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Pruritus and sleep disturbances in patients with psoriasis

Archives of Dermatological Research volume 312, pages 103–111 (2020)Cite this article

Abstract

Psoriasis is a prevalent skin disease that impairs multiple domains of quality of life (QoL). Pruritus, a common symptom in patients with psoriasis, may directly affect sleep, but studies investigating this are limited. We investigated the relationships between pruritus and sleep in 104 in-patients with psoriasis, who underwent dermatological assessment and completed questionnaires to determine psoriasis severity, pruritus intensity, sleep quality, QoL (skin disease-specific and generic), depressive mood and anxiety. In total, 80% of patients reported pruritus, and 39% had sleep disturbances, most commonly awakenings during sleep (33%) and sleepiness during the daytime (30%). Sleep impairment was more frequent in patients with pruritus, who had more difficulty falling asleep (P = 0.031). Overall, 14% of all patients and 34% of the patients who reported sleep disturbances reported that their sleep problems were caused by pruritus. Patients who reported sleep disturbances had lower generic QoL. Pruritus in patients with psoriasis was frequent and relevant, as evidenced by the higher rate of sleep problems in this patient group, and it was linked to a lower QoL.

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References

  1. Altena E, Van Der Werf YD, Strijers RL, Van Someren EJ (2008) Sleep loss affects vigilance: effects of chronic insomnia and sleep therapy. J Sleep Res 17(3):335–343. https://doi.org/10.1111/j.1365-2869.2008.00671.x(Epub 2008/10/11)

    Article  PubMed  Google Scholar 

  2. Amatya B, Wennersten G, Nordlind K (2008) Patients' perspective of pruritus in chronic plaque psoriasis: a questionnaire-based study. J Eur Acad Dermatol Venereol 22(7):822–826. https://doi.org/10.1111/j.1468-3083.2008.02591.x

    Article  CAS  PubMed  Google Scholar 

  3. Beck AT, Steer RA, Garbin MG (1988) Psychometric properties of the beck depression inventory—25 years of evaluation. Clin Psychol Rev 8(1):77–100. https://doi.org/10.1016/0272-7358(88)90050-5

    Article  Google Scholar 

  4. Breslau N, Roth T, Rosenthal L, Andreski P (1996) Sleep disturbance and psychiatric disorders: a longitudinal epidemiological study of young adults. Biol Psychiatry 39(6):411–418 (Epub 1996/03/15)

    Article  CAS  PubMed  Google Scholar 

  5. Carney CE, Segal ZV, Edinger JD, Krystal AD (2007) A comparison of rates of residual insomnia symptoms following pharmacotherapy or cognitive-behavioral therapy for major depressive disorder. J Clin Psychiatry 68(2):254–260 (Epub 2007/03/06)

    Article  CAS  PubMed  Google Scholar 

  6. Finlay AY, Khan GK (1994) Dermatology Life Quality Index (DLQI)–a simple practical measure for routine clinical use. Clin Exp Dermatol 19(3):210–216

    Article  CAS  PubMed  Google Scholar 

  7. Franzen PL, Buysse DJ (2008) Sleep disturbances and depression: risk relationships for subsequent depression and therapeutic implications. Dialogues Clin Neurosci 10(4):473–481 (Epub 2009/01/28)

    PubMed  PubMed Central  Google Scholar 

  8. Gezer O, Batmaz I, Sariyildiz MA, Sula B, Ucmak D, Bozkurt M, Nas K (2017) Sleep quality in patients with psoriatic arthritis. Int J Rheum Dis 20(9):1212–1218. https://doi.org/10.1111/1756-185X.12505(Epub 2014/11/05)

    Article  CAS  PubMed  Google Scholar 

  9. Globe D, Bayliss MS, Harrison DJ (2009) The impact of itch symptoms in psoriasis: results from physician interviews and patient focus groups. Health Qual Life Outcomes 7:62. https://doi.org/10.1186/1477-7525-7-62

    Article  PubMed  PubMed Central  Google Scholar 

  10. Gowda S, Goldblum OM, McCall WV, Feldman SR (2010) Factors affecting sleep quality in patients with psoriasis. J Am Acad Dermatol 63(1):114–123. https://doi.org/10.1016/j.jaad.2009.07.003

    Article  PubMed  Google Scholar 

  11. Hawro M, Maurer M, Weller K, Maleszka R, Zalewska-Janowska A, Kaszuba A, Gerlicz-Kowalczuk Z, Hawro T (2017) Lesions on the back of hands and female gender predispose to stigmatization in patients with psoriasis. J Am Acad Dermatol 76(4):648–654. https://doi.org/10.1016/j.jaad.2016.10.040(e642, Epub 2017/01/11)

    Article  PubMed  Google Scholar 

  12. Hawro T, Miniszewska J, Chodkiewicz J, Sysa-Jedrzejowska A, Zalewska A (2007) Anxiety, depression and social support in patients with psoriasis. Przegl Lek 64(9):568–571

    PubMed  Google Scholar 

  13. Hawro T, Ohanyan T, Schoepke N, Metz M, Peveling-Oberhag A, Staubach P, Maurer M, Weller K (2018) Comparison and interpretability of the available urticaria activity scores. Allergy 73(1):251–255. https://doi.org/10.1111/all.13271(Epub 2017/08/18)

    Article  CAS  PubMed  Google Scholar 

  14. Jensen P, Zachariae C, Skov L, Zachariae R (2018) Sleep disturbance in psoriasis: a case-controlled study. Br J Dermatol 179(6):1376–1384. https://doi.org/10.1111/bjd.16702(Epub 2018/04/29)

    Article  CAS  PubMed  Google Scholar 

  15. Kaaz K, Szepietowski JC, Matusiak L (2018) Influence of itch and pain on sleep quality in atopic dermatitis and psoriasis. Acta Derm Venereol. https://doi.org/10.2340/00015555-3065(Epub 2018/10/12)

    Article  PubMed  Google Scholar 

  16. Kabashima K, Furue M, Hanifin JM, Pulka G, Wollenberg A, Galus R, Etoh T, Mihara R, Nakano M, Ruzicka T (2018) Nemolizumab in moderate-to-severe atopic dermatitis: randomized, phase II, long-term extension study. J Allergy Clin Immunol. https://doi.org/10.1016/j.jaci.2018.03.018(Epub 2018/05/13)

    Article  PubMed  Google Scholar 

  17. Kido-Nakahara M, Katoh N, Saeki H, Mizutani H, Hagihara A, Takeuchi S, Nakahara T, Masuda K, Tamagawa-Mineoka R, Nakagawa H, Omoto Y, Matsubara K, Furue M (2015) Comparative cut-off value setting of pruritus intensity in visual analogue scale and verbal rating scale. Acta Derm Venereol 95(3):345–346. https://doi.org/10.2340/00015555-1972(Epub 2014/09/18)

    Article  PubMed  Google Scholar 

  18. Krause K, Kessler B, Weller K, Veidt J, Chen SC, Martus P, Church MK, Metz M, Maurer M (2013) German version of ItchyQoL: validation and initial clinical findings. Acta Derm Venereol 93(5):562–568. https://doi.org/10.2340/00015555-1544(Epub 2013/03/16)

    Article  PubMed  Google Scholar 

  19. Krueger G, Koo J, Lebwohl M, Menter A, Stern RS, Rolstad T (2001) The impact of psoriasis on quality of life: results of a 1998 National Psoriasis Foundation patient-membership survey. Arch Dermatol 137(3):280–284

    CAS  PubMed  Google Scholar 

  20. Lavery MJ, Stull C, Nattkemper LA, Sanders KM, Lee H, Sahu S, Valdes-Rodriguez R, Chan YH, Yosipovitch G (2017) Nocturnal pruritus: prevalence, characteristics, and impact on ItchyQoL in a chronic itch population. Acta Derm Venereol 97(4):513–515. https://doi.org/10.2340/00015555-2560(Epub 2016/11/03)

    Article  PubMed  Google Scholar 

  21. Leger D, Scheuermaier K, Philip P, Paillard M, Guilleminault C (2001) SF-36: evaluation of quality of life in severe and mild insomniacs compared with good sleepers. Psychosom Med 63(1):49–55 (Epub 2001/02/24)

    Article  CAS  PubMed  Google Scholar 

  22. Mease PJ, Menter MA (2006) Quality-of-life issues in psoriasis and psoriatic arthritis: outcome measures and therapies from a dermatological perspective. J Am Acad Dermatol 54(4):685–704. https://doi.org/10.1016/j.jaad.2005.10.008(Epub 2006/03/21)

    Article  PubMed  Google Scholar 

  23. Mrowietz U, Chouela EN, Mallbris L, Stefanidis D, Marino V, Pedersen R, Boggs RL (2015) Pruritus and quality of life in moderate-to-severe plaque psoriasis: post hoc explorative analysis from the PRISTINE study. J Eur Acad Dermatol Venereol 29(6):1114–1120. https://doi.org/10.1111/jdv.12761(Epub 2014/11/05)

    Article  CAS  PubMed  Google Scholar 

  24. Neckelmann D, Mykletun A, Dahl AA (2007) Chronic insomnia as a risk factor for developing anxiety and depression. Sleep 30(7):873–880 (Epub 2007/08/09)

    Article  PubMed  PubMed Central  Google Scholar 

  25. Nutt D, Wilson S, Paterson L (2008) Sleep disorders as core symptoms of depression. Dialog Clin Neurosci 10(3):329–336 (Epub 2008/11/05)

    Google Scholar 

  26. O'Neill JL, Chan YH, Rapp SR, Yosipovitch G (2011) Differences in itch characteristics between psoriasis and atopic dermatitis patients: results of a web-based questionnaire. Acta Derm Venereol 91(5):537–540. https://doi.org/10.2340/00015555-1126

    Article  PubMed  Google Scholar 

  27. Reich A, Chatzigeorkidis E, Zeidler C, Osada N, Furue M, Takamori K, Ebata T, Augustin M, Szepietowski JC, Stander S (2017) Tailoring the cut-off values of the visual analogue scale and numeric rating scale in itch assessment. Acta Derm Venereol 97(6):759–760. https://doi.org/10.2340/00015555-2642(Epub 2017/02/23)

    Article  PubMed  Google Scholar 

  28. Reich A, Hrehorów E, Szepietowski JC (2010) Pruritus is an important factor negatively influencing the well-being of psoriatic patients. Acta Derm Venereol 90(3):257–263. https://doi.org/10.2340/00015555-0851

    Article  PubMed  Google Scholar 

  29. Roth T (2000) Diagnosis and management of insomnia. Clin Cornerstone 2(5):28–38 (Epub 2000/06/30)

    Article  CAS  PubMed  Google Scholar 

  30. Sampogna F, Gisondi P, Melchi CF, Amerio P, Girolomoni G, Abeni D, Investigators IDIMPRoVE (2004) Prevalence of symptoms experienced by patients with different clinical types of psoriasis. Br J Dermatol 151(3):594–599. https://doi.org/10.1111/j.1365-2133.2004.06093.x

    Article  CAS  PubMed  Google Scholar 

  31. Shahwan KT, Kimball AB (2017) Itch intensity in moderate-to-severe plaque psoriasis versus atopic dermatitis: a meta-analysis. J Am Acad Dermatol 76(6):1198–1200. https://doi.org/10.1016/j.jaad.2017.02.002(e1191, Epub 2017/05/20)

    Article  PubMed  Google Scholar 

  32. Skevington SM, Lotfy M, O'Connell KA, Group W (2004) The World Health Organization's WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group. Qual Life Res 13(2):299–310

    Article  Google Scholar 

  33. Smolensky MH, Portaluppi F, Manfredini R, Hermida RC, Tiseo R, Sackett-Lundeen LL, Haus EL (2015) Diurnal and twenty-four hour patterning of human diseases: acute and chronic common and uncommon medical conditions. Sleep Med Rev 21:12–22. https://doi.org/10.1016/j.smrv.2014.06.005(Epub 2014/08/19)

    Article  PubMed  Google Scholar 

  34. Spielberger CD, Gorsuch RL, Lushene R, Vagg P-R, Jacobs GA (1983) Manual for the state-trait anxiety inventory. Consulting Psychologists Press, Palo Alto

    Google Scholar 

  35. Staner L (2003) Sleep and anxiety disorders. Dialog Clin Neurosci 5(3):249–258 (Epub 2003/09/01)

    Google Scholar 

  36. Suilmann T, Zeidler C, Osada N, Riepe C, Stander S (2018) Usability of validated sleep-assessment questionnaires in patients with chronic pruritus: an interview-based study. Acta Derm Venereol. https://doi.org/10.2340/00015555-2947(Epub 2018/04/25)

    Article  PubMed  Google Scholar 

  37. Szepietowski JC, Reich A, Szepietowski T (2005) Emollients with endocannabinoids in the treatment of uremic pruritus: Discussion of the therapeutic options. Ther Apheresis Dial 9(3):277–279. https://doi.org/10.1111/j.1774-9987.2005.00271.x

    Article  Google Scholar 

  38. Vgontzas AN, Liao D, Bixler EO, Chrousos GP, Vela-Bueno A (2009) Insomnia with objective short sleep duration is associated with a high risk for hypertension. Sleep 32(4):491–497 (Epub 2009/05/06)

    Article  PubMed  PubMed Central  Google Scholar 

  39. Wichniak A, Wierzbicka A, Walecka M, Jernajczyk W (2017) Effects of antidepressants on sleep. Curr Psychiatry Rep 19(9):63. https://doi.org/10.1007/s11920-017-0816-4(Epub 2017/08/10)

    Article  PubMed  PubMed Central  Google Scholar 

  40. Wolkove N, Elkholy O, Baltzan M, Palayew M (2007) Sleep and aging: 1 Sleep disorders commonly found in older people. CMAJ 176(9):1299–1304. https://doi.org/10.1503/cmaj.060792 (Epub 2007/04/25)

    Article  PubMed  PubMed Central  Google Scholar 

  41. Yosipovitch G, Goon A, Wee J, Chan YH, Goh CL (2000) The prevalence and clinical characteristics of pruritus among patients with extensive psoriasis. Br J Dermatol 143(5):969–973

    Article  CAS  PubMed  Google Scholar 

  42. Yosipovitch G, Goon AT, Wee J, Chan YH, Zucker I, Goh CL (2002) Itch characteristics in Chinese patients with atopic dermatitis using a new questionnaire for the assessment of pruritus. Int J Dermatol 41(4):212–216

    Article  PubMed  Google Scholar 

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Acknowledgements

We are grateful for the editorial assistance provided by Gillian Brodie of Orbit Medical Communications, Cambridge, UK, with the help of the urticaria network e.V. (UNEV, https://www.urtikaria.net). We also thank Professor Andrzej Kaszuba for enabling us recruitment of patients at the Department of Dermatology, Pediatric Dermatology and Oncology, Medical University of Łódź, Łódź, Poland.

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Authors and Affiliations

  1. Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Tomasz Hawro, Marlena Hawro, Karsten Weller, Martin Metz & Marcus Maurer

  2. Psychodermatology Department, Clinical Immunology and Rheumatology, Medical University of Łódź, Łódź, Poland

    Anna Zalewska-Janowska

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  1. Tomasz Hawro
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Correspondence to Marcus Maurer.

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MH, AZJ, KW, MM and MM have no relevant conflicts of interest. TH has served on an advisory board for Galderma.

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All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Ethics Committee of the Medical University of Łódź; approval no. RNN/240/09/KE) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Hawro, T., Hawro, M., Zalewska-Janowska, A. et al. Pruritus and sleep disturbances in patients with psoriasis. Arch Dermatol Res 312, 103–111 (2020). https://doi.org/10.1007/s00403-019-01998-7

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  • DOI: https://doi.org/10.1007/s00403-019-01998-7

Keywords

  • Psoriasis
  • Sleep
  • Pruritus
  • Quality of life
  • Anxiety
  • Depression