Levocetirizine for the treatment of itch in psoriasis patients: An open-label pilot study in a real-world setting

Itch is the most bothersome symptom in psoriasis, often leading to impaired quality of life. Treatment of psoriasis-induced itch is frequently unsatisfactory as the various therapies employed have a delayed onset of effect. Histamine-1 receptor (H1) antihistamines are not recommended in treatment guidelines as histamine is not considered a key mediator in psoriasis. However, patients using H1 antihistamines frequently report benefits in questionnaire-based studies. To address these contradictions, we examined the short-term effects of levocetirizine, a nonsedating H1 antihistamine, on psoriasis-related itch and itch-related quality of life. In this pilot study, patients with psoriasis-related itch received levocetirizine 5-10 mg daily as a concomitant treatment for 5 days. Change of itch intensity as measured by hourly itch ratings and the change of itch-related quality of life were measured at different time points. A total of 29 of 30 patients (96%) reported a decline in itch within 5 days. Mean itch reduction was 23% after Day 1 (p = .005), 40% after Day 3 (p<.001), and 41% after Day 5 (p<.001). Furthermore, itch-related quality of life also significantly improved after 5 days (p<.001). Only 2 of 30 patients (6.7%) reported mild sleepiness. Levocetirizine 5-10 mg daily as an add-on therapy seems to be an effective treatment to improve itch and itch-related quality of life within only a few days.