Is there a way to curb scratching? I have had psoriasis for 20 years and my husband has been very supportive, but recently he has started to complain about my constant scratching. He knows I need to scratch to relieve itching, but it seems to bother him more now. I’m afraid we’re heading for marital problems unless I can stop scratching or he can stop letting it bother him. Any suggestions?

Psoriasis in a spouse can be difficult for both marriage partners. The spouse with psoriasis not only suffers from the disease and perhaps from problems with self-image, but also may be acutely aware of the partner’s struggles to be supportive. Over time, it is the ”little things” that can come between partners—for example, flaked-off skin that must be shaken from bed sheets every morning, or in this case the spouse’s constant scratching that becomes a “last straw” for an otherwise supportive husband.

The husband’s growing irritation may actually be a message worth heeding, however. While scratching is effective in temporarily relieving pruritus, hard scratching can also be a trigger for formation of new psoriatic lesions or worsening of existing lesions. Especially during active phases of psoriasis, abrasion of the skin is one of the causes of Koebner’s phenomenon—the induction of psoriatic lesions by injury to the skin. Hard, constant scratching can cause the type of skin injury that leads to development of Koebner’s phenomenon.

Since pruritus has become a major issue for both husband and wife, the issue should be discussed with the patient’s dermatologist. Pruritus control should perhaps be made a focus of psoriasis treatment, along with educational counseling of both marriage partners. As discussed in May’s Update, general measures for control of pruritus include keeping the skin cool and moisturized and avoiding irritating fabrics. Ice packs may help stop the itching. A heavy moisturizing cream applied twice daily will help control scaling and pruritus. Specific pharmacologic measures should be prescribed by the dermatologist on the basis of the patient’s history of psoriasis and overall medical condition.