Table 1 Select Comments Regarding Itch Symptoms from Clinician Interviews

Assessment of Severity

"By how much the patient describes the itch. Like, if they say, it wakes me up at night, or it keeps me up at night, or it's relentless, or it drives me crazy, I know the itch is severe. Plus, you know, I might ask the patient to grade it on a scale of one to ten, how bad is your itch, with ten being the worst, one is being pretty mild or not present. (...) Oh, just the one to ten scale, that's the only systematic way I can grade itch numerically."

"Well, I don't have a scale typically in the clinic. There is no numeric scale that I use, but I go by whether it keeps them up at night, or not. That's typically the threshold. The severity of itching really keeps a patient aware at night, and that's about it. I know that's very subjective, but I don't use anything more quantifiable than itch."

Itch

"In psoriasis it's less than it is for atopic dermatitis. It doesn't usually keep them up at night, but it is, in some people, a symptom that is annoying, rather than disabling."

"If they're able to sleep at night, or it disables them during the daytime, if they've got to stop what they're doing to scratch. I also – well, I look at their skin to see if there are scratch marks, and if there's other accompanying signs of what we call excoriations, where they're digging at their skin, scratching and digging at their skin."

"Itch is a very bothersome symptom for psoriasis and other skin conditions such as eczema. And itch can be more problematic than pain. Itch is constant. Itch is something patients are much more aware of, and they're always scratching themselves to the point where they start to bleed, and their skin gets infected. And it's usually worse at nighttime, because patients are more aware about their body, as opposed to daytime, where people are more – you know, they're more busy at work and things. That's when then get home, then they start to itch more. But I would say itch by far is the number one factor that drives patients crazy."

Relevance of itch

"I think it's highly relevant, because it's probably the most day in, day out thing that a lot of people face in that the itching is – comes to the top of forefront of symptomology, whether it's itching in your scalp, or itching on the patches of psoriasis. And it's again probably one of the single most bothersome things, other than the fact that it's there."

Location

"Scalp – wherever the plaques are, but scalp drives them crazy. Anywhere on the body."

"Is the itch from lesions? Usually, yes."

"Commonly hands, knees, ankles."

"Their scalp and their lower legs. It can be where there's no lesions in the scalp, but in the lower legs there usually some evidence of dry, scaling skin with some scratch marks."

Treatment/management challenges

"Like if the treatment works, that's great, but if it doesn't work, then we've got to keep adding things to help control the itch, whether it be a pill for itch that they take at nighttime, like an antihistamine, or using various creams to keep applying to control the itch... I would probably say maybe 60% of the time the itch can be controlled with one treatment, whether it be the shots or light therapy. And then 40% of the time it's not adequate, it's got to add in something else, like a topical cream, to control the itch."

"Particular challenges (related to the treatment or management of the itch)? Again, I think it's related to treating the underlying psoriasis itself."

"Yes, there's no specific oral anti-itch medication. And some of the topical anti-itch medications are not always effective for long periods of time over large areas of the skin. Effective or feasible. If they have total body involvement, it's hard to – lotions, anti-itch lotions all over their body."