Pruritus Lowers Quality of Life, Sleep Quality in Patients With Psoriasis

Patients with psoriasis who also experienced pruritus had a lower quality of life and worse sleep quality compared with those without psoriasis and pruritus, according to a study published in the Journal of Clinical Medicine.

Psoriasis is linked to quality of life, as patients with psoriasis are often self-conscious of the rashes that they have. Sleep quality has been reported as suffering due to psoriasis but data on this is limited. The current study aimed to “investigate and characterize the differences of [quality of life] and sleep problems in different clinical variants of psoriasis with a special emphasis put on the role of pruritus, as it is the most frequent and the most bothersome subjective symptom of psoriasis.”

The current study was conducted from June 2020 to November 2021 in Poland and Turkey. Participants were recruited from patients visiting dermatological departments. Patients were included if they had an established diagnosis of psoriasis that could be classified into a predefined subtype and were able to complete questionnaires. Patients were excluded if they were aged 15 years and younger, were illiterate, had treatment for psoriasis within 2 or 4 weeks before study inclusion, were pregnant, were breastfeeding, or had used drugs that had natipruritic potential.

All participants were split into 9 groups depending on their manifestation of psoriasis: large-plaque psoriasis, small-plaque psoriasis, guttate psoriasis, palmoplantar psoriasis, psoriasis on the scalp, inverse psoriasis, erythrodermic psoriasis, palmoplantar pustular psoriasis (PPPP), and generalized pustular psoriasis.

Quality of life was determined with the Dermatology Life Quality Index (DLQI). The Numerical Rating Scale and the Pruritus Severity Scale were used to assess pruritus in the participants.

The researchers found that the quality of life of almost all patients was diminished. The mean (SD) DLQI was 12.7 (7.9) points out of 30. Patients demonstrated either a very large effect (36.7%) or an extremely large effect (26.5%) of psoriasis on quality of life. Only 7.5% reported no influence on their quality of life. The erythrodermic psoriasis variant saw the largest effect on quality of life (mean DLQI, 18.1 [6.9]) compared with other subtypes.

A total of 39.3% of participants had occasional problems in falling asleep and 22.7% had difficulties falling asleep almost every night. A total of 20.3% woke up during sleep almost every night and 33.6% had this issue sporadically. Most of the participants (79.0%) did not take any sleep medications, despite these issues.

Participants with more severe psoriasis had a worse quality of life. A higher DLQI score was also found in participants with pruritus within the previous 3 days (mean DLQI in group with pruritus, 13.5 [7.5] points vs DLQI in group without pruritis, 8.0 [8.0]). Patients with generalized pruritus had the highest mean DLQI score of 16.9 (7.6) points.

Scoring of DLQI was independent of gender (female, 12.4 [7.7] vs male, 12.8 [8.1]), age, psoriasis duration, and the existence of psoriatic arthritis (with vs without psoriatic arthritis, 13.4 [8.7] vs 12.6 [7.8] points).

Pruritus was also associated with sleeping problems. Participants with more severe pruritus reported difficulties falling asleep, waking up from sleep, and needing sleeping pills more often than those with less severe pruritus. Quality of life was linked to the intensity of pruritus, notably in patients with psoriasis of the scalp and PPPP.

There were some limits to this study. Only the DLQI was used to measure quality of life and did not have a specific instrument for psoriasis. Sleeping impairment was diagnosed based on 3 questions rather than a questionnaire.

The researchers concluded that psoriasis markedly decreased the participants’ quality of life and sleep quality due to the presence of pruritus.

Reference

Jaworecka K, Rzepko M, Marek-Jozefowicz L, et al. The impact of pruritus on the quality of life and sleep disturbances in patients suffering from different clinical variants of psoriasis. J Clin Med. 2022;11:5553. doi:10.3390/jcm11195553