Pruritus as a sign of systemic disease.

Pruritus, as one of the most common clinical manifestations in medicine, has been recognized for many centuries. Defined as an unpleasant sensation resulting in the need to scratch, it is divided into acute and chronic stages, based on the duration of the clinical manifestation. Classically, pruritus is associated with cutaneous disorders; however, it may also accompany various systemic disorders, including renal, hepatic, hematologic, or oncologic, and be the first or solitary manifestation of an underlying systemic disease. Additionally, the clinical manifestation may occur as an adverse reaction to drug administration. The pathogenesis of itch is multifactorial, involving various neuromediators and cytokines, with a prominent role of peripheral and central nervous system in its development. Based on an underlying disorder, the affected patients present different clinical patterns of pruritus. Diagnostic approach is based on detailed history taking and physical examination. Frequently, additional diagnostic measures, including laboratory or imaging tests, are performed, especially when the cause of pruritus is unknown. Pruritus remains a challenging clinical manifestation with a significant importance for physicians managing systemic disorders.

Clinical Aspects of Itch in Lichen Planus.

Lichen planus (LP) skin lesions are often accompanied by itch, but this symptom has not been thoroughly examined in LP. To better characterize itch in LP, 78 patients with LP were investigated. Itch was present in 94.9% of patients and was usually described as the most vexing symptom of LP. The mean?±?SD severity of itch according to visual analogue scale score was 6.9?±?2.8 points. Most patients experienced itching daily, pruritus episodes lasted longer than 1 min, and most often occurred in the evening. Itch was frequently described as burning and, for many patients, it was considered burdensome and annoying. The following factors most often increased the perceived severity of pruritus: sweating, high temperature, stress and hot water, while cold water and cold air often resulted in itch reduction. In conclusion, itch is the major subjective symptom of LP. Effective treatment of pruritus should be one of the main goals of LP therapy.

IL-31 is overexpressed in lichen planus but its level does not correlate with pruritus severity.

BACKGROUND: Pruritus is one of the major features of lichen planus (LP); however, its pathogenesis remains largely unknown. Objective. The aim of our study was to analyze the role of IL-31 in the pathogenesis of pruritus in LP. MATERIALS AND METHODS: The study group included 22 patients with LP. Control group consisted of 14 healthy volunteers. All subjects underwent thorough examination. Pruritus severity was evaluated with the visual analogue scale (VAS) and the 12-item Itch Questionnaire. IL-31 expression in the skin was assessed using semiquantitative immunofluorescence analysis. RESULTS: Pruritus maximal intensity according to VAS was 6.5 ± 2.7 points and according to the 12-item Itch Questionnaire 6.9 ± 2.8 points. Lesional LP skin showed significantly higher IL-31 expression compared to healthy skin (P < 0.001). The most abundant immunofluorescence was observed within granular layer. However, there was no correlation between expression of IL-31 and pruritus intensity assessed according to VAS (VASmax: ρ = -0.08, P = 0.73), as well as 12-item Itch Questionnaire: ρ = -0.11, P = 0.65. CONCLUSIONS: Pruritus is a very common symptom of LP. For the first time we have demonstrated that IL-31 is overexpressed in the lesional skin of LP but its expression does not correlate with intensity of pruritus.

Apprehension of the disease by patients suffering from psoriasis.

INTRODUCTION: Psoriasis affects about 1-2% of the entire population. Due to its chronicity and relapsing course, psoriasis has a great influence on patients' quality of life and psychological status. AIM: To evaluate apprehensaion of the disease by psoriatic patients. MATERIAL AND METHODS: One hundred psoriasis patients (36 females, 64 males; mean age 47.3 ±15.8 years) were enrolled. Mean psoriasis severity assessed according to PASI was 17.1 ±10.0 points. Each participant underwent a careful physical examination and completed a specially designed questionnaire containing questions about perception of psoriasis severity, disease aggravating factors, most bothersome symptoms, possible causes of psoriasis and treatment efficacy. RESULTS: A correlation between patients' psoriasis assessment and objective measurement of disease intensity by PASI was weak, albeit significant (ρ = 0.37, p < 0.001). A total of 49% of patients indicated that psoriasis had an enormous negative impact on their life and 40% declared that psoriasis decreased their self-esteem. Patients with decreased self-esteem were significantly younger and more frequently employed. A marked portion of patients believed that their disease will be cured in the future. Patients expecting a rapid cure of disease had experienced a later disease onset and suffered from psoriasis significantly shorter. The most burdensome symptoms of psoriasis were intense epidermal scaling (66% of responders), itching (65%), skin redness (51%), burning (44%), dandruff (38%), and nail abnormalities (37%). CONCLUSIONS: Psoriasis may negatively affect patients' everyday life, but the degree of that influence and the level of psoriasis understanding depend on various clinical parameters as well as on demographic characteristics.

Mediators of pruritus in lichen planus.

Lichen planus (LP) is an inflammatory mucocutaneous disease, showing a wide variety of clinical subtypes. The classic presentation of LP involves the appearance of polygonal, flat-topped, violaceous papules and plaques with reticulated white lines, termed "Wickham's striae". Cutaneous lesions tend to be extremely pruritic, and this symptom does not subside after common antipruritic treatment. Moreover, based on our previous pilot study, it could be stated, that itch is the most unpleasant and bothersome symptom of LP for majority of patients suffering from this disease. However, the underlying mechanisms of itch in lichen planus remain still unknown. In addition, there is no study on mediators of this sensation, but taking into account pathogenesis of LP there are some possible mediators implicated to transmit or modulate itch. In pathogenesis of LP important are such mechanisms as apoptosis, autoimmune reaction, and role of stress. With these pathways some, previously described in other diseases, itch mediators such as cytokines, proteases, and opioid system are connected. Whether these mechanisms are involved in pruritus accompanying LP requires further investigation. Limited knowledge of pruritus origin in lichen planus is responsible for the lack of the effective antipruritic treatments. Here, we describe possible mechanisms participating the pathogenesis of pruritus in lichen planus.