteristics and impact on various quality of life (QoL) domains have been studied extensively (13–17). However, few reports have provided data on itch characteristics and burden among elderly patients with psoriasis (10, 18). In addition, taking into account the abundance of pathogenic factors associated with CI (19), including coexisting systemic disorders and drug intake, this symptom in psoriatic patients may be associated with factors other than the underlying dermatosis, especially in elderly patients. The possible role of other cofactors is supported by the observation that treatment of psoriasis does not necessarily provide relief in pruritus (20). The aim of the present study was to investigate the prevalence and detailed clinical characteristics of CI in psoriatic patients, as well as QoL and stigmatization aspects, with a particular emphasis on itch-related para- meters in relation to different age groups, comorbidities and pharmacotherapy. METHODS Study population and design This cross-sectional study was conducted between January 2017 and May 2018. Among 176 dermatology inpatients diagnosed with psoriasis vulgaris, 143 (81.3%) agreed to participate in the study. Patients diagnosed with another coexistent cutaneous condition presenting with itch (e.g. urticaria, allergic contact dermatitis, etc.) were excluded. A detailed medical history was obtained, including baseline demographics, systemic comorbidities and systemic drug intake. Dermatological history included the presence of coexisting dermatoses, application of emollients (if positive, the daily frequency was noted) and the time of psoriasis onset. The results of routine laboratory blood tests performed during hospi- talization were noted, including concentrations of haemoglobin (Hb; reference range 12–16 g/dl in females, 14–18 g/dl in males), C-reactive protein (CRP; reference range 0.2–5 mg/l), aspartate This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica. doi: 10.2340/00015555-3147 Acta Derm Venereol 2019; 99: 429–434