Clinical and Laboratory Investigations Prevalence of symptoms experienced by patients with different clinical types of psoriasis F.SAMPOGNA, P.GISONDI, C.F.MELCHI, P.AMERIO,* G.GIROLOMONI, D.ABENI AND THE IDI MULTIPURPOSE PSORIASIS RESEARCH ON VITAL EXPERIENCES (IMPROVE) INVESTIGATORS Istituto Dermopatico dell’Immacolata, IRCCS, Via dei Monti di Creta 104, 00167 Rome, Italy *Department of Dermatology, University of Chieti, Chieti, Italy Accepted for publication 16 February 2004 Summary Background The main dermatology textbooks describe only in passing pruritus in psoriasis and rarely mention other symptoms. A quantification of the presence of symptoms is not available for clinical subgroups of psoriasis. Objectives To investigate the prevalence of symptoms experienced by patients with different clinical types of psoriasis. Methods The study was carried out in patients hospitalized for psoriasis between February 2000 and February 2002 at the inpatient wards of the Istituto Dermopatico dell’Immacolata, Rome, Italy. Symptoms were evaluated using the symptoms scale of Skindex-29. Clinical severity was assessed by the dermatologists using the Psoriasis Area and Severity Index (PASI), and by the patients completing the self-administered PASI. Psychiatric morbidity was evaluated using the 12-item General Health Questionnaire. Results In total, 936 eligible patients were analysed. The proportions of patients experiencing symptoms often or always in the 4 weeks before hospitalization were: 63Æ8% itching, 59Æ7% irri- tation, 46Æ1% burning ⁄ stinging, 39% sensitivity, 26% pain (from 10% in guttate psoriasis to 50% in arthropathic), 25Æ4% bleeding (17% pustular, 19% localized plaque, 36% palmoplantar), and 23Æ9% bothered by water (from 8Æ5% in the guttate form to 68% in palmoplantar). The prevalence of all symptoms was significantly higher in women and tended to increase with clinical severity. Conclusions Our study provides evidence of the high frequency of a number of symptoms in different subgroups of psoriasis patients determined by their sociodemographic characteristics, clinical type and disease severity. Symptoms represent a serious disabling factor in patients affected by psoriasis, including those with low levels of psychological distress. Dermatologists should include symptoms in the evaluation of disease severity both in clinical practice and in clinical trials. Key words: itching, psoriasis, quality of life, PASI, Skindex-29, symptoms Psoriasis is a chronic inflammatory skin disease with an estimated point prevalence varying between 0Æ8 and 2Æ8% in different countries. 1,2 Psoriasis may have an impact on patients’ quality of life because it affects self-perception and interferes with social relation- ships. 3–5 However, the psoriatic lesions may also be symptomatic, adding further disabling factors. Recen- tly, considerable attention has been devoted to the cla- rification of the mechanism and mediators involved in the pruritus of psoriasis vulgaris 6 but, interestingly, many leading textbooks still describe only in passing the symptoms experienced by patients. 7–12 Moreover, the only symptom which is at times considered is itching, whereas pain, burning or bleeding are mentioned even A complete list of the IMPROVE investigators who contributed to this study appears in the Acknowledgements. Correspondence: Damiano Abeni. E-mail: d.abeni@idi.it British Journal of Dermatology 2004; 151: 594–599. DOI: 10.1111/j.1365-2133.2004.06093.x 594 Ó 2004 British Association of Dermatologists