Factors predicting pruritus in psoriasis

(1)

Factors predicting pruritus in psoriasis

Facteurs predictifs du prurit dans le psoriasis

Psoriasisisacommonimmune-mediatedskincondition.Long considerednon-itchy,itiscurrentlywellestablishedthatpruritus isamajor sign,whoselevelsmay beaffectedby arangeof variables.Publisheddataonpruritusinpsoriasisislimited.The aimofthisstudywastoevaluatethefrequencyofpruritusand identifyfactorspredictingpruritusinpatientswithpsoriasis.

Weanalyzeddataofpsoriaticpatientsdiagnosedinourdepart- mentof Dermatologyat Ibn SinaHospital in Rabatbetween January2007andDecember2016collectedretrospectively.

Datawerecollectedfrom59patientswithameanageof42.8 years,ofwhom57,62%weremale.Thirty-fivepatientsreported experiencingpruritus(59.3%) withvaryingfrequencies(37%

severe,40%moderateand22,9%mild).Nosignificantrelation wasfoundbetweenpruritusandage,gender,educationalsta- tus,maritalstatusorcomorbidities.Obesepatientsseemedless likely to have pruritus (P=0.03). Psoriasis vulgaris was the predominant form (71.1%) followed by erythroderma (15.3%), pustular (10.2%) and the inverse forms (3.4%). A significantrelation existed betweenclinical typeof psoriasis andpruritus:theerythrodermic(P=0.048)andpustular(0.038) forms.Theaverageskinareareachedwasestimatedat43%and theaveragePASIscoreat20.6.Reportedprurituswasrelatedto overall psoriasis severity: PASI>15 (P=0.01) and cutaneous area>70%(P=0.04).

Althoughpsoriasisisdefinedasanon-pruriticskindisease, recentstudiesreportedthatpruritusisaverycommoncause ofmorbidityinpsoriasis.Publisheddataonbothprevalence andclinicalmanifestationofpruritusinpsoriasisislimitedand theresultsarecontradictory.Wefoundarelativelyhighprev- alenceofpruritusinpsoriaticpatients(59.38%),butourrate waslower thanthat reportedinprevious studies inwhich Pruritusisobservedinabout70–90%ofpatientswithpsoria- sis[1–3].

Weevaluated the relation betweensociodemographic variables,comorbidities andpruritus,butdetectedno differences.

Likeinourstudy,Szepietowskietal.andotherauthorsreported thatprurituswasnotrelatedtotheageorgenderofthepatients [2].ResultsofPrignano's studyindicatedthat prevalenceand

intensityofprurituswerecorrelatedwithBMI[3].Inourstudy, obesepatientsseemedlesslikelytohavepruritus.

Ourresultssuggestedthatthepresenceofprurituswasrelated toclinicaltypeofpsoriasis,mostlytheerythrodermicandpus- tularforms,incontrarywithafewstudies[2,4].

Anotherfindingfrom ourstudyisthatprurituswascorrelated withtheseverityofthereachedskinareaandhigherPASIscore.

ThisfindingremainsinaccordancewithreportsofSinghetal.and someotherauthorswhofoundpruritusintensityorfrequency[1]

toberelatedtopsoriasisseverity[2,4].Prignanoetal.,aswellas otherauthors,failedtofindsucharelationship[3].

Itiswellknownthatpsychiatricdiseaseshavebeenassociated with pruritus. Although, itch severity has been found to be mediated by stress andanxiety andmay beexacerbated by thescratch–itchcycle[2].Remrödetal.foundthatpatientswith psoriasis and severepruritus had high associateddepressive scores[5].Inourstudyweidentifiedonly7(11.8%)patients whoreporteddepression.Duetothesocioculturalcharacteristics ofourcountry,patientstendtohidetheirdiagnosesofpsychi- atricdisorderssuchasdepression.

This study has demonstrated that pruritus is very prevalent amongpsoriasispatientsandyieldedseveralclinicallyrelevant findingsconcerningfactorspredictingpruritusinpatientswith psoriasis. Dermatologistsshouldbeaware ofthepresence of pruritus in their patients when deciding upon therapeutic approachesforpsoriasis.

Disclosureofinterest:theauthorsdeclarethattheyhavenocompeting interest.

References

[1] Janowski K, Steuden S, BogaczewiczJ. Clinical andpsychological characteristicsofpatientswithpsoriasisreportingvariousfrequencies ofpruritus.IntJDermatol2014;53(7):820–9.

[2] SzepietowskiJC, ReichA, Wis´nickaB. Itchinginpatientssufferingfrom psoriasis.ActaDermatovenerolCroat2002;10(4):221–6.

[3] PrignanoF, RicceriF, PescitelliL, LottiT. Itchinpsoriasis:epidemiology, clinicalaspectsandtreatment options.ClinCosmetInvestigDermatol 2009;2:9–13.

[4] BahaliAG, OnsunN,SuO,OzkayaDB, DizmanD, TopukcuB,etal.The relationshipbetweenpruritusandclinicalvariablesinpatientswithpsori- asis.AnBrasDermatol2017;92(4):470–3.

[5] RemrödC, SjöströmK, SvenssonÅ. Pruritusinpsoriasis:astudyof personalitytraits,depressionandanxiety.ActaDermVenereol2015;95 (4):439–43.

LPM-3756 Tocitethisarticle:MansouriS,etal.Factors predictingpruritusin psoriasis.PresseMed.(2019),https://doi.org/10.1016/j.

lpm.2019.02.016

tomexx>n8x>xx2018

Letter to the editor

1

PresseMed.2019;//:///

enlignesur/onlineon www.em-consulte.com/revue/lpm www.sciencedirect.com

(2)

SihamMansouri,C.Ebongo,L.Benzekri,K.Senouci,B.Hassam IbnSinaHospital,DermatologyDepartment,10000Rabat,Morocco Correspondence:SihamMansouri,IbnSinaHospital,Dermatology Department,10000Rabat,Morocco siham-mnsr@hotmail.fr

Received1stSeptember2018 Accepted13February2019 Availableonline:

https://doi.org/10.1016/j.lpm.2019.02.016

S.Mansouri,C.Ebongo,L.Benzekri,K.Senouci,B.Hassam

tomexx>n8x>xx2018

Tocitethisarticle:MansouriS,etal.Factorspredictingpruritusinpsoriasis.PresseMed.(2019),https://doi.org/10.1016/j.

lpm.2019.02.016

2