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. 2023 Dec;13(12):3137-3151.
doi: 10.1007/s13555-023-01047-2. Epub 2023 Oct 14.

Efficacy of Avène Hydrotherapy on Chronic Pruritus in Patients with Plaque Psoriasis

Marie-Dominique Thouvenin  1 , Adeline Bacquey  2 , Marine Babin  2 , Fabrice Lestienne  3 , Christophe Lauze  3 , Eléonore Gravier  3 , Diana Placintescu  4 , Ariadna Ortiz-Brugués  5   6 , Sonja Ständer  7
Affiliations

Efficacy of Avène Hydrotherapy on Chronic Pruritus in Patients with Plaque Psoriasis

Marie-Dominique Thouvenin et al. Dermatol Ther (Heidelb). 2023 Dec.

Abstract

Introduction: Pruritus is a prevalent symptom, described as one of the most bothersome of psoriasis. Specific itch management remains a challenge, for which hydrotherapy could be used as adjunct care to medical treatment. Therefore, we assessed the immediate and longer-term benefit of 3 weeks of Avène thermal spring water hydrotherapy on chronic pruritus in patients in addition to their usual psoriasis and/or pruritus management.

Methods: Twenty-six patients suffering from chronic pruritus due to psoriasis were evaluated before and after 3 weeks of hydrotherapy with a 3 and 6 month follow-up. A control group (18 patients) did not undergo hydrotherapy and continued to follow their usual skin management. Pruritus was assessed according to the numeric rating scale (NRS, pruritus intensity), the visual dynamic pruritus score (vDPS, change in pruritus intensity), and the 5-D itch scale (pruritus characteristics). Psoriasis severity was measured using the psoriasis area and severity index (PASI) score. The "itchy quality of life" (ItchQoL) scale was used to assess quality-of-life (QoL) impact related to itch. Pruritus and psoriasis gene and protein biomarkers were measured in lesional and nonlesional skin.

Results: Pruritus measurements (NRS, vDPS, and 5-D itch scale) indicated an immediate and long-lasting positive effect of hydrotherapy compared with control patients. The psoriasis area and severity index (PASI) was decreased by 40.0% by hydrotherapy, which was sustained over 6 months. The ItchQoL also improved directly after hydrotherapy, which was still much improved even 6 months later. Analysis of gene and/or protein biomarkers revealed a significant decrease of inflammation biomarkers (IL-8, IL-1α, IL-1RA, and RANTES), of psoriasis biomarkers (PI3, S100A7, and IL-17), and of pruritus biomarkers (IL-31, TRPV1, and CGRP1).

Conclusions: These findings demonstrated an immediate and long-lasting improvement of pruritus in patients with psoriasis who underwent Avène thermal spring water hydrotherapy, indicating that this would be a good complementary therapy in the management of this disease.

Trial registration: NCT03023254.

Keywords: Avène hydrotherapy; Chronic pruritus; Clinical; Itch; Psoriasis.

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Conflict of interest statement

Marie-Dominique Thouvenin, Adeline Bacquey, Marine Babin, Fabrice Lestienne, Christophe Lauze, Eléonore Gravier, and Ariadna Ortiz-Brugués are employees of Pierre Fabre Dermo-Cosmétique. Sonja Ständer is an employee of the University Hospital Münster, Germany. The authors report no other conflicts of interest in this work.

Figures

Fig. 1
Fig. 1
Change in (i) the mean and (ii) the worst pruritus intensity over the previous 3 days using the pruritus numerical rating scale (NRS). Values are a mean, with statistical differences (intragroup and intergroup statistical analyses) shown as *p < 0.05, **p < 0.001. HYDRO hydrotherapy group, CON control group, V1–4 visits 1–4
Fig. 2
Fig. 2
Change of pruritus intensity compared with baseline assessed with the visual dynamic pruritus score (vDPS). Values are a % change, with statistical differences (intragroup and intergroup statistical analyses) shown as *p < 0.05, **p < 0.001. HYDRO hydrotherapy group, CON control group, V2–4 visits 2–4
Fig. 3
Fig. 3
Global score of pruritus characteristics assessed with the 5-D itch scale. Values are a mean, with statistical differences (intragroup and intergroup statistical analyses) shown as *p < 0.05, **p < 0.001. HYDRO hydrotherapy group, CON control group, V1–4 visits 1–4
Fig. 4
Fig. 4
Impact of hydrotherapy on the quality of sleep evaluated in the 5-D itch scale questionnaire. Values are the % of patients in the hydrotherapy (HYDRO) and control (CON) groups reporting a worsening (red), no change (gray), or improved (green) sleep on different visits. HYDRO hydrotherapy group, CON control group, V2–4 visits 2–4
Fig. 5
Fig. 5
Change of psoriasis severity measured using the psoriasis area and severity index (PASI) score. Values are a mean, with statistical differences (intragroup and intergroup statistical analyses) shown as *p < 0.05, **p < 0.001, ns not significant p > 0.05. HYDRO hydrotherapy group, CON control group, V1–4 visits 1–4
Fig. 6
Fig. 6
Quality of life assessed using the “itchy quality of life” (ItchQoL) scale. Values are a mean, with statistical differences (intragroup and intergroups) shown as *p < 0.05, **p < 0.001. HYDRO hydrotherapy group, CON control group, V1–4 visits 1–4
Fig. 7
Fig. 7
Heat map of biomarkers (i) mRNA expression normalized by housekeeping gene YWHAZ quantified by digital droplet PCR and (ii) protein level quantified by Multiplexed EIA (pg/ml). HYDRO hydrotherapy group, CON control group, V1–3 visits 1–3
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