In addition, women with psoriasis often reported vulvar pruritus that did not necessarily correlate with the presence of vulvar psoriatic plaques ( Zamirska et al. Usually, pruritus was limited to lesional skin, but in some patients (in about 20%–30%) itch was also present within the uninvolved skin ( Yosipovitch et al. Importantly, itch was the most common subjective symptom reported by psoriatic patients ( Sampogna et al. Other authors confirmed high frequency of itching among psoriatic subjects, which has ranged from 64% to 97% of studied individuals ( Gupta et al. In 1977, Newbold noted pruritus in 92% of 200 consecutive hospitalized patients with psoriasis. However, studies being performed over the last 30 years have clearly documented that pruritus in psoriasis must be considered as a frequent phenomenon ( Weisshaar 2012). PREVALENCE, SEVERITY, AND CLINICAL PRESENTATION OF ITCH IN PSORIASISįor years, psoriasis was handled as a skin disease, which only occasionally was accompanied by pruritus. Altogether, genetic and extrinsic factors lead to abnormal keratinocyte proliferation, cutaneous inflammation, and skin vessel disturbances finally resulting in clinical features of psoriasis ( Reich and Szepietowski 2007).Ĥ.2. However, environmental factors like infections, stress, some drugs, smoking, or alcohol also play a role. The genetic background seems to be the most important factor, and many genes have been identified to predispose to this skin disease so far ( van de Kerkhof 2003 Reich and Szepietowski 2007). The pathogenesis of psoriasis is still not completely understood. The disease may occur at any age, but two peaks of morbidity can be observed: the first one between 20 and 30 years of age, and the second one between 50 and 60 years of age ( van de Kerkhof 2003). Many patients (up to 80%) have nail abnormalities, and some of them (about 5%–30%) develop psoriatic arthritis. Other clinical subtypes include guttate, erythrodermic, and generalized or localized pustular psoriasis. Less often skin lesions may occur within the flexures and on the face. The most common variant of psoriasis, namely, plaque-type psoriasis, is clinically characterized by the presence of well-demarcated papules and plaques covered by silvery scales, which classically demonstrate symmetric distribution involving most commonly scalp, sacral area, and extensor surfaces of elbows and knees ( Figure 4.1). Psoriasis is a chronic, inflammatory skin disease affecting about 1% to 3% of the Caucasian population and slightly less frequently occurring also in other races.
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