Itch intensity in moderate-to-severe plaque psoriasis versus atopic dermatitis: A meta-analysis

Shahwan, Kathryn T.; Kimball, Alexa B.

doi:10.1016/j.jaad.2017.02.002

Cited by 15 publications

(12 citation statements)

References 4 publications

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“…Itch has historically been used as a differentiating factor to distinguish atopic dermatitis (AD) from psoriasis – the former being characteristically pruritic, while the latter has often been considered nonpruritic. However, a recent meta‐analysis of data from 22 clinical trials showed no significant difference in baseline itch between psoriasis and AD . Indeed, itch is a diagnostic criterion for AD and is an important clinical end point in AD studies.…”

Section: Introductionmentioning

confidence: 99%

“…However, a recent meta-analysis of data from 22 clinical trials showed no significant difference in baseline itch between psoriasis and AD. 9 Indeed, itch is a diagnostic criterion for AD and is an important clinical end point in AD studies. Similarly, itch is increasingly being recognized as one of the most burdensome symptoms of psoriasis.…”

Section: Introductionmentioning

confidence: 99%

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Itch: an under‐recognized problem in psoriasis

Elewski

Alexis

Lebwohl

et al. 2019

Acad Dermatol Venereol

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Psoriasis has historically been considered a nonpruritic dermatosis, in contrast with atopic dermatitis. Thus, itch has often been underappreciated and overlooked in psoriasis. However, increasing evidence over the past decade has shown that itch can be one of the most prevalent and burdensome symptoms associated with psoriasis, affecting almost every patient to some degree. Itch can involve the entire body, although it predominantly affects the legs, hands, back, body and especially the scalp. Uncontrolled itch can significantly impact all aspects of the well‐being and quality of life of the patient. While there has been some progress in trying to better understand the pathophysiology of itch in psoriasis, more research effort and interest are needed. This under‐recognition of itch in psoriasis is clearly reflected in the dearth of treatment options targeting itch despite significant advancement in treating the lesions themselves. Recently, however, clinical studies have begun to include itch as a study outcome. 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. This article takes a closer look at this debilitating symptom, reviewing the available epidemiology data for psoriatic itch, presenting the current understanding of psoriatic itch pathophysiology and highlighting important clinical data for various treatment options for itch. Practical considerations for increasing the recognition of itch as well as improving its management in psoriasis are also provided.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Itch: an under‐recognized problem in psoriasis

Elewski

Alexis

Lebwohl

et al. 2019

Acad Dermatol Venereol

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“…The itch is generally limited to lesional skin; however, 20–30% experience itch on uninvolved skin and some suffer from generalized pruritus . Worsening of psoriasis can occur due to increased scratching and subsequent koebnerization …”

Section: Introductionmentioning

confidence: 99%

Pruritus characteristics in a large Italian cohort of psoriatic patients

Damiani

Cazzaniga

Conic

et al. 2019

Acad Dermatol Venereol

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Background Psoriasis (Ps) is a chronic systemic autoimmune disease associated with pruritus in 64–98% of patients. However, few modestly sized studies assess factors associated with psoriatic pruritus. Objective To investigate factors associated with Ps pruritus intensity. Methods Psoriasis patients 18 years or older seen in one of 155 centres in Italy between September 2005 and 2009 were identified from the Italian PsoCare registry. Patients without cutaneous psoriasis and those with missed information on pruritus were excluded. Results We identified 10 802 patients, with a mean age 48.8 ± 14.3 years. Mild itch was present in 33.2% of patients, moderate in 34.4%, severe in 18.7% and very severe in 13.7%. Higher itch intensity was associated with female gender, lower educational attainment compared to university degree, pustular psoriasis, psoriasis on the head, face, palmoplantar areas, folds and genitalia, more severe disease, disease duration <15 years, and no or few prior systemic treatments. Limitations Effects of specific medication on itch were not assessed. Conclusions Pruritus should be evaluated during psoriasis visits, and physicians should be aware of patients at higher risk for itch. Further studies are needed to assess the effects of medications on itch, and establish therapy for psoriasis patients with persistent itch.

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“…8 Itch is a nearly universal feature of AD and is an essential clinical component in most diagnostic criteria. 13,14 Sleep disturbance due to itch is common in patients with AD, and this itch is often exacerbated at night in a circadian manner. 12 The pruritus can be intense even when there are no visible skin lesions.…”

Section: Itch Characteristics In Admentioning

confidence: 99%

“…In fact, AD is commonly referred as "the itch that rashes," which reflects itch often precedes skin lesions in AD. 13,14 Sleep disturbance due to itch is common in patients with AD, and this itch is often exacerbated at night in a circadian manner. 15 Furthermore, transepidermal water loss (TEWL) is associated with itch intensity in AD, 16 and TEWL increases at night in patients with AD, which may explain why AD patients have nocturnal bouts of itch.…”

Section: Itch Characteristics In Admentioning

confidence: 99%

Immune mediators and therapies for pruritus in atopic dermatitis and psoriasis

Zhou

et al. 2019

J Cutaneous Imm & Allergy

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This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. AbstractAtopic dermatitis (AD) and psoriasis (Pso) are two common inflammatory skin diseases which are symptomatically characterized by pruritus to variable degrees.Whereas AD is nearly always associated with pruritus, only 50%-70% of patients with Pso suffer from itching. Within the last decade, the development of biologic agents targeting specific cytokines or cytokine receptors has led to tremendous progress in suppressing inflammation (and thus improving quality of life) in these two diseases.While suppressing inflammation would generally reduce pruritus in these inflammatory diseases, pruritus is still recalcitrant for treatment in some patients due to relative lack of therapeutics that specifically inhibit pruritus signaling. There is abundant evidence that certain cytokines and neuropeptides-ion channels signaling mediate pruritus that is independent of inflammation in AD and psoriasis. Of note, Janus kinase (JAK) and nerve growth factor (NGF)-tropomyosin receptor kinase A (TrkA)transient receptor potential vanilloid 1 (TRPV1) signaling partially regulates pruritus in AD and psoriasis. JAK kinases inhibitors decrease the extent of itch in patients with AD and psoriasis. In clinical trials, topical inhibitors of TrkA and TRPV1 have been reported to reduce pruritus in patients with Pso and AD, respectively. In this article, we review recent literature knowledge regarding the mechanisms underlying pruritus in AD and Pso, providing hypotheses for why pruritus may be more common in AD than in Pso. In light of the different mechanisms underlying these two diseases, the current and developing therapeutics, either in human clinical trials or animal studies, for targeting pruritus are also discussed. K E Y W O R D SIL-31, neuropeptide, PAR2, SP, thymic stromal lymphopoietin, TRPA1, TRPV1

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Itch intensity in moderate-to-severe plaque psoriasis versus atopic dermatitis: A meta-analysis

Cited by 15 publications

References 4 publications

Itch: an under‐recognized problem in psoriasis

Itch: an under‐recognized problem in psoriasis

Pruritus characteristics in a large Italian cohort of psoriatic patients

Immune mediators and therapies for pruritus in atopic dermatitis and psoriasis

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