gms | German Medical Science

Background and state of (inter)national research: About 60-90% of patients with psoriasis suffer from pruritus and 65% report itching as one of the most burdensome symptoms, raising significant quality of life (QoL) impairments. However, pruritus is not only an intrapersonal symptom but a socially interactive phenomenon and little is known about the effects of itching on interpersonal experiences.

Research questions and objectives: This study aimed

1.

to compare the burden of psoriasis and patient needs between patients with moderate/severe vs. none/mild pruritus, and

2.

to examine the impact of disease parameters and intrapersonal burden on perceived stigmatization and sexual relationships.

Methods or hypothesis: Cross-sectional observational study including German patients aged ≥ 18 years with psoriasis. Psoriasis severity was assessed with PASI and severity of pruritus was rated by patients within a numeric rating scale (NRS) ranging from 0 to 10; patients also reported on skin-generic QoL (DLQI), pruritus-specific QoL (Itchy-QoL), patient benefit index (PBI, including the patient needs questionnaire [PNQ] and patient benefits questionnaire [PBQ]), Dysmorphic Concern Questionnaire (DCQ), Perceived Stigmatization Questionnaire (PSQ) and Relationship and Sexuality Scale (RSS).

Results: 107 patients with psoriasis (mean age=46.3±14.6; 52.3% male), 64 with no/mild pruritus (NRS ≤ 3) and 43 with moderate/severe pruritus (NRS ≥ 4) were included. Analyses of covariance, controlling for gender, biologic treatment, comorbidities and PASI, showed that patients with moderate/severe pruritus reported more QoL impairments (F(1, 101)=27.3, p < 0.01 for DLQI and F(1, 94)=39.3, p < 0.01 for Itchy-QoL), more dysmorphic concerns (F(1, 98)=4.5, p=0.04) but less treatment benefits (F(1, 88)=16.5, p < 0.01) than those with none/mild pruritus. No significant differences were found for interpersonal experiences (i.e., PSQ and RSS). The patient needs most frequently rated as “very/quite important“ were: “be healed of all skin defects“ (88.8%), “be free of itching“ (87.0%) and “have confidence in the therapy“ (86.0%), with no differences between the groups. However, patients with moderate/severe pruritus rated the needs of “no longer have burning sensations on skin” (Z=-2.0, p=0.04), “be less of a burden to relatives and friends” (Z=-2.2, p=0.03), “be able to engage in normal leisure activities” (Z=-2.1, p=0.04), “be less burdened in partnership” (Z=-2.5, p=0.01) and “regain control of the disease” (Z=-2.3, p=0.02) as more important. Regression analyses explained 48.9% of the variance of PSQ and 41.9% of RSS. Higher stigmatization was associated with younger age, higher PASI, higher frequency of scratching behaviors, more dysmorphic concerns and more treatment benefits, while more sexual dysfunction was associated with higher PASI, sleeping problems and more DLQI impairments.

Discussion: Pruritus induces significant burden and therapeutic needs in patients with psoriasis. Along with disease severity, intrapersonal burden has a great impact on social and dyadic relationships.

Practical implications: Treatment choices that are effective in reducing pruritus should be prioritized in patient-centered healthcare.