Abstract
The pathogenesis of pruritus in psoriasis remains unclear. Many possible mediators were implicated to transmit or modulate this sensation in psoriasis, but none has been clearly proven to be a causative agent of itching. The most often discussed theory mentioned the importance of impaired innervations and neuropeptides imbalance in psoriatic skin. Other possible causes of itching might be increased expression of interleukin 2 or vascular abnormalities. Recent data indicated that pruritus could be also evoked by opioid system, prostanoids, interleukin 31, serotonin, or proteases. Whether these mechanisms are also involved in pruritus accompanying psoriasis requires further investigation. Limited knowledge of pruritus origin in psoriasis is responsible for the lack of the effective antipruritic treatments for psoriatics. Here, we summarize the current knowledge about the pathogenesis of pruritus in psoriasis and point out possible directions of future studies aiming the pathogenesis of this symptom in psoriasis.
Highlights
Local inflammatory mechanisms may induce pruritus in many dermatoses
Despite less intensive, pruritus was mentioned by many psoriatic patients as the most bothersome symptom of psoriasis [5] and it was clearly documented that pruritus intensity significantly correlated in psoriatics with degree of quality of life impairment, level of stigmatization, as well as the presence and severity of depressive symptoms [12]
It seems that patients with pruritus suffer from more severe psoriasis [4, 6, 8] some authors did not find a significant relationship between pruritus intensity and psoriasis severity [5]
Summary
Local inflammatory mechanisms may induce pruritus in many dermatoses. Mild-to-severe pruritus accompanies numerous inflammatory skin disorders including atopic dermatitis, eczema, psoriasis, or lichen planus. The mean intensity of this symptom assessed according to 10 point Visual Analogue Scale ranged between 3.7–6.4 points [5, 7, 10,11,12] This is less than the intensity of pruritus observed in atopic dermatitis or uremic pruritus [13, 14]. Despite less intensive, pruritus was mentioned by many psoriatic patients as the most bothersome symptom of psoriasis [5] and it was clearly documented that pruritus intensity significantly correlated in psoriatics with degree of quality of life impairment, level of stigmatization, as well as the presence and severity of depressive symptoms [12]. We reviewed the available literature data on this symptom in order to summarize our current knowledge of the origin of pruritus in psoriasis
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