Symptoms: Itching and Burning

If you have plaque psoriasis, you know how upsetting it can be. Your psoriasis lesions may feel itchy and painful much of the time. But when you scratch them, they may hurt, burn, and itch even more.^1-7

Severe itching of the skin is called pruritus. Four out of 5 people with plaque psoriasis experience it – most of them daily. This itching may bother you physically, emotionally, and mentally. But science can shed some light on causes and treatments for this intense itch.^1-7

Why does my skin itch more than other people’s skin?

When you have psoriasis, your skin handles itch differently than other people’s skin does. Psoriasis-affected skin may have:^3,4,6

• More nerves than healthy skin, reacting more strongly to things that affect them (stimuli)
• More itch-sensitive fibers, which sense itch more strongly
• An imbalance of opioid receptors, making you feel pain more intensely
• More blood vessels, leading to a stronger immune response (swelling and itching)

What causes itching and pain with psoriasis?

Three main types of events can trigger psoriatic itch and pain: skin stimulation, plaque lesion stimulation, and mental stimulation. In each case, itch is activated in a complex way.^2-4,6

Skin stimulation

Events both outside and inside of your skin can start the itch-scratch-itch-pain sequence. Here is how itch can be activated in your skin:^2,6

• Chemical substances in your body activate your skin’s itch-receptor nerves.
• Those nerves send itch messages to your brain.
• Your brain responds with a scratch impulse.
• Scratching releases itch-provoking substances.
• These substances trigger your immune system’s inflammatory (swelling) response, leading to more itching and pain.
• Dry, flaky, cracked, damaged, or bleeding skin can also cause itching and pain.

Plaque lesion stimulation

Your plaque lesions themselves can also set the itch sequence in motion.^2-4,6

• Overactive skin cell growth forms plaques, activating immune system cells.
• These trigger inflammation, followed by itching.
• Plaque lesions easily become dry, cracked, and damaged, triggering itching.

Mental stimulation

Finally, mental stress can cause your brain to send chemical “itch” messages to your plaque lesions:^2,3

• Stress activates your nervous, chemical messaging, and behavioral systems.
• These systemic responses can decrease your body’s ability to take care of itself.
• Severe, ongoing stress hinders your skin’s ways of repairing itself.
• Impaired skin repair can lead to itching, scratching, damaged, painful skin, and further itching.
• Stress can also trigger scratching – an attempt to get rid of a painful situation.

How do itching and pain affect quality of life?

Constant itching and painful scratching may make your life more difficult. You may experience some or all of the following effects:^2,4,6

• Lack of good sleep, or inability to sleep at all
• Changed social life
• Strained relationships
• Trouble with daily activities (housework, cooking, errands)
• Trouble concentrating and performing well at work/school
• Appetite changes
• Embarrassment, frustration, annoyance, anger
• Depression, anxiety, or even thoughts of self-harm

How is itching treated?

Managing your symptoms can help you live your best life despite psoriasis itch and pain. Most people benefit from a combination of:^2,4,7

• Products applied to the skin (topical products)
• Light therapy (aka phototherapy)
• Biologic medicines
• Stress-management training

Topical products

Topical products can lessen itch and pain by reducing inflammation, dryness, and flaking. They are available over the counter or by prescription. Topicals for psoriasis include:^4,7

• Ointments with coal tar, salicylic acid, and corticosteroids
• Cold wraps and cool baths/showers
• Antihistamines like hydroxyzine or chlorpheniramine maleate

Phototherapy

Treating psoriasis with a special type of light may relieve itch and pain. Phototherapy might cause sensitivity at first, so your doctor may suggest other treatments at the same time.^4,7

Biologic medicines

Special medicines called biologics may calm your body’s reactions to psoriasis triggers. These drugs block active elements in your body that are part of the inflammatory itch cycle. The US Food and Drug Administration (FDA) has approved 11 biologics for psoriasis, and 3 are approved for use with children.⁷

• Adalimumab (Humira®)
• Brodalumab (Siliq™)
• Certolizumab pegol (Cimzia®)
• Etanercept (Enbrel®)
• Guselkumab (Tremfya™)
• Infliximab (Remicade®)
• Ixekizumab (Taltz®)
• Risankizumab (Skyrizi™)
• Secukinumab (Cosentyx®)
• Tildrakizumab (Ilumya™)
• Ustekinumab (Stelara®)

Stress-management training and counseling

One research review noted that people with psoriasis often had difficult situations in their past. Such life situations may include:^1,2

• Childhood trauma
• Stressful life events
• Long-lasting family distress
• Family secrets
• Emotional abuse
• Substance use disorder

The stress of these events, together with present-day stress, can make psoriasis and itching worse. It also can lead to:²

• Chronic stress
• Depression
• Helplessness
• Anxiety
• Inability to feel safe

Counseling, stress-management techniques, and medicines may help manage this cycle. In one study of people with psoriasis, family counseling sessions helped decrease stress. This notably reduced the patients’ need to itch. Participants reported better quality of life, daily performance, and sleep.²

Together with your doctor, skin-health specialist (dermatologist), and a counselor, you can find relief from psoriasis itch and burn. Talk with your doctor about which treatment options are best for you.^2,4