From healthcentral.com
Up to 90% of people with psoriasis experience itch—here’s why it happens and how to find relief, from expert treatments to simple at-home remedies
Thick, scaly, discoloured patches of skin are a hallmark of plaque psoriasis, the most common form of this chronic autoimmune condition. While not everyone with psoriasis experiences itching, it’s a prevalent and often distressing symptom. “In my experience, most psoriasis patients do itch,” says board-certified dermatologist Debra Jaliman, M.D., who has a private practice in New York City. In fact, research shows that 60% to 90% of people with psoriasis experience itch (also known as pruritus), which the American Academy of Dermatology (AAD) notes can be the most bothersome symptom for many.
Why Is Psoriasis Itchy?
So why does psoriasis itch—and why does it happen for some people with the condition, but not others? To answer this, we need to go back to the root cause of psoriasis, which is an overactive immune system that triggers inflammation in the skin, leading to the overproduction of skin cells and resulting in those thick, scaly patches. As part of this immune response, skin cells release inflammatory molecules called cytokines, says Shari Lipner, M.D., Ph.D., board-certified dermatologist at Weill Cornell Medicine in New York City. “These cytokines irritate nerves, and signals get transmitted to the spinal cord (the collection of nerves in the center of the spine that carries messages between the brain and the body), which then results in itch,” Dr. Lipner explains.
One of the cytokines released in psoriasis is interleukin-31 (IL-31), which is associated with inflammation and itchiness. “Patients with a higher level of IL-31 seem to have a higher level of itching,” says Dr. Jaliman. However, research to date hasn’t established the exact role of IL-31 in psoriasis, or a clear link between itch severity and IL-31 levels in psoriasis patients.
The amount of skin covered by psoriasis and the severity of disease are all factors that can affect whether a psoriasis patient experiences itch (and to what extent), says Dr. Lipner. “These factors cause different degrees of inflammation,” she explains. “For example, someone with thick plaques covering their whole body will generally be itchier than someone with one small patch.”
The location of psoriasis plaques is also relevant, notes Dr. Jaliman. “If you have psoriasis on your scalp or your lower back, where there’s a higher density of nerve endings to begin with, you might be itchier,” she says.
Factors That Worsen Psoriasis Itching
On top of the itching that occurs as part of the inflammatory response itself, other factors can exacerbate psoriasis itch. The following are common itch triggers, say our experts.
Dry Skin
It’s important to keep your skin hydrated at all times and especially when it’s more susceptible to dryness, such as during cold weather. If you’re prone to dry skin, opt for a heavier moisturizing product, such as an ointment or a cream rather than a lotion. “This forms more of a protective barrier between your skin and the environment,” says Dr. Jaliman. With that protection in place, more moisture will stay in your skin to help keep itch (along with other psoriasis symptoms like cracking and flaking) to a minimum.
Stress
The relationship between stress and psoriasis goes both ways—stress can trigger a psoriasis flare, and living with psoriasis can, in turn, increase stress levels. Experts believe that chronic stress overstimulate the hypothalamic-pituitary-adrenal (HPA) axis, a brain-body pathway that releases hormones and chemicals, fuelling inflammation throughout the body.
Weather
According to the National Psoriasis Foundation (NPF), four out of 10 PsO patients who took part in global NPF research chose winter as the season that most aggravates their condition. But, as the Mayo Clinic points out, being too hot can also exacerbate psoriasis itch.
Certain Fabrics
Many people with itchy skin conditions like psoriasis find that they have to dress accordingly. “Wool, mohair, and synthetic materials like polyester and nylon can irritate the skin, which can then cause itching, says Dr. Jaliman. She recommends wearing natural, lightweight, breathable fabrics that won’t cause discomfort, like cotton or silk. And keep your garments loose if you’re having a flare, so that air can circulate and you’re less likely to sweat (which can also add to the itch factor).
Scratching
The temptation to scratch can often be too much to resist, but it can lead to a frustrating itch-scratch cycle that can be tough to break. Keep your nails clean and trimmed and wear cotton gloves to bed if you have a habit of nocturnal scratching. The AAD suggests reaching for your moisturizer whenever you have the urge to scratch (it’s a good idea to have travel sizes of your favourite hydrating ointment so it’s easy to take out with you, wherever you go). Another way to get instant relief from itch is by placing something cool on your skin, like a cold compress. (The nerves that send those “itch signals” to your brain are less effective when they’re cold, says the AAD.)
How to Relieve Psoriasis Itching
The best way to relieve psoriasis itch is to work with a board-certified dermatologist to find a treatment plan that works for you, says Dr. Lipner. “The better managed your psoriasis is, the less you will itch,” she explains.
It’s important to follow the treatment plan that’s right for you—and everyone is different in how they respond to certain medications and therapies. But you might want to consider some of these suggestions from our experts.
Topical Treatments
Many over-the-counter topicals are available to help relieve psoriasis symptoms, including itch. Dr. Jaliman recommends Sarna Anti-Itch Lotion, which contains menthol and camphor to help with itching and CeraVe Itch Relief Moisturizing Cream, which contains pramoxine (a topical anaesthetic) to numb the area. Many skin care products marketed for eczema can also be great for psoriasis (itch is central to eczema), such as Eucerin Eczema Relief Cream, which contains colloidal oatmeal and ceramides to strengthen the skin’s protective barrier.
Corticosteroids (commonly known as steroids) may help to relieve itch as well as reducing irritation and swelling and slowing the growth of skin cells. Stronger formulations are available on prescription, but an over-the-counter option is Cortizone-10 Intensive-Healing Formula Hydrocortisone 1% Cream. A study published in the Journal of the American Academy of Dermatology found that a four-week course of topical hydrocortisone cream applied twice per day reduced the severity of the participants’ symptoms from a Target Lesion Score (TLS) of 8 (severe) to 2 (mild).
Phototherapy
Phototherapy for psoriasis involves regular exposure of the skin to ultraviolet light, typically ultraviolet A (UVA) and ultraviolet B (UVB) rays. Usually done at a doctor’s office or dermatology clinic, it’s been shown to help with itch. One of the benefits of phototherapy is that if it works for you, it usually works quickly: a study published in the Journal of the German Society of Dermatology found that about 50% to 75% of individuals who had UVB light therapy achieved at least 75% or greater improvement from their baseline within four to six weeks.
Systemic Medications
If you have moderate to severe psoriasis, topical treatments might not be enough to keep your symptoms under control. Your doctor may recommend systemic drugs like cyclosporine (Neoral) and methotrexate (Trexall), prescription drugs that work throughout the body, if topical treatments and phototherapy have been unsuccessful. Unlike topicals that you apply to your skin, systemic meds may be taken orally, by injection, or by infusion. By affecting how the immune system behaves, systemic drugs help to reduce inflammation, which eases itch and other symptoms.
Home Remedies
Tried-and-tested at-home ways to alleviate itch include applying aloe vera to affected areas of skin and taking oatmeal baths, says Dr. Lipner. Meanwhile, Dr. Jaliman recommends using a humidifier to help hydrate the skin and replacing hot baths with lukewarm showers. “Use a moisturizer immediately after getting out of the shower to hydrate your skin, and make sure it’s a fragrance-free product as fragrance can dry out and irritate sensitive skin, leading to more itching,” she adds.
Avoiding Triggers
Knowing your personal psoriasis triggers is a big step in figuring out how to manage your symptoms and avoiding itch. For instance, if stress is a trigger for you, practical tips from the AAD include yoga, support groups, deep breathing exercises, and keeping daily gratitude lists.
Itch may be a common psoriasis symptom—and one that’s not always easy to control—but that doesn’t mean you have to let it take over your life. “If your psoriasis itch is making you uncomfortable, interfering with your ability to concentrate or perform your daily activities, disrupting your sleep, it’s important to see your board-certified dermatologist,” says Dr. Lipner.
If you’re experiencing sore joints alongside severe itch, this may be a sign of psoriatic arthritis. And if your itch is intense to the point that it feels like a burning sensation, this may be erythrodermic psoriasis, a rare type of psoriasis that can appear suddenly and may require emergency medical treatment.
Bottom Line
Psoriasis itch can be one of the trickiest symptoms of the condition but there are different ways to manage it—so persevere until you find the right one. Sometimes, managing symptoms involves a combination of medications, treatments, and lifestyle changes—with some trial-and-error along the way! Remember, your dermatologist is there to help you determine the best way forward.
https://www.healthcentral.com/condition/psoriasis/is-psoriasis-itchy
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