건선과 소양증 = Pruritus in Psoriasis

다국어 초록 (Multilingual Abstract)

Pruritus is much more commonly complained in psoriatic patients than generally expected and the significance of this complaint has often been overlooked by dermatologists. The clinical features and cause of pruritus in psoriasis are not well known. This lecture is aimed to review the prevalence and related clinical characteristics of pruritus in Korean psoriatic patients and the expression of pruritogenic factors in psoriatic lesions with or without pruritus. Questionnaire data from 152 psoriatic patients were analyzed and psoriasis severity was determined by PASI score evaluation. 112 of 152 (73.7%) psoriatic patients suffered from pruritus. The severity and extent of psoriasis in pruritic patients were significantly higher as compared to non-pruritic patients. Important factors to exacerbate pruritus were emotional stress, hot bath, sweating, and so on. There was no correlation between pruritus and sex, age, duration of disease, family history of psoriasis, smoking, and alcohol habits. The pruritus significantly affected quality of life of psoriatic patients. A skin biopsy was obtained from 10 psoriatic patients with pruritus, 10 psoriatic patients without pruritus and 10 normal controls. Immunofluorescence stainings and confocal laser scanning microscopy were performed. Keratinocytes in the psoriatic plaques of patients with pruritus showed consistently increased expression of substance P receptor (SPR), high-affinity nerve growth factor receptor (TrkA) and calcitonin gene-related peptide receptor (CGRPR). In conclusions, pruritus is a common feature in psoriasis. Considering the well-known roles of neuropeptides in pathogenesis of both psoriasis and pruritus, increased SPR, TrkA and CGRPR may be involved in the pathogenesis of pruritus in psoriasis and in the severity of psoriasis. The attempt to relieve symptom of pruritus may improve the overall quality of life of patients with psoriasis and the psoriatic lesion.