Underestimated itching symptom in psoriasis: diagnostic limitations and correction paths

The burden of psoriasis is caused not only by severity, duration of the disease course, damage to visible areas of the skin and scalp, inclusion of the nail plates and joints, comorbidities, reduced quality of life, disability, as well as difficulties in the disease control, but by intense itching, painful sensations, burning sensation, which are present in more than 80% of the cases. The severity of psoriasis (clinical manifestations) is assessed using various indices (PASI, BSI, DLQI, NAPSI) and is the basis for therapy selection, but subjective symptoms are not always considered. Intense itching, which exacerbates when the clinical picture worsens, is the most common cause for seeking medical attention in search for effective therapy along with rashes. Modern methods of itchy psoriasis treatment are limited (emollients, topical glucocorticosteroids, including combination medicinal products with calcipotriol, antihistamines, psychopharmacotherapy and psychotherapy, GIBT, phototherapy, «small molecules»). Pathogenesis of itching in psoriasis has not been fully studied, but the role of neurotransmitters, participation of the immune, endocrine, nervous systems and aggravation in presence of the patient’s psychoemotional state disorder are discussed. The stress factor acts as a trigger in the onset and relapses of the process, often contributing to the preservation of subjective feelings. Regular use of background therapy with emollients, as well as combination medicinal products containing betamethasone and calcipotriol, allows to reduce the clinical picture specific for psoriasis and control the itching. The positive effect is confirmed by clinical data, questionnaire results (VAS, ItchyQol) and long-term follow-up. The work analyzes clinical experience of treatment of patients with itchy psoriasis, nuances of topical therapy administration, features of clinical status of patients, as well as substantiates the pathogenetic component of therapy considering the literature data.