Associations Between Factors Affecting Itching and Quality of Life in Thai Patients with Psoriasis: A Cross-Sectional Study

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The factors influencing itch and its impact on the quality of life in Thai psoriasis patients are unknown. We aimed to identify these factors and their effect on quality of life. Methods In this questionnaire-based cross-sectional study, we included patients with psoriasis who received treatment at Chulabhorn Hospital in Thailand from January 2019 to July 2021. Interviewer is the non-dermatologist practician. The patient’s information was collected, including demographic data, Itch Numeric Rating Scale (Itch NRS) score, factors affecting itch, and score on the Thai version of the Dermatology Life Quality Index (DLQI). We performed descriptive statistics and logistic regression analysis. Results Of 100 participants, most (99%) experienced itching, with a moderate degree of pruritus (mean Itch NRS score 6.5 ± 2.6) and a moderate effect on quality of life (mean DLQI score 9.4 ± 6.2). Factors associated with itch aggravation were dry skin (p-value = 0.003) and heat and humidity (p-value = 0.042). The results of binary logistic regression revealed that factors associated with moderate-to-extremely large DLQI scores were itch intensity (no-to-mild vs. moderate-to-severe itch: odds ratio [OR] = 13.33; 95% confidence interval [CI] = 2.72–65.32, p < 0.001; and adjusted odds ratio [AOR] = 31.17; 95% CI = 4.55–213.36; p < 0.001. Conclusions Our findings revealed that the quality of life among patients with psoriasis is their greatest concern. Eliminating the itch intensity that affects their quality of life is crucial but remains challenging in Thailand. 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F1000Research 2025, 13 :1242 ( https://doi.org/10.12688/f1000research.156703.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Revised Associations Between Factors Affecting Itching and Quality of Life in Thai Patients with Psoriasis: A Cross-Sectional Study [version 2; peer review: 2 approved, 1 approved with reservations] Phurichaya Teyateeti https://orcid.org/0000-0003-0975-1997 1 , Chanita Autchayawat https://orcid.org/0009-0005-9698-7165 2 , Wiriya Mahikul https://orcid.org/0000-0001-5834-5173 2 , Rithee Smithrithee https://orcid.org/0009-0008-3136-3898 2 Phurichaya Teyateeti https://orcid.org/0000-0003-0975-1997 1 , Chanita Autchayawat https://orcid.org/0009-0005-9698-7165 2 , Wiriya Mahikul https://orcid.org/0000-0001-5834-5173 2 , Rithee Smithrithee https://orcid.org/0009-0008-3136-3898 2 PUBLISHED 25 Apr 2025 Author details Author details 1 Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, 10210, Thailand 2 Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, 10210, Thailand Phurichaya Teyateeti Roles: Conceptualization, Data Curation, Funding Acquisition, Investigation, Resources, Writing – Original Draft Preparation, Writing – Review & Editing Chanita Autchayawat Roles: Conceptualization, Data Curation, Funding Acquisition, Investigation, Resources, Writing – Original Draft Preparation, Writing – Review & Editing Wiriya Mahikul Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Resources, Software, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Rithee Smithrithee Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Project Administration, Resources, Writing – Original Draft Preparation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Introduction Psoriasis is a chronic skin disease affecting quality of life and causing pruritus. The factors influencing itch and its impact on the quality of life in Thai psoriasis patients are unknown. We aimed to identify these factors and their effect on quality of life. Methods In this questionnaire-based cross-sectional study, we included patients with psoriasis who received treatment at Chulabhorn Hospital in Thailand from January 2019 to July 2021. Interviewer is the non-dermatologist practician. The patient’s information was collected, including demographic data, Itch Numeric Rating Scale (Itch NRS) score, factors affecting itch, and score on the Thai version of the Dermatology Life Quality Index (DLQI). We performed descriptive statistics and logistic regression analysis. Results Of 100 participants, most (99%) experienced itching, with a moderate degree of pruritus (mean Itch NRS score 6.5 ± 2.6) and a moderate effect on quality of life (mean DLQI score 9.4 ± 6.2). Factors associated with itch aggravation were dry skin (p-value = 0.003) and heat and humidity (p-value = 0.042). The results of binary logistic regression revealed that factors associated with moderate-to-extremely large DLQI scores were itch intensity (no-to-mild vs. moderate-to-severe itch: odds ratio [OR] = 13.33; 95% confidence interval [CI] = 2.72–65.32, p < 0.001; and adjusted odds ratio [AOR] = 31.17; 95% CI = 4.55–213.36; p < 0.001. Conclusions Our findings revealed that the quality of life among patients with psoriasis is their greatest concern. Eliminating the itch intensity that affects their quality of life is crucial but remains challenging in Thailand. READ ALL READ LESS Keywords Itch; Pruritus; Psoriasis; Quality of life; Thailand Corresponding Author(s) Wiriya Mahikul ( [email protected] ) Rithee Smithrithee ( [email protected] ) Close Corresponding authors: Wiriya Mahikul, Rithee Smithrithee Competing interests: No competing interests were disclosed. Grant information: Chulabhorn Royal Academy- RAA 2564/058 The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2025 Teyateeti P et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Teyateeti P, Autchayawat C, Mahikul W and Smithrithee R. Associations Between Factors Affecting Itching and Quality of Life in Thai Patients with Psoriasis: A Cross-Sectional Study [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2025, 13 :1242 ( https://doi.org/10.12688/f1000research.156703.2 ) First published: 17 Oct 2024, 13 :1242 ( https://doi.org/10.12688/f1000research.156703.1 ) Latest published: 25 Apr 2025, 13 :1242 ( https://doi.org/10.12688/f1000research.156703.2 ) Revised Amendments from Version 1 As per the suggestions of the reviewers, we have thoroughly revised our manuscript to address all comments and concerns. Major differences from the previous version include the addition of detailed methodology and clarification of participant recruitment. Specifically, we now report that approximately 90% of patients completed the survey via telephone and 10% in person, and we have included this information in both the Survey Procedures and Limitations sections. We have also provided a sample size calculation to support the study’s statistical power. The classification of BMI was revised from WHO standards to Asia-Pacific guidelines to better reflect the Thai population. In response to requests for more clarity regarding psoriasis severity, we clarified that PASI scores were not available and included this as a study limitation. Similarly, limitations related to self-reported data on triggers such as dry skin, humidity, and seasonality were explicitly acknowledged. To improve readability, the manuscript underwent professional English editing. Additionally, we cited and discussed a relevant recent Thai study on pruritus in psoriasis (Junsuwan et al., 2023), comparing it with our findings in both the Introduction and Discussion sections. These revisions significantly enhance the methodological transparency, contextual relevance, and clarity of our work while preserving the integrity of our findings. As per the suggestions of the reviewers, we have thoroughly revised our manuscript to address all comments and concerns. Major differences from the previous version include the addition of detailed methodology and clarification of participant recruitment. Specifically, we now report that approximately 90% of patients completed the survey via telephone and 10% in person, and we have included this information in both the Survey Procedures and Limitations sections. We have also provided a sample size calculation to support the study’s statistical power. The classification of BMI was revised from WHO standards to Asia-Pacific guidelines to better reflect the Thai population. In response to requests for more clarity regarding psoriasis severity, we clarified that PASI scores were not available and included this as a study limitation. Similarly, limitations related to self-reported data on triggers such as dry skin, humidity, and seasonality were explicitly acknowledged. To improve readability, the manuscript underwent professional English editing. Additionally, we cited and discussed a relevant recent Thai study on pruritus in psoriasis (Junsuwan et al., 2023), comparing it with our findings in both the Introduction and Discussion sections. These revisions significantly enhance the methodological transparency, contextual relevance, and clarity of our work while preserving the integrity of our findings. See the authors' detailed response to the review by Narumol Silpa-archa See the authors' detailed response to the review by Napatra Tovanabutra READ REVIEWER RESPONSES Introduction Psoriasis is among the diseases that most adversely affect quality of life. Psoriasis is a common, chronic immune-mediated inflammatory skin disease influenced by both genetic and environmental factors. The worldwide prevalence of psoriasis ranges from 0.91% to 8.5%, with people living in countries located closer to the equator tending to be affected by psoriasis less than those in more distant countries. 1 The burden of psoriasis not only involves the skin but also has the potential to cause other inflammatory conditions, such as arthritis, metabolic syndrome, cardiovascular diseases, inflammatory bowel diseases, and depression. 2 Therefore, a holistic approach to the management of patients with psoriasis is needed to improve overall outcomes and quality of life. Psoriasis has not been regarded as being associated with pruritus until recently. Data have demonstrated that the prevalence of pruritus in patients with psoriasis ranges from 64% to 97%. 3 According to previous survey data, patients with psoriasis consider itching to be the most important factor responsible for disease severity, which differs from the opinion of dermatologists who only consider the location or the size of skin lesions. 4 A previous study conducted in Thailand extracted pruritus data from medical records of patients attending an outpatient psoriasis clinic between 2020 and 2021, revealing an overall prevalence of 81.2%. 5 The pathogenesis of pruritus in psoriasis remains unclear owing to complex interactions between the nervous, immune, neuroendocrine, and vascular systems. 6 , 7 Thus, no promising treatment is available for pruritus in patients with psoriasis. 8 Moreover, factors identified to be associated with itching in patients with psoriasis differ across studies and may be affected by race and ethnicity, climate, and lifestyle. In this study, we aimed to investigate the association of pruritus with quality of life, the number of patients affected by itching, and factors associated with itching among Thai patients with psoriasis. Methods Study design & settings The present research was a questionnaire-based cross-sectional study. We included patients diagnosed with psoriasis who received treatment at Chulabhorn Hospital in Thailand from January 2019 to July 2021. To estimate the sample size, we used the infinite population proportion formula: n = Z 2 p(1−p)/d 2 . Based on the assumption that 67% of patients reported a moderate to extremely large impact on their quality of life (DLQI > 6), 9 a 10% precision (d), a 95% confidence level, and accounting for a 10% non-response rate, the minimum calculated sample size was 95. The response rate was determined by dividing the number of respondents by the total number invited to the study. For example, 100 out of 125 individuals responded, yielding an 80% response rate. However, the total number of respondents still exceeds the sample size required to ensure sufficient statistical power for the study. Survey procedures The inclusion criteria were patients over 18 years old without any cognitive or related problems, such as delirium or dementia. Each patient responded to the questionnaire by telephone (90%) or face-to-face (10%) with a non-dermatologist interviewer to avoid any bias. Alternatively, patients could choose to complete and return the questionnaire via postal mail. Patients were informed that they could stop the interview at any point and could also refuse to participate in the study without any effect on their treatment in the future. We collected information on patients’ demographic data, current treatment, Itch Numeric Rating Scale (Itch NRS) scores, 10 factors affecting itch, and scores on the Thai version of the Dermatology Life Quality Index (DLQI). 11 Measures For the assessment of itch intensity in this questionnaire-based study, we used the Itch NRS scale, a manual rating scale used to assess the intensity of pruritus, with scores ranging from 0 to 10. The Itch NRS was the instrument of choice because of our study design, its simplicity of assessment, and the high validity and high correlation with other manual rating scales, such as the visual analog scale (VAS) and verbal rating scale (VRS). 10 , 12 , 13 Quality of life was evaluated using the validated Thai version of DLQI was developed by Kulthanan K., et al., 14 a validated and widely used tool with a version available in Thailand. 14 Statistical analysis Data analysis using IBM SPSS software version 26 (IBM Corp., Armonk, NY, USA). Continuous variables are presented as mean with standard deviation. Categorical variables are summarized as frequency and percentage. To examine the association between different itchiness scales and factors, a chi-square test was performed, and p-values < 0.05 were considered statistically significant. Logistic regression analysis was conducted to assess the association between itching severity (dependent variable) and possible risk factors while controlling for potential confounding factors. Additionally, regression analysis was also conducted to assess the association between quality of life (dependent variable) and itching severity (independent variable) while controlling for potential confounding factors. Odds ratios (ORs) and adjusted odds ratios (AORs) with corresponding 95% confidence intervals (CIs) were estimated to quantify the association between itching severity and quality of life. Model fit statistics, such as the Hosmer–Lemeshow test and area under the receiver operating characteristic curve (AUC) were computed to assess the goodness-of-fit and predictive accuracy of the logistic regression model. Results Overall, one hundred patients were enrolled in this study, all are Thai. Participants’ demographic data are shown in Table 1 . Participants comprised 51 men and 49 women, with mean age 53.4 ± 15.2 years. Patients mean body mass index (BMI) was 25.0 ± 4.4 kg/m 2 , which is classified as obese (BMI ≥25 kg/m 2 according to Asia Pacific guidelines). 15 Of the total, 45% of participants had a BMI of ≥ 25.0 kg/m 2 , which is recognized as pre-obese and obese (BMI ≥ 25 kg/m 2 ). 15 Most patients were married (65%) and unemployed (37%), in the other word, pensioner. Among those who were employed, 31% were government employees. One-third of participants had no comorbidities; however, both hypertension and dyslipidemia were identified in 36 participants. Most patients were non-smokers and did not drink alcohol. Table 1. Demographic data of patients (N = 100). Variables N = % Sex Male 51 Female 49 Age (years) Mean ± SD 53.4 ± 15.2 ≤ 35 17 36–59 44 ≥ 60 39 BMI (kg/m 2 ) Mean ± SD 25.0 ± 4.4 < 18.5 (Underweight) 2 18.5–22.9 (Normal) 35 23–24.9 (Overweight) 18 ≥ 25.0 (Obese) 45 Marital status Single 28 Married 65 Divorced 4 Widowed 3 Occupation Unemployed 37 Government employee 31 Non-government employee 32 Comorbidities Diabetes mellitus 21 Hypertension 36 Dyslipidemia 36 Cancer 10 Osteoarthritis 3 Coronary heart disease 4 Chronic kidney disease 5 Stroke 3 Fatty liver 3 Depression 1 No comorbidity 33 Smoking Yes 21 No 79 Alcohol consumption Yes 32 (31 cases, socially) No 68 Treatment Topical medication 88 Systemic oral medication 17 Biologics 6 Antihistamines 35 Itch numeric rating scale Mean ± SD 6.5 ± 2.6 None (0) 1 Mild (1–3) 11 Moderate (4–6) 35 Severe (7–10) 53 DLQI score Mean ± SD 9.4 ± 6.2 No effect (0–1) 7 Small effect (2–5) 27 Moderate effect (6–10) 27 Very large and extremely large effect (11–30) 39 The mean Itch NRS score was 6.5 ± 2.6 points. In our study, 88% of patients had moderate-to-severe itch, 11% reported mild itch, and only one patient had no itch. The mean DLQI score was 9.4 ± 6.2 points, which is classified as a moderate effect on quality of life. However, 39% of patients reported an extremely negative effect on their quality of life. Among participants, 88% received topical treatment (topical corticosteroids, calcineurin inhibitors, or calcipotriene) and 17% received systemic oral medication (methotrexate, cyclosporine, or systemic retinoids). Only 6% received biologics as treatment. None of our patients had received phototherapy at the time of the interview. Moreover, 35% of patients were prescribed antihistamines for pruritus control. Factors affecting pruritus are shown in Table 2 . Factors leading to the aggravated itching among moderate-to-severe pruritus patients were dry skin (78.4%), poor sleep (65.9%), sweating (62.5%), stress (61.4%), and heat and humidity (59.1%). Factors associated with itch relief among moderate-to-severe pruritus patients were exercise (22.7%), followed by a cold environment and synthetic fabrics (11.4%, 9.1%, respectively). Table 2. Factors affecting pruritus (N = 100). Variables Aggravated itching n (%) Relieved itching n (%) No effect n (%) p-value Itch NRS † 0–3 4–10 0–3 4–10 0–3 4–10 Stress 4 (33.3) 54 (61.4) 0 (0.0) 0 (0.0) 8 (66.7) 34 (38.6) 0.065 Dry skin 4 (33.3) 69 (78.4) * 0 (0.0) 0 (0.0) 8 (66.7) 19 (21.6) 0.003 * Warm shower 2 (16.7) 22 (25.0) 0 (0.0) 0 (0.0) 10 (83.3) 66 (75.0) 0.725 Cold shower 0 (0.0) 2 (2.3) 1 (8.3) 6 (6.8) 11 (91.7) 80 (90.9) 0.762 Sweating 5 (41.7) 55 (62.5) 1 (8.3) 0 (0.0) 6 (50.0) 33 (37.5) 0.065 Heat and humidity 4 (33.3) 52 (59.1) * 1 (8.3) 0 (0.0) 7 (58.3) 36 (40.9) 0.042 * Cold environment 1 (8.3) 33 (37.5) 1 (8.3) 10 (11.4) 10 (83.3) 45 (51.1) 0.064 Poor sleep 5 (41.7) 58 (65.9) 0 (0.0) 1 (1.1) 7 (58.3) 29 (33.0) 0.224 Exercise 1 (8.3) 8 (9.1) 4 (33.3) 20 (22.7) 7 (58.3) 60 (68.2) 0.736 Natural fabrics 0 (0.0) 10 (11.4) 1 (8.3) 5 (5.7) 11 (91.7) 73 (83.0) 0.251 Synthetic fabrics 1 (8.3) 8 (9.1) 0 (0.0) 8 (9.1) 11 (91.7) 72 (81.8) 0.338 * p < 0.05, chi-square test. † Itch Numerical Rating Scale (NRS) scores were divided into groups with no-to-mild (score 0–3) and moderate-to-severe (score 4–10) itch. A chi-square test indicated significant differences in itchiness scales between the group with no-to-mild itch and the group with moderate-to-severe itch for two factors: dry skin ( p -value = 0.003) and heat and humidity ( p -value = 0.042). Other factors, including stress, warm or cold shower, sweating, cold environment, poor sleep, exercise, natural fabrics, and synthetic fabrics, were not associated with either aggravating or relieving itching. The results of binary logistic regression revealed no significant association between itching and sex, age, BMI, marital status, occupation, comorbidities, smoking, or drinking alcohol. However, the results of binary logistic regression revealed that factors related to a moderate-to-extremely large DLQI were itch intensity (no-to-mild vs. moderate-to-severe itch: OR = 13.33; 95% CI = 2.72–65.32, p < 0.001 and AOR = 31.17; 95% CI = 4.55–213.36, p 5 score) Crude Adjusted Sex Male 13 (25.5) 38 (74.5) 1.00 1.00 Female 21 (42.9) 28 (57.1) 0.46 (0.19,1.06) 0.42 (0.11,1.58) 0.198 Age (years) ≤ 35 5 (29.4) 12 (70.6) 1.00 1.00 36–59 13 (29.5) 31 (70.5) 0.99 (0.29,3.39) 0.95 (0.16,5.56) 0.951 ≥ 60 16 (41.0) 23 (59.0) 0.59 (0.18,2.04) 0.53 (0.07,4.01) 0.543 BMI (kg/m 2 ) < 25.0 19 (34.5) 36 (65.5) 1.00 1.00 ≥ 25.0 15 (33.3) 30 (66.7) 1.06 (0.46,2.43) 1.18 (0.42,3.32) 0.762 Marital status Single 8 (28.6) 20 (71.4) 1.00 1.00 Married or Widowed 26 (36.1) 46 (63.9) 0.71 (0.27,1.83) 0.60 (0.15,2.36) 0.468 Occupation Unemployed 15 (40.5) 22 (59.5) 1.00 1.00 Government employee 10 (32.3) 21 (67.7) 1.43 (0.53,3.89) 1.09 (0.29,4.11) 0.899 Non-government employee 9 (28.1) 23 (71.9) 1.74 (0.63,4.79) 1.92 (0.46,7.96) 0.371 Comorbidities No 10 (30.3) 23 (69.7) 1.00 1.00 Yes 24 (35.8) 43 (64.2) 0.78 (0.32,1.91) 0.77 (0.21,2.76) 0.685 Smoking No 29 (36.7) 50 (63.3) 1.00 1.00 Yes 5 (23.8) 16 (76.2) 1.86 (0.62,5.59) 2.80 (0.49,15.84) 0.244 Alcohol consumption No 25 (36.8) 43 (63.2) 1.00 1.00 Yes 9 (28.1) 23 (71.9) 1.49 (0.59,3.71) 1.05 (0.26,4.24) 0.950 Topical medication No 6 (50.0) 6 (50.0) 1.00 1.00 Yes 28 (31.8) 60 (68.2) 2.14 (0.63,7.24) 0.21 (0.01,15.72) 0.479 Systemic oral medication No 28 (33.7) 55 (66.3) 1.00 1.00 Yes 6 (35.3) 11 (64.7) 0.93 (0.31,2.79) 1.88 (0.42, 8.40) 0.411 Biologics No 33 (35.1) 61 (64.9) 1.00 1.00 Yes 1 (16.7) 5 (83.3) 2.71 (0.30,24.13) 2.09 (0.14,31.65) 0.595 Antihistamines No 24 (36.9) 41 (63.1) 1.00 1.00 Yes 10 (28.6) 25 (71.4) 1.46 (0.60,3.56) 1.32 (0.42,4.12) 0.639 Itch numeric rating scale No to mild 10 (83.3) 2 (16.7) 1.00 1.00 Moderate to severe 24 (27.3) 64 (72.7) 13.33 (2.72,65.32) 31.17 (4.55,213.36) <0.001 * * p < 0.05. Discussion Psoriasis is a common, chronic immune-mediated inflammatory skin disease that affects not only the skin but can also cause other inflammatory conditions. Unlike the concerns of dermatologists, itching is one of the most concerning symptoms among patients with psoriasis. 4 Itching in psoriasis may involve any area of the body, with the lesional skin affected more than non-lesional skin, usually spare face and neck area, or it can be generalized in some patients. 16 , 17 Pruritus tends to appear in the evening and at night. 18 The common characteristics of pruritus described by patients include stinging, tickling, and crawling sensations. Moreover, a number of patients report pain and heat as accompanying sensations. 16 Our study results revealed itching in 99% of patients or almost all the patients, which was surprisingly high compared to previous data of 64%–97%. 3 , 5 Among all patients, 88% had moderate-to-severe itching. The only patient without pruritus was a patient with nail psoriasis, which is considerably less likely to involve itching. 19 Our data (mean Itch NRS score 6.5 ± 2.6) were correlated with previous data reported by Yosipovitch et al, Reich et al, Amatya et al, and Damiani et al, in that most patients with psoriasis had pruritus to a moderate degree (mean VAS of 6.4 ± 2.5 [the worst], 5.2 ± 2.4, 5.2 ± 2.6, and 4.6 ± 3.2, respectively). 16 , 18 , 20 , 21 The NRS and VAS were validated to have a high correlation. 12 Emphasizing that itching is the major factor effecting quality of life in psoriasis patients. Approximately one-quarter of our patients received systemic treatment, either oral systemic or biologic drugs; the remainder (77% of patients) had limited disease severity or less than 10% body surface area involvement. These data may imply that even in patients with mildly severe psoriasis, regardless of the psoriasis area and severity index (PASI), itching can still occur. Similarly, other studies have reported no significant correlation between itch intensity and PASI score. 8 , 18 , 22 – 25 Moreover, the mismatch of an improvement in PASI without an improvement in itching indicates that PASI cannot completely represent itching in patients with psoriasis, and not represent successful treatment for psoriasis patients. 19 This emphasizes the role of itch control in these patients, not only in those with higher PASI but also in those with a milder form of psoriasis. However, some authors have reported that the intensity of pruritus is correlated with the severity of psoriasis. 26 , 27 The disparity in these data may be affected by the differences in study populations with respect to the severity of disease, treatment received, race and ethnicity, and local climate. The mean DLQI score of patients with psoriasis in our study was 9.4 ± 6.2, which is classified as representing a moderate effect of itching on quality of life. Similarly, most other studies have reported a moderate-to-very large effect on QOL. Several studies reporting a moderate effect of psoriasis on quality of life were conducted in Iran, 28 Taiwan, 9 and Malaysia, 29 with a mean DLQI of 8, 9.2 ± 6.3, and 6 (median, interquartile range 4.0), respectively. While studies in Poland, 30 Greece, 31 Korea, 32 and China 33 have reported an exceptionally large effect on quality of life, with a mean DLQI of 17.8 ± 5.9, 12.6 ± 4.9, 12.4 ± 7.6, and 13.3, respectively. In our study, 66% of patients reported a moderate-to-extremely large effect, according to DLQI score. Moreover, our data indicated that itch intensity was significantly associated with patients’ DLQI, similarly to those of other studies. 18 , 22 , 24 , 34 Many studies also indicated that itching was not only associated with the DLQI of patients with psoriasis but was also correlated with feelings of stigmatization, stress within the month before a psoriasis outbreak, anxiety, sleep disturbance, fatigue, and various depressive symptoms. 22 , 24 , 34 Female patients reported a significantly negative impact on quality of life and are more likely to have lower self-esteem than male patients. 31 , 32 Younger age has been identified as an independent risk factor for psychological complications and severely impaired quality of life in patients with psoriasis. 35 Moreover, patients with psoriasis who have lesions on both sensitive and non-sensitive areas (genitals, scalp, and face) had significantly increased DLQI scores compared with patients who had lesions on non-sensitive body areas only. 34 Furthermore, regardless of the cause, the severity of pruritus also affects the patient’s quality of life. 36 For the factors that aggravating itching, dry skin (73%), poor sleep (63%), sweating (60%), stress (58%), and heat and humidity (56%) were revealed. Concordance to previous studies, mostly reported as factors aggravating itching in previous studies were stress, sweating, being sick or unwell, a hot ambient temperature, dryness or dry skin, and the winter season. 16 , 18 , 19 , 25 , 37 A study in Italy uniquely reported that significant aggravating factors included hot water, exercise, large meals, bad mood, the supine position, and contact with clothes. 37 This study found that itch-relieving factors included exercise (24%), a cold environment (11%), synthetic fabric (8%), and a cold shower (7%). Those factors most commonly reported as itch relievers from previous studies included sleep, cold water, and the sun. 16 , 18 , 37 However, our data indicated only two factors to be significantly associated with itch aggravation: dry skin ( p -value = 0.003) and heat and humidity ( p -value = 0.042). A positive correlation between pruritus intensity and stress was reported by Amatya et al. (r = 0.8, p < 0.05) and Reich et al. (p = 0.015). 16 , 21 Heat or warm stimuli can provoke itch via transient receptor potential vanilloid subtype 1 (TRPV1) and calcitonin gene-related peptide (CGRP), both of which are involved in the pathogenesis of itching with psoriasis. 7 , 38 In summary, studies in countries with subtropical climates, such as Thailand and Singapore, report hot temperatures and sweating as itch aggravators and cold water and cold temperatures as itch relievers. However, a study from Sweden in Northern Europe described sun as an itch reliever. This data indicate that climate also influences itch symptoms. Patients with psoriasis in countries with different climates may have different factors that aggravate or relieve itching symptoms. The hypothesis may be, in a warm and moist weather zone, the cold environment relieving itching from every daily life sweating, and warm. In contrary, from the patients from cold and dry weather zone, the sweating and high humidity may alleviate the symptoms. The changing of the surrounding environment might be the key to improving QOL in psoriatic patients, as in climatotherapy. There was no statistically significant correlation between itching and sex, age, BMI, marital status, occupation, comorbidities, smoking, or drinking alcohol in this study. A large cohort study from Italy with 10,802 participants also reported no statistical significance between itching and age, BMI, marital status, smoking, or drinking alcohol. 20 Nevertheless, female sex was significantly associated with itch intensity, with both sexes having a mean VAS score indicating moderate severity. 20 Similarly, Amatya et al. demonstrated that women more often reported itching than men (OR, 3.8; 95% CI, 2–15; p < 0.05). 16 Conversely, some studies found no correlation between sex and itching. 18 , 25 , 26 When the disease is not active, female patients with psoriasis had a significantly lower VAS score than male patients. 18 Variations in study populations, number of participants, and severity of disease in each study may affect variation in the correlations between itching and factors influencing itch intensity. Owing to the complex pathogenesis of pruritus in psoriasis, no promising treatment is available for pruritus in patients with psoriasis. In our study, 35% of patients were prescribed antihistamines for itch control. However, there was no significant difference in the mean plasma concentration of histamine between patients with psoriasis and controls, nor between patients who had pruritic psoriasis, those with non-pruritic psoriasis, and controls. 39 , 40 Thus, histamine may not be a key mediator in psoriasis-associated pruritus. 41 Nonetheless, most data indicate that antihistamines have no or only short-term effects. 16 , 18 , 42 , 43 Topical treatments were used by 88% of our participants. According to some studies, topical corticosteroids have more short-term effects than long-term benefits or have no antipruritic effect at all. 16 , 18 A fixed-dose combination of betamethasone dipropionate and calcipotriene has demonstrated significant itch relief, with rapid onset. 44 , 45 Phototherapy has been reported to have variable outcomes. Yosipovitch et al. found that 65% of patients who received UVB phototherapy reported no antipruritic effect, and the remaining patients reported more short-term benefits than long-term ones. 18 Additionally, Amatya reported an equal percentage of benefit in both the short and long term. 16 However, Narbutt et al. found a significant reduction in pruritus scores after 10 irradiations, and two-thirds of patients also reported no itch symptoms after irradiation. 46 Methotrexate and systemic retinoids had no effect on itch reduction. 16 , 18 In contrast, cyclosporine was reported to significantly relieve itching in patients with psoriasis. 47 Biologics can lead to itch improvement. 47 Of all biologics, anti-interleukin 17 showed the most significant magnitude in terms of itch reduction among patients with psoriasis. 48 However, we did not evaluate itch responses according to each treatment modality in our study. Limitations Limitations in our study include the specific patients with small sample size, population bias with mild severity of disease, and no available PASI score. This study might not represent all the psoriasis patients due to our institute taking care only of the patient with health care benefit. On the other hands, the optimized treatment may unrevealed the effect of itching on the well-treated psoriasis patients. However, itching still affected the quality of life of our patients. Additionally, there are many more factors that influence itching and quality of life in patients with psoriasis beyond our scope, and that vary by country. Other causes of pruritus, such as kidney, liver, and hematologic diseases, may affect these data. However, the presence of systemic disease has shown no significant effect on pruritus in patients with psoriasis. 49 Increasing the study population might improve the significance of the results. Our study relied on self-reported factors and itch outcomes, which should not be interpreted as confirmed clinical measurements or diagnoses. Lastly, this study used a telephone-based cross-sectional survey method during the COVID-19 pandemic to minimize the risk of transmission. As a result, causal relationships could not be established, and the sample was limited to individuals with telephone access. Therefore, the findings may not fully represent the entire population. Conclusions Itching is a problem for most patients with psoriasis and optimizing itch control remains challenging. Our study found that most participants had a moderate-to-severe degree of pruritus, and itch intensity also had a statistically significant association with DLQI score. Factors identified as being significantly associated with itch aggravation were dry skin as well as heat and humidity. Identifying all the possible factors aggravating psoriasis is the most important to improve QoL. Pruritus control will benefit patients by both preventing the Koebner phenomenon and improving their QoL. A comprehensive approach is needed to provide the best outcome for all patients with psoriasis. Ethics and consent Prior to the commencement of this study, ethical approval was granted by the Human Research Ethics Committee of Chulabhorn Royal Academy, Thailand (EC 042/2564) on 15 th October 2021 for 6 months, and it conformed to the ethics guidelines of the Declaration of Helsinki. All procedures were performed in accordance with relevant guidelines and regulations. Additionally, the study received approval from the general community. All participants in the study provided signed informed consent before completing the questionnaires. Data availability Underlying data Associations between factors affecting itching and quality of life in Thai patients with psoriasis: A cross-sectional study Figshare: https://doi.org/10.6084/m9.figshare.27042550 50 This project contains the following underlying data: • Data-Excel.xlsx Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Extended data Associations between factors affecting itching and quality of life in Thai patients with psoriasis: A cross-sectional study Figshare: https://doi.org/10.6084/m9.figshare.27181140 51 This project contains the following extended data: • Questionnaire.docx Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Acknowledgments This research project was sponsored by the Chulabhorn Royal Academy. We thank Analisa Avila, MPH, ELS, of Edanz ( www.edanz.com/ac ) for editing a draft of this manuscript. References 1. 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PubMed Abstract | Publisher Full Text 30. Kowalewska B, Cybulski M, Jankowiak B, et al. : Acceptance of Illness, Satisfaction with Life, Sense of Stigmatization, and Quality of Life among People with Psoriasis: A Cross-Sectional Study. Dermatol. Ther (Heidelb). 2020 Jun; 10 (3): 413–30. Epub 2020/03/21. eng. PubMed Abstract | Publisher Full Text | Free Full Text 31. Kouris A, Christodoulou C, Stefanaki C, et al. : Quality of life and psychosocial aspects in Greek patients with psoriasis: a cross-sectional study. An. Bras. Dermatol. 2015 Nov-Dec; 90 (6): 841–5. Epub 2016/01/07. PubMed Abstract | Publisher Full Text | Free Full Text 32. Jung S, Lee SM, Suh D, et al. : The association of socioeconomic and clinical characteristics with health-related quality of life in patients with psoriasis: a cross-sectional study. Health Qual. Life Outcomes. 2018 Sep 12; 16 (1): 180. Epub 2018/09/14. PubMed Abstract | Free Full Text 33. 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Stinco G, Trevisan G, Piccirillo F, et al. : Pruritus in chronic plaque psoriasis: a questionnaire-based study of 230 Italian patients. Acta Dermatovenerol. Croat. 2014; 22 (2): 122–8. Epub 2014/08/12. PubMed Abstract 38. Murota H, Katayama I: Evolving understanding on the aetiology of thermally provoked itch. Eur. J. Pain. 2016 Jan; 20 (1): 47–50. Epub 2015/09/30. PubMed Abstract | Publisher Full Text | Free Full Text 39. Ayasse MT, Buddenkotte J, Alam M, et al. : Role of neuroimmune circuits and pruritus in psoriasis. Exp. Dermatol. 2020 Apr; 29 (4): 414–26. Epub 2020/01/19. PubMed Abstract | Publisher Full Text 40. Szepietowski J, Reich A, Orda A: Histamine, Substance P and Calcitonin Gene-Related Peptide Plasma Concentration and Pruritus in Patients Suffering from Psoriasis. Dermatology and Psychosomatics/Dermatologie Und Psychosomatik. 2004 06/01; 5 : 73–78. Publisher Full Text 41. 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Reference Source Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 17 Oct 2024 ADD YOUR COMMENT Comment Author details Author details 1 Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, 10210, Thailand 2 Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, 10210, Thailand Phurichaya Teyateeti Roles: Conceptualization, Data Curation, Funding Acquisition, Investigation, Resources, Writing – Original Draft Preparation, Writing – Review & Editing Chanita Autchayawat Roles: Conceptualization, Data Curation, Funding Acquisition, Investigation, Resources, Writing – Original Draft Preparation, Writing – Review & Editing Wiriya Mahikul Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Resources, Software, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Rithee Smithrithee Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Project Administration, Resources, Writing – Original Draft Preparation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information Chulabhorn Royal Academy- RAA 2564/058 The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Article Versions (2) version 2 Revised Published: 25 Apr 2025, 13:1242 https://doi.org/10.12688/f1000research.156703.2 version 1 Published: 17 Oct 2024, 13:1242 https://doi.org/10.12688/f1000research.156703.1 Copyright © 2025 Teyateeti P et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Teyateeti P, Autchayawat C, Mahikul W and Smithrithee R. Associations Between Factors Affecting Itching and Quality of Life in Thai Patients with Psoriasis: A Cross-Sectional Study [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2025, 13 :1242 ( https://doi.org/10.12688/f1000research.156703.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 2 VERSION 2 PUBLISHED 25 Apr 2025 Revised Views 0 Cite How to cite this report: Reich A. Reviewer Report For: Associations Between Factors Affecting Itching and Quality of Life in Thai Patients with Psoriasis: A Cross-Sectional Study [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2025, 13 :1242 ( https://doi.org/10.5256/f1000research.181039.r381203 ) The direct URL for this report is: https://f1000research.com/articles/13-1242/v2#referee-response-381203 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 24 May 2025 Adam Reich , Department of Dermatology, University of Rzeszów, Rzeszów, Poland Approved VIEWS 0 https://doi.org/10.5256/f1000research.181039.r381203 The authors performed a study among Thai patients with psoriasis on the prevalence and intensity of itching. I found the study interesting, relevant, and well-performed. The results are important, as they document a high prevalence of itch in psoriasis patients ... Continue reading READ ALL The authors performed a study among Thai patients with psoriasis on the prevalence and intensity of itching. I found the study interesting, relevant, and well-performed. The results are important, as they document a high prevalence of itch in psoriasis patients (99%) and a significant impact of pruritus on quality of life. Regarding data presentation, I would suggest reconsidering the following statement: " (...) most (99%) experienced itching, with a moderate degree of pruritus (mean Itch NRS score 6.5 ± 2.6) and a moderate effect on quality of life (mean DLQI score 9.4 ± 6.2). Please note that these are mean values. However, about 50% of patients demonstrate DLQI scoring >10, which indicates a very large or extremely large effect on QoL. The same applies to NRS, in which a substantial proportion of patients had NRS scoring >7, which indicates high pruritus intensity. Please modify reference 21 as follows: Reich A, Szepietowski JC, Wisnicka B, et al. : Does Stress Influence Itching in Psoriatic Patients? Dermatology and Psychosomatics/Dermatologie und Psychosomatik. 2003 09/01; 4 : 151–155 Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Pruritus, psychodermatology, psoriasis I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Reich A. Reviewer Report For: Associations Between Factors Affecting Itching and Quality of Life in Thai Patients with Psoriasis: A Cross-Sectional Study [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2025, 13 :1242 ( https://doi.org/10.5256/f1000research.181039.r381203 ) The direct URL for this report is: https://f1000research.com/articles/13-1242/v2#referee-response-381203 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Silpa-archa N. Reviewer Report For: Associations Between Factors Affecting Itching and Quality of Life in Thai Patients with Psoriasis: A Cross-Sectional Study [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2025, 13 :1242 ( https://doi.org/10.5256/f1000research.181039.r380765 ) The direct URL for this report is: https://f1000research.com/articles/13-1242/v2#referee-response-380765 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 14 May 2025 Narumol Silpa-archa , Dermatology Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Mahidol University,, Thailand Approved VIEWS 0 https://doi.org/10.5256/f1000research.181039.r380765 Following the first revisions, the manuscript becomes more knowledgeable ... Continue reading READ ALL Following the first revisions, the manuscript becomes more knowledgeable and well-written. The authors responded well, based on the comments. Competing Interests: No competing interests were disclosed. Reviewer Expertise: Photodermatology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Silpa-archa N. Reviewer Report For: Associations Between Factors Affecting Itching and Quality of Life in Thai Patients with Psoriasis: A Cross-Sectional Study [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2025, 13 :1242 ( https://doi.org/10.5256/f1000research.181039.r380765 ) The direct URL for this report is: https://f1000research.com/articles/13-1242/v2#referee-response-380765 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 17 Oct 2024 Views 0 Cite How to cite this report: Silpa-archa N. Reviewer Report For: Associations Between Factors Affecting Itching and Quality of Life in Thai Patients with Psoriasis: A Cross-Sectional Study [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2025, 13 :1242 ( https://doi.org/10.5256/f1000research.172051.r371560 ) The direct URL for this report is: https://f1000research.com/articles/13-1242/v1#referee-response-371560 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 22 Apr 2025 Narumol Silpa-archa , Dermatology Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Mahidol University,, Thailand Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.172051.r371560 The authors did an interesting cross-sectional study on itch and DLQI in Thai psoriasis. These are questions and comments. 1. How many patients were interviewed by phone and how many were questioned on-site? Please provide additional information. 2. ... Continue reading READ ALL The authors did an interesting cross-sectional study on itch and DLQI in Thai psoriasis. These are questions and comments. 1. How many patients were interviewed by phone and how many were questioned on-site? Please provide additional information. 2. Are there any data on psoriasis severity, BSA, PGA, or PASI from onsite patients? Please clarify, as this is one of the major causes of itching in psoriasis. 3. The authors determined that dry skin, heat, and humidity were key causes of itching. Please provide further information about dry skin (any measurements) and season affect (winter or summer). These can provide additional information to the reader. 4. Which locations are most affected by psoriasis itching, according to this study? 5. To increase the value of the manuscript, it should be examined by a native English speaker. 6. The author can add a published study on itch in Thai psoriasis patients, and add comparison in discussion part. Please see [Ref 1] Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? I cannot comment. A qualified statistician is required. Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Yes References 1. Junsuwan N, Likittanasombat S, Chularojanamontri L, Chaiyabutr C, et al.: Prevalence and clinical characteristics of pruritus, and the factors significantly associated with high pruritic intensity in patients with psoriasis: a cross-sectional study. Ann Med Surg (Lond) . 2023; 85 (7): 3396-3402 PubMed Abstract | Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: Photodermatology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Silpa-archa N. Reviewer Report For: Associations Between Factors Affecting Itching and Quality of Life in Thai Patients with Psoriasis: A Cross-Sectional Study [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2025, 13 :1242 ( https://doi.org/10.5256/f1000research.172051.r371560 ) The direct URL for this report is: https://f1000research.com/articles/13-1242/v1#referee-response-371560 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 07 May 2025 Wiriya Mahikul , Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, 10210, Thailand 07 May 2025 Author Response Reviewer 2 Narumol Silpa-archa, Dermatology Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Mahidol University, Thailand Approved With Reservations info_outline The authors did an interesting cross-sectional study on itch ... Continue reading Reviewer 2 Narumol Silpa-archa, Dermatology Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Mahidol University, Thailand Approved With Reservations info_outline The authors did an interesting cross-sectional study on itch and DLQI in Thai psoriasis. These are questions and comments. 1. How many patients were interviewed by phone and how many were questioned on-site? Please provide additional information. Thank you for your comments. We agree with the reviewer. Upon rechecking the data, we found that approximately 90% of participants were assessed via telephone interviews for itchiness and quality of life due to the survey being conducted during the COVID-19 pandemic, while only 10% participated in face-to-face interviews. We have clarified this in the Survey Procedures and Limitations sections, as follows: Survey procedures: ' Each patient responded to the questionnaire by telephone (90%) or face-to-face (10%) with a non-dermatologist interviewer to avoid any bias.' - line 78-79 Limitations sections: 'Lastly, this study used a telephone-based cross-sectional survey method during the COVID-19 pandemic to minimize the risk of transmission. As a result, causal relationships could not be established, and the sample was limited to individuals with telephone access. Therefore, the findings may not fully represent the entire population'- line 279-282 2. Are there any data on psoriasis severity, BSA, PGA, or PASI from onsite patients? Please clarify, as this is one of the major causes of itching in psoriasis. Thank you for your comments. However, we did not have any data on psoriasis severity, BSA, PGA, or PASI from onsite patients. We added this in the limitation as following. 'Limitations in our study include the specific patients with small sample size, population bias with mild severity of disease, and no available PASI score.' - line 281 3. The authors determined that dry skin, heat, and humidity were key causes of itching. Please provide further information about dry skin (any measurements) and season affect (winter or summer). These can provide additional information to the reader. The assessment was based on patient self-reports regarding the effects of dry skin, heat and humidity, and seasonal factors (e.g., cold environments) on their itch symptoms. We asked patients how these factors influenced their itch—whether symptoms worsened, improved, or remained unchanged. As this information is self-reported, it may not be as accurate as standardized measurements; however, this limitation has been acknowledged in the manuscript as follow; 'Our study relied on self-reported factors and itch outcomes, which should not be interpreted as confirmed clinical measurements or diagnoses' - line 281-282 4. Which locations are most affected by psoriasis itching, according to this study? We did not have data on the locations most affected by psoriasis-related itching because we did not ask participants to specify the location of their itch. Instead, we used the Itch Numeric Rating Scale (Itch NRS), which is typically used to assess overall or general itch intensity, often referring to whole-body itch. 5. To increase the value of the manuscript, it should be examined by a native English speaker. Thank you for your comments. We have had some sentences revised by a native English speaker. We thank Analisa Avila, MPH, ELS, of Edanz (www.edanz.com/ac) for editing a draft of this manuscript. 6. The author can add a published study on itch in Thai psoriasis patients, and add comparison in discussion part. Please see [Ref 1] : 1. Junsuwan N, Likittanasombat S, Chularojanamontri L, Chaiyabutr C, et al.: Prevalence and clinical characteristics of pruritus, and the factors significantly associated with high pruritic intensity in patients with psoriasis: a cross-sectional study. Ann Med Surg (Lond) . 2023; 85 (7): 3396-3402 PubMed Abstract | Publisher Full Text Thank you for your advice. We have added this reference in the Introduction and included a comparison in the Discussion section as follows: In introduction as 'A previous study conducted in Thailand extracted pruritus data from medical records of patients attending an outpatient psoriasis clinic between 2020 and 2021, revealing an overall prevalence of 81.2% 3 ' - line 57-59 In discussion as ' Our study results revealed itching in 99% of patients or almost all the patients, which was surprisingly high compared to previous data of 64%–97% 3, 4 ' . - line 184 Reference 1. Lin TY, See LC, Shen YM, Liang CY, Chang HN, Lin YK. Quality of life in patients with psoriasis in northern Taiwan. Chang Gung Med J. 2011 Mar-Apr;34(2):186-96. PubMed PMID: 21539761. Epub 2011/05/05. 2. Consultation WHOE. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004 Jan 10;363(9403):157-63. PubMed PMID: 14726171. Epub 2004/01/17. 3. Junsuwan N, Likittanasombat S, Chularojanamontri L, Chaiyabutr C, Wongpraparut C, Silpa-Archa N. Prevalence and clinical characteristics of pruritus, and the factors significantly associated with high pruritic intensity in patients with psoriasis: a cross-sectional study. Ann Med Surg (Lond). 2023 Jul;85(7):3396-402. PubMed PMID: 37427235. Pubmed Central PMCID: PMC10328595. Epub 2023/07/10. eng. 4. Tsianakas A, Mrowietz U. [Pruritus in psoriasis : Profile and therapy]. Hautarzt. 2016 Aug;67(8):601-5. PubMed PMID: 27376751. Epub 2016/07/05. Pruritus bei Psoriasis : Profil und Therapie. Reviewer 2 Narumol Silpa-archa, Dermatology Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Mahidol University, Thailand Approved With Reservations info_outline The authors did an interesting cross-sectional study on itch and DLQI in Thai psoriasis. These are questions and comments. 1. How many patients were interviewed by phone and how many were questioned on-site? Please provide additional information. Thank you for your comments. We agree with the reviewer. Upon rechecking the data, we found that approximately 90% of participants were assessed via telephone interviews for itchiness and quality of life due to the survey being conducted during the COVID-19 pandemic, while only 10% participated in face-to-face interviews. We have clarified this in the Survey Procedures and Limitations sections, as follows: Survey procedures: ' Each patient responded to the questionnaire by telephone (90%) or face-to-face (10%) with a non-dermatologist interviewer to avoid any bias.' - line 78-79 Limitations sections: 'Lastly, this study used a telephone-based cross-sectional survey method during the COVID-19 pandemic to minimize the risk of transmission. As a result, causal relationships could not be established, and the sample was limited to individuals with telephone access. Therefore, the findings may not fully represent the entire population'- line 279-282 2. Are there any data on psoriasis severity, BSA, PGA, or PASI from onsite patients? Please clarify, as this is one of the major causes of itching in psoriasis. Thank you for your comments. However, we did not have any data on psoriasis severity, BSA, PGA, or PASI from onsite patients. We added this in the limitation as following. 'Limitations in our study include the specific patients with small sample size, population bias with mild severity of disease, and no available PASI score.' - line 281 3. The authors determined that dry skin, heat, and humidity were key causes of itching. Please provide further information about dry skin (any measurements) and season affect (winter or summer). These can provide additional information to the reader. The assessment was based on patient self-reports regarding the effects of dry skin, heat and humidity, and seasonal factors (e.g., cold environments) on their itch symptoms. We asked patients how these factors influenced their itch—whether symptoms worsened, improved, or remained unchanged. As this information is self-reported, it may not be as accurate as standardized measurements; however, this limitation has been acknowledged in the manuscript as follow; 'Our study relied on self-reported factors and itch outcomes, which should not be interpreted as confirmed clinical measurements or diagnoses' - line 281-282 4. Which locations are most affected by psoriasis itching, according to this study? We did not have data on the locations most affected by psoriasis-related itching because we did not ask participants to specify the location of their itch. Instead, we used the Itch Numeric Rating Scale (Itch NRS), which is typically used to assess overall or general itch intensity, often referring to whole-body itch. 5. To increase the value of the manuscript, it should be examined by a native English speaker. Thank you for your comments. We have had some sentences revised by a native English speaker. We thank Analisa Avila, MPH, ELS, of Edanz (www.edanz.com/ac) for editing a draft of this manuscript. 6. The author can add a published study on itch in Thai psoriasis patients, and add comparison in discussion part. Please see [Ref 1] : 1. Junsuwan N, Likittanasombat S, Chularojanamontri L, Chaiyabutr C, et al.: Prevalence and clinical characteristics of pruritus, and the factors significantly associated with high pruritic intensity in patients with psoriasis: a cross-sectional study. Ann Med Surg (Lond) . 2023; 85 (7): 3396-3402 PubMed Abstract | Publisher Full Text Thank you for your advice. We have added this reference in the Introduction and included a comparison in the Discussion section as follows: In introduction as 'A previous study conducted in Thailand extracted pruritus data from medical records of patients attending an outpatient psoriasis clinic between 2020 and 2021, revealing an overall prevalence of 81.2% 3 ' - line 57-59 In discussion as ' Our study results revealed itching in 99% of patients or almost all the patients, which was surprisingly high compared to previous data of 64%–97% 3, 4 ' . - line 184 Reference 1. Lin TY, See LC, Shen YM, Liang CY, Chang HN, Lin YK. Quality of life in patients with psoriasis in northern Taiwan. Chang Gung Med J. 2011 Mar-Apr;34(2):186-96. PubMed PMID: 21539761. Epub 2011/05/05. 2. Consultation WHOE. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004 Jan 10;363(9403):157-63. PubMed PMID: 14726171. Epub 2004/01/17. 3. Junsuwan N, Likittanasombat S, Chularojanamontri L, Chaiyabutr C, Wongpraparut C, Silpa-Archa N. Prevalence and clinical characteristics of pruritus, and the factors significantly associated with high pruritic intensity in patients with psoriasis: a cross-sectional study. Ann Med Surg (Lond). 2023 Jul;85(7):3396-402. PubMed PMID: 37427235. Pubmed Central PMCID: PMC10328595. Epub 2023/07/10. eng. 4. Tsianakas A, Mrowietz U. [Pruritus in psoriasis : Profile and therapy]. Hautarzt. 2016 Aug;67(8):601-5. PubMed PMID: 27376751. Epub 2016/07/05. Pruritus bei Psoriasis : Profil und Therapie. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 07 May 2025 Wiriya Mahikul , Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, 10210, Thailand 07 May 2025 Author Response Reviewer 2 Narumol Silpa-archa, Dermatology Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Mahidol University, Thailand Approved With Reservations info_outline The authors did an interesting cross-sectional study on itch ... Continue reading Reviewer 2 Narumol Silpa-archa, Dermatology Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Mahidol University, Thailand Approved With Reservations info_outline The authors did an interesting cross-sectional study on itch and DLQI in Thai psoriasis. These are questions and comments. 1. How many patients were interviewed by phone and how many were questioned on-site? Please provide additional information. Thank you for your comments. We agree with the reviewer. Upon rechecking the data, we found that approximately 90% of participants were assessed via telephone interviews for itchiness and quality of life due to the survey being conducted during the COVID-19 pandemic, while only 10% participated in face-to-face interviews. We have clarified this in the Survey Procedures and Limitations sections, as follows: Survey procedures: ' Each patient responded to the questionnaire by telephone (90%) or face-to-face (10%) with a non-dermatologist interviewer to avoid any bias.' - line 78-79 Limitations sections: 'Lastly, this study used a telephone-based cross-sectional survey method during the COVID-19 pandemic to minimize the risk of transmission. As a result, causal relationships could not be established, and the sample was limited to individuals with telephone access. Therefore, the findings may not fully represent the entire population'- line 279-282 2. Are there any data on psoriasis severity, BSA, PGA, or PASI from onsite patients? Please clarify, as this is one of the major causes of itching in psoriasis. Thank you for your comments. However, we did not have any data on psoriasis severity, BSA, PGA, or PASI from onsite patients. We added this in the limitation as following. 'Limitations in our study include the specific patients with small sample size, population bias with mild severity of disease, and no available PASI score.' - line 281 3. The authors determined that dry skin, heat, and humidity were key causes of itching. Please provide further information about dry skin (any measurements) and season affect (winter or summer). These can provide additional information to the reader. The assessment was based on patient self-reports regarding the effects of dry skin, heat and humidity, and seasonal factors (e.g., cold environments) on their itch symptoms. We asked patients how these factors influenced their itch—whether symptoms worsened, improved, or remained unchanged. As this information is self-reported, it may not be as accurate as standardized measurements; however, this limitation has been acknowledged in the manuscript as follow; 'Our study relied on self-reported factors and itch outcomes, which should not be interpreted as confirmed clinical measurements or diagnoses' - line 281-282 4. Which locations are most affected by psoriasis itching, according to this study? We did not have data on the locations most affected by psoriasis-related itching because we did not ask participants to specify the location of their itch. Instead, we used the Itch Numeric Rating Scale (Itch NRS), which is typically used to assess overall or general itch intensity, often referring to whole-body itch. 5. To increase the value of the manuscript, it should be examined by a native English speaker. Thank you for your comments. We have had some sentences revised by a native English speaker. We thank Analisa Avila, MPH, ELS, of Edanz (www.edanz.com/ac) for editing a draft of this manuscript. 6. The author can add a published study on itch in Thai psoriasis patients, and add comparison in discussion part. Please see [Ref 1] : 1. Junsuwan N, Likittanasombat S, Chularojanamontri L, Chaiyabutr C, et al.: Prevalence and clinical characteristics of pruritus, and the factors significantly associated with high pruritic intensity in patients with psoriasis: a cross-sectional study. Ann Med Surg (Lond) . 2023; 85 (7): 3396-3402 PubMed Abstract | Publisher Full Text Thank you for your advice. We have added this reference in the Introduction and included a comparison in the Discussion section as follows: In introduction as 'A previous study conducted in Thailand extracted pruritus data from medical records of patients attending an outpatient psoriasis clinic between 2020 and 2021, revealing an overall prevalence of 81.2% 3 ' - line 57-59 In discussion as ' Our study results revealed itching in 99% of patients or almost all the patients, which was surprisingly high compared to previous data of 64%–97% 3, 4 ' . - line 184 Reference 1. Lin TY, See LC, Shen YM, Liang CY, Chang HN, Lin YK. Quality of life in patients with psoriasis in northern Taiwan. Chang Gung Med J. 2011 Mar-Apr;34(2):186-96. PubMed PMID: 21539761. Epub 2011/05/05. 2. Consultation WHOE. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004 Jan 10;363(9403):157-63. PubMed PMID: 14726171. Epub 2004/01/17. 3. Junsuwan N, Likittanasombat S, Chularojanamontri L, Chaiyabutr C, Wongpraparut C, Silpa-Archa N. Prevalence and clinical characteristics of pruritus, and the factors significantly associated with high pruritic intensity in patients with psoriasis: a cross-sectional study. Ann Med Surg (Lond). 2023 Jul;85(7):3396-402. PubMed PMID: 37427235. Pubmed Central PMCID: PMC10328595. Epub 2023/07/10. eng. 4. Tsianakas A, Mrowietz U. [Pruritus in psoriasis : Profile and therapy]. Hautarzt. 2016 Aug;67(8):601-5. PubMed PMID: 27376751. Epub 2016/07/05. Pruritus bei Psoriasis : Profil und Therapie. Reviewer 2 Narumol Silpa-archa, Dermatology Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Mahidol University, Thailand Approved With Reservations info_outline The authors did an interesting cross-sectional study on itch and DLQI in Thai psoriasis. These are questions and comments. 1. How many patients were interviewed by phone and how many were questioned on-site? Please provide additional information. Thank you for your comments. We agree with the reviewer. Upon rechecking the data, we found that approximately 90% of participants were assessed via telephone interviews for itchiness and quality of life due to the survey being conducted during the COVID-19 pandemic, while only 10% participated in face-to-face interviews. We have clarified this in the Survey Procedures and Limitations sections, as follows: Survey procedures: ' Each patient responded to the questionnaire by telephone (90%) or face-to-face (10%) with a non-dermatologist interviewer to avoid any bias.' - line 78-79 Limitations sections: 'Lastly, this study used a telephone-based cross-sectional survey method during the COVID-19 pandemic to minimize the risk of transmission. As a result, causal relationships could not be established, and the sample was limited to individuals with telephone access. Therefore, the findings may not fully represent the entire population'- line 279-282 2. Are there any data on psoriasis severity, BSA, PGA, or PASI from onsite patients? Please clarify, as this is one of the major causes of itching in psoriasis. Thank you for your comments. However, we did not have any data on psoriasis severity, BSA, PGA, or PASI from onsite patients. We added this in the limitation as following. 'Limitations in our study include the specific patients with small sample size, population bias with mild severity of disease, and no available PASI score.' - line 281 3. The authors determined that dry skin, heat, and humidity were key causes of itching. Please provide further information about dry skin (any measurements) and season affect (winter or summer). These can provide additional information to the reader. The assessment was based on patient self-reports regarding the effects of dry skin, heat and humidity, and seasonal factors (e.g., cold environments) on their itch symptoms. We asked patients how these factors influenced their itch—whether symptoms worsened, improved, or remained unchanged. As this information is self-reported, it may not be as accurate as standardized measurements; however, this limitation has been acknowledged in the manuscript as follow; 'Our study relied on self-reported factors and itch outcomes, which should not be interpreted as confirmed clinical measurements or diagnoses' - line 281-282 4. Which locations are most affected by psoriasis itching, according to this study? We did not have data on the locations most affected by psoriasis-related itching because we did not ask participants to specify the location of their itch. Instead, we used the Itch Numeric Rating Scale (Itch NRS), which is typically used to assess overall or general itch intensity, often referring to whole-body itch. 5. To increase the value of the manuscript, it should be examined by a native English speaker. Thank you for your comments. We have had some sentences revised by a native English speaker. We thank Analisa Avila, MPH, ELS, of Edanz (www.edanz.com/ac) for editing a draft of this manuscript. 6. The author can add a published study on itch in Thai psoriasis patients, and add comparison in discussion part. Please see [Ref 1] : 1. Junsuwan N, Likittanasombat S, Chularojanamontri L, Chaiyabutr C, et al.: Prevalence and clinical characteristics of pruritus, and the factors significantly associated with high pruritic intensity in patients with psoriasis: a cross-sectional study. Ann Med Surg (Lond) . 2023; 85 (7): 3396-3402 PubMed Abstract | Publisher Full Text Thank you for your advice. We have added this reference in the Introduction and included a comparison in the Discussion section as follows: In introduction as 'A previous study conducted in Thailand extracted pruritus data from medical records of patients attending an outpatient psoriasis clinic between 2020 and 2021, revealing an overall prevalence of 81.2% 3 ' - line 57-59 In discussion as ' Our study results revealed itching in 99% of patients or almost all the patients, which was surprisingly high compared to previous data of 64%–97% 3, 4 ' . - line 184 Reference 1. Lin TY, See LC, Shen YM, Liang CY, Chang HN, Lin YK. Quality of life in patients with psoriasis in northern Taiwan. Chang Gung Med J. 2011 Mar-Apr;34(2):186-96. PubMed PMID: 21539761. Epub 2011/05/05. 2. Consultation WHOE. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004 Jan 10;363(9403):157-63. PubMed PMID: 14726171. Epub 2004/01/17. 3. Junsuwan N, Likittanasombat S, Chularojanamontri L, Chaiyabutr C, Wongpraparut C, Silpa-Archa N. Prevalence and clinical characteristics of pruritus, and the factors significantly associated with high pruritic intensity in patients with psoriasis: a cross-sectional study. Ann Med Surg (Lond). 2023 Jul;85(7):3396-402. PubMed PMID: 37427235. Pubmed Central PMCID: PMC10328595. Epub 2023/07/10. eng. 4. Tsianakas A, Mrowietz U. [Pruritus in psoriasis : Profile and therapy]. Hautarzt. 2016 Aug;67(8):601-5. PubMed PMID: 27376751. Epub 2016/07/05. Pruritus bei Psoriasis : Profil und Therapie. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Tovanabutra N. Reviewer Report For: Associations Between Factors Affecting Itching and Quality of Life in Thai Patients with Psoriasis: A Cross-Sectional Study [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2025, 13 :1242 ( https://doi.org/10.5256/f1000research.172051.r364699 ) The direct URL for this report is: https://f1000research.com/articles/13-1242/v1#referee-response-364699 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 28 Feb 2025 Napatra Tovanabutra , Chiang Mai University, Chiang Mai, Chiang Mai, Thailand Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.172051.r364699 Overall, this is a well-written manuscript which evaluates the association between factors affecting itch and quality of life in Thai patient with psoriasis. The result of the analysis seems accurate. The following are minor comments which need to be addressed ... Continue reading READ ALL Overall, this is a well-written manuscript which evaluates the association between factors affecting itch and quality of life in Thai patient with psoriasis. The result of the analysis seems accurate. The following are minor comments which need to be addressed and revised. Due to this study allowing the patient response to the questionnaire by telephone, it would be good if the authors can report the number of patients who response by the different methods and whether the difference of the results between these two methods. Authors should demonstrate the sample-size calculations. According to the study involved Thai patients, Asian-Pacific BMI should be used instead of WHO BMI. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? I cannot comment. A qualified statistician is required. Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Dermatologist I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Tovanabutra N. Reviewer Report For: Associations Between Factors Affecting Itching and Quality of Life in Thai Patients with Psoriasis: A Cross-Sectional Study [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2025, 13 :1242 ( https://doi.org/10.5256/f1000research.172051.r364699 ) The direct URL for this report is: https://f1000research.com/articles/13-1242/v1#referee-response-364699 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 04 Mar 2025 Wiriya Mahikul , Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, 10210, Thailand 04 Mar 2025 Author Response Reviewer 1 Napatra Tovanabutra, Chiang Mai University, Chiang Mai, Chiang Mai, Thailand Approved With Reservations info_outline Overall, this is a well-written manuscript which evaluates the association between factors ... Continue reading Reviewer 1 Napatra Tovanabutra, Chiang Mai University, Chiang Mai, Chiang Mai, Thailand Approved With Reservations info_outline Overall, this is a well-written manuscript which evaluates the association between factors affecting itch and quality of life in Thai patient with psoriasis. The result of the analysis seems accurate. The following are minor comments which need to be addressed and revised. Thank you for the positive reviews on our manuscript and for the reviewers’ comments on how to improve the publication. Due to this study allowing the patient response to the questionnaire by telephone, it would be good if the authors can report the number of patients who response by the different methods and whether the difference of the results between these two methods. Thank you for your comments. We agree with the reviewer. Upon rechecking the data, we found that approximately 90% of participants were assessed via telephone interviews for itchiness and quality of life due to the survey being conducted during the COVID-19 pandemic, while only 10% participated in face-to-face interviews. This small proportion of face-to-face interviews was insufficient to perform a subgroup analysis comparing the two methods. We have clarified this in the Survey Procedures and Limitations sections, as follows: Survey procedures: ' Each patient responded to the questionnaire by telephone (90%) or face-to-face (10%) with a non-dermatologist interviewer to avoid any bias.' - line 78-79 Limitation: 'Lastly, this study used a telephone-based cross-sectional survey method during the COVID-19 pandemic to minimize the risk of transmission. As a result, causal relationships could not be established, and the sample was limited to individuals with telephone access. Therefore, the findings may not fully represent the entire population.' - line 286-289 Authors should demonstrate the sample-size calculations. Thank you for your comments. We have provided the sample size calculation as follows: 'To estimate the sample size, we used the infinite population proportion formula: n = Z²p(1-p)/d². Based on the assumption that 67% of patients reported a moderate to extremely large impact on their quality of life (DLQI > 6) 1 , a 10% precision (d), a 95% confidence level, and accounting for a 10% non-response rate, the minimum calculated sample size was 95. The response rate was determined by dividing the number of respondents by the total number invited to the study. For example, 100 out of 125 individuals responded, yielding an 80% response rate. However, the total number of respondents still exceeds the sample size required to ensure sufficient statistical power for the study.' - line 68-75 According to the study involved Thai patients, Asian-Pacific BMI should be used instead of WHO BMI. We agree with the reviewer. Therefore, we changed the BMI classification from the WHO BMI to the Asian-Pacific BMI, as the study involved Thai patients, as follows: 'Patients mean body mass index (BMI) was 25.0 ± 4.4 kg/m 2 , which is classified as obese (BMI ≥25 kg/m 2 according to Asia Pacific guidelines) 2 . Of the total, 45% of participants had a BMI of ≥ 25.0 kg/m 2 , which is recognized as obese (BMI ≥ 25 kg/m 2 ) 2 .' - line 117-119 and Table 1 Table 1. Demographic data of patients (N = 100) Variables N = % BMI (kg/m 2 ) Mean ± SD 25.0 ± 4.4 < 18.5 (Underweight) 2 18.5–22.9 (Normal) 35 23–24.9 (Overweight) 18 ≥ 25.0 (Obese) 45 However, this change does not affect our main results, as there is still no significant difference between BMI and DLQI. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? I cannot comment. A qualified statistician is required. Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Dermatologist I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Reference 1. Lin TY, See LC, Shen YM, Liang CY, Chang HN, Lin YK. Quality of life in patients with psoriasis in northern Taiwan. Chang Gung Med J. 2011 Mar-Apr;34(2):186-96. PubMed PMID: 21539761. Epub 2011/05/05. 2. Consultation WHOE. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004 Jan 10;363(9403):157-63. PubMed PMID: 14726171. Epub 2004/01/17. Reviewer 1 Napatra Tovanabutra, Chiang Mai University, Chiang Mai, Chiang Mai, Thailand Approved With Reservations info_outline Overall, this is a well-written manuscript which evaluates the association between factors affecting itch and quality of life in Thai patient with psoriasis. The result of the analysis seems accurate. The following are minor comments which need to be addressed and revised. Thank you for the positive reviews on our manuscript and for the reviewers’ comments on how to improve the publication. Due to this study allowing the patient response to the questionnaire by telephone, it would be good if the authors can report the number of patients who response by the different methods and whether the difference of the results between these two methods. Thank you for your comments. We agree with the reviewer. Upon rechecking the data, we found that approximately 90% of participants were assessed via telephone interviews for itchiness and quality of life due to the survey being conducted during the COVID-19 pandemic, while only 10% participated in face-to-face interviews. This small proportion of face-to-face interviews was insufficient to perform a subgroup analysis comparing the two methods. We have clarified this in the Survey Procedures and Limitations sections, as follows: Survey procedures: ' Each patient responded to the questionnaire by telephone (90%) or face-to-face (10%) with a non-dermatologist interviewer to avoid any bias.' - line 78-79 Limitation: 'Lastly, this study used a telephone-based cross-sectional survey method during the COVID-19 pandemic to minimize the risk of transmission. As a result, causal relationships could not be established, and the sample was limited to individuals with telephone access. Therefore, the findings may not fully represent the entire population.' - line 286-289 Authors should demonstrate the sample-size calculations. Thank you for your comments. We have provided the sample size calculation as follows: 'To estimate the sample size, we used the infinite population proportion formula: n = Z²p(1-p)/d². Based on the assumption that 67% of patients reported a moderate to extremely large impact on their quality of life (DLQI > 6) 1 , a 10% precision (d), a 95% confidence level, and accounting for a 10% non-response rate, the minimum calculated sample size was 95. The response rate was determined by dividing the number of respondents by the total number invited to the study. For example, 100 out of 125 individuals responded, yielding an 80% response rate. However, the total number of respondents still exceeds the sample size required to ensure sufficient statistical power for the study.' - line 68-75 According to the study involved Thai patients, Asian-Pacific BMI should be used instead of WHO BMI. We agree with the reviewer. Therefore, we changed the BMI classification from the WHO BMI to the Asian-Pacific BMI, as the study involved Thai patients, as follows: 'Patients mean body mass index (BMI) was 25.0 ± 4.4 kg/m 2 , which is classified as obese (BMI ≥25 kg/m 2 according to Asia Pacific guidelines) 2 . Of the total, 45% of participants had a BMI of ≥ 25.0 kg/m 2 , which is recognized as obese (BMI ≥ 25 kg/m 2 ) 2 .' - line 117-119 and Table 1 Table 1. Demographic data of patients (N = 100) Variables N = % BMI (kg/m 2 ) Mean ± SD 25.0 ± 4.4 < 18.5 (Underweight) 2 18.5–22.9 (Normal) 35 23–24.9 (Overweight) 18 ≥ 25.0 (Obese) 45 However, this change does not affect our main results, as there is still no significant difference between BMI and DLQI. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? I cannot comment. A qualified statistician is required. Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Dermatologist I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Reference 1. Lin TY, See LC, Shen YM, Liang CY, Chang HN, Lin YK. Quality of life in patients with psoriasis in northern Taiwan. Chang Gung Med J. 2011 Mar-Apr;34(2):186-96. PubMed PMID: 21539761. Epub 2011/05/05. 2. Consultation WHOE. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004 Jan 10;363(9403):157-63. PubMed PMID: 14726171. Epub 2004/01/17. Competing Interests: Non-Financial Competing Interests Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 04 Mar 2025 Wiriya Mahikul , Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, 10210, Thailand 04 Mar 2025 Author Response Reviewer 1 Napatra Tovanabutra, Chiang Mai University, Chiang Mai, Chiang Mai, Thailand Approved With Reservations info_outline Overall, this is a well-written manuscript which evaluates the association between factors ... Continue reading Reviewer 1 Napatra Tovanabutra, Chiang Mai University, Chiang Mai, Chiang Mai, Thailand Approved With Reservations info_outline Overall, this is a well-written manuscript which evaluates the association between factors affecting itch and quality of life in Thai patient with psoriasis. The result of the analysis seems accurate. The following are minor comments which need to be addressed and revised. Thank you for the positive reviews on our manuscript and for the reviewers’ comments on how to improve the publication. Due to this study allowing the patient response to the questionnaire by telephone, it would be good if the authors can report the number of patients who response by the different methods and whether the difference of the results between these two methods. Thank you for your comments. We agree with the reviewer. Upon rechecking the data, we found that approximately 90% of participants were assessed via telephone interviews for itchiness and quality of life due to the survey being conducted during the COVID-19 pandemic, while only 10% participated in face-to-face interviews. This small proportion of face-to-face interviews was insufficient to perform a subgroup analysis comparing the two methods. We have clarified this in the Survey Procedures and Limitations sections, as follows: Survey procedures: ' Each patient responded to the questionnaire by telephone (90%) or face-to-face (10%) with a non-dermatologist interviewer to avoid any bias.' - line 78-79 Limitation: 'Lastly, this study used a telephone-based cross-sectional survey method during the COVID-19 pandemic to minimize the risk of transmission. As a result, causal relationships could not be established, and the sample was limited to individuals with telephone access. Therefore, the findings may not fully represent the entire population.' - line 286-289 Authors should demonstrate the sample-size calculations. Thank you for your comments. We have provided the sample size calculation as follows: 'To estimate the sample size, we used the infinite population proportion formula: n = Z²p(1-p)/d². Based on the assumption that 67% of patients reported a moderate to extremely large impact on their quality of life (DLQI > 6) 1 , a 10% precision (d), a 95% confidence level, and accounting for a 10% non-response rate, the minimum calculated sample size was 95. The response rate was determined by dividing the number of respondents by the total number invited to the study. For example, 100 out of 125 individuals responded, yielding an 80% response rate. However, the total number of respondents still exceeds the sample size required to ensure sufficient statistical power for the study.' - line 68-75 According to the study involved Thai patients, Asian-Pacific BMI should be used instead of WHO BMI. We agree with the reviewer. Therefore, we changed the BMI classification from the WHO BMI to the Asian-Pacific BMI, as the study involved Thai patients, as follows: 'Patients mean body mass index (BMI) was 25.0 ± 4.4 kg/m 2 , which is classified as obese (BMI ≥25 kg/m 2 according to Asia Pacific guidelines) 2 . Of the total, 45% of participants had a BMI of ≥ 25.0 kg/m 2 , which is recognized as obese (BMI ≥ 25 kg/m 2 ) 2 .' - line 117-119 and Table 1 Table 1. Demographic data of patients (N = 100) Variables N = % BMI (kg/m 2 ) Mean ± SD 25.0 ± 4.4 < 18.5 (Underweight) 2 18.5–22.9 (Normal) 35 23–24.9 (Overweight) 18 ≥ 25.0 (Obese) 45 However, this change does not affect our main results, as there is still no significant difference between BMI and DLQI. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? I cannot comment. A qualified statistician is required. Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Dermatologist I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Reference 1. Lin TY, See LC, Shen YM, Liang CY, Chang HN, Lin YK. Quality of life in patients with psoriasis in northern Taiwan. Chang Gung Med J. 2011 Mar-Apr;34(2):186-96. PubMed PMID: 21539761. Epub 2011/05/05. 2. Consultation WHOE. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004 Jan 10;363(9403):157-63. PubMed PMID: 14726171. Epub 2004/01/17. Reviewer 1 Napatra Tovanabutra, Chiang Mai University, Chiang Mai, Chiang Mai, Thailand Approved With Reservations info_outline Overall, this is a well-written manuscript which evaluates the association between factors affecting itch and quality of life in Thai patient with psoriasis. The result of the analysis seems accurate. The following are minor comments which need to be addressed and revised. Thank you for the positive reviews on our manuscript and for the reviewers’ comments on how to improve the publication. Due to this study allowing the patient response to the questionnaire by telephone, it would be good if the authors can report the number of patients who response by the different methods and whether the difference of the results between these two methods. Thank you for your comments. We agree with the reviewer. Upon rechecking the data, we found that approximately 90% of participants were assessed via telephone interviews for itchiness and quality of life due to the survey being conducted during the COVID-19 pandemic, while only 10% participated in face-to-face interviews. This small proportion of face-to-face interviews was insufficient to perform a subgroup analysis comparing the two methods. We have clarified this in the Survey Procedures and Limitations sections, as follows: Survey procedures: ' Each patient responded to the questionnaire by telephone (90%) or face-to-face (10%) with a non-dermatologist interviewer to avoid any bias.' - line 78-79 Limitation: 'Lastly, this study used a telephone-based cross-sectional survey method during the COVID-19 pandemic to minimize the risk of transmission. As a result, causal relationships could not be established, and the sample was limited to individuals with telephone access. Therefore, the findings may not fully represent the entire population.' - line 286-289 Authors should demonstrate the sample-size calculations. Thank you for your comments. We have provided the sample size calculation as follows: 'To estimate the sample size, we used the infinite population proportion formula: n = Z²p(1-p)/d². Based on the assumption that 67% of patients reported a moderate to extremely large impact on their quality of life (DLQI > 6) 1 , a 10% precision (d), a 95% confidence level, and accounting for a 10% non-response rate, the minimum calculated sample size was 95. The response rate was determined by dividing the number of respondents by the total number invited to the study. For example, 100 out of 125 individuals responded, yielding an 80% response rate. However, the total number of respondents still exceeds the sample size required to ensure sufficient statistical power for the study.' - line 68-75 According to the study involved Thai patients, Asian-Pacific BMI should be used instead of WHO BMI. We agree with the reviewer. Therefore, we changed the BMI classification from the WHO BMI to the Asian-Pacific BMI, as the study involved Thai patients, as follows: 'Patients mean body mass index (BMI) was 25.0 ± 4.4 kg/m 2 , which is classified as obese (BMI ≥25 kg/m 2 according to Asia Pacific guidelines) 2 . Of the total, 45% of participants had a BMI of ≥ 25.0 kg/m 2 , which is recognized as obese (BMI ≥ 25 kg/m 2 ) 2 .' - line 117-119 and Table 1 Table 1. Demographic data of patients (N = 100) Variables N = % BMI (kg/m 2 ) Mean ± SD 25.0 ± 4.4 < 18.5 (Underweight) 2 18.5–22.9 (Normal) 35 23–24.9 (Overweight) 18 ≥ 25.0 (Obese) 45 However, this change does not affect our main results, as there is still no significant difference between BMI and DLQI. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? I cannot comment. A qualified statistician is required. Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Dermatologist I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Reference 1. Lin TY, See LC, Shen YM, Liang CY, Chang HN, Lin YK. Quality of life in patients with psoriasis in northern Taiwan. Chang Gung Med J. 2011 Mar-Apr;34(2):186-96. PubMed PMID: 21539761. Epub 2011/05/05. 2. Consultation WHOE. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004 Jan 10;363(9403):157-63. PubMed PMID: 14726171. Epub 2004/01/17. Competing Interests: Non-Financial Competing Interests Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 17 Oct 2024 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 3 Version 2 (revision) 25 Apr 25 read read Version 1 17 Oct 24 read read Napatra Tovanabutra , Chiang Mai University, Chiang Mai, Thailand Narumol Silpa-archa , Mahidol University, Bangkok, Thailand Adam Reich , University of Rzeszów, Rzeszów, Poland Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Reich A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 24 May 2025 | for Version 2 Adam Reich , Department of Dermatology, University of Rzeszów, Rzeszów, Poland 0 Views copyright © 2025 Reich A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The authors performed a study among Thai patients with psoriasis on the prevalence and intensity of itching. I found the study interesting, relevant, and well-performed. The results are important, as they document a high prevalence of itch in psoriasis patients (99%) and a significant impact of pruritus on quality of life. Regarding data presentation, I would suggest reconsidering the following statement: " (...) most (99%) experienced itching, with a moderate degree of pruritus (mean Itch NRS score 6.5 ± 2.6) and a moderate effect on quality of life (mean DLQI score 9.4 ± 6.2). Please note that these are mean values. However, about 50% of patients demonstrate DLQI scoring >10, which indicates a very large or extremely large effect on QoL. The same applies to NRS, in which a substantial proportion of patients had NRS scoring >7, which indicates high pruritus intensity. Please modify reference 21 as follows: Reich A, Szepietowski JC, Wisnicka B, et al. : Does Stress Influence Itching in Psoriatic Patients? Dermatology and Psychosomatics/Dermatologie und Psychosomatik. 2003 09/01; 4 : 151–155 Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Pruritus, psychodermatology, psoriasis I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Reich A. Peer Review Report For: Associations Between Factors Affecting Itching and Quality of Life in Thai Patients with Psoriasis: A Cross-Sectional Study [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2025, 13 :1242 ( https://doi.org/10.5256/f1000research.181039.r381203) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-1242/v2#referee-response-381203 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Silpa-archa N. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 14 May 2025 | for Version 2 Narumol Silpa-archa , Dermatology Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Mahidol University,, Thailand 0 Views copyright © 2025 Silpa-archa N. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Following the first revisions, the manuscript becomes more knowledgeable and well-written. The authors responded well, based on the comments. Competing Interests No competing interests were disclosed. Reviewer Expertise Photodermatology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Silpa-archa N. Peer Review Report For: Associations Between Factors Affecting Itching and Quality of Life in Thai Patients with Psoriasis: A Cross-Sectional Study [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2025, 13 :1242 ( https://doi.org/10.5256/f1000research.181039.r380765) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-1242/v2#referee-response-380765 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Silpa-archa N. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 22 Apr 2025 | for Version 1 Narumol Silpa-archa , Dermatology Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Mahidol University,, Thailand 0 Views copyright © 2025 Silpa-archa N. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The authors did an interesting cross-sectional study on itch and DLQI in Thai psoriasis. These are questions and comments. 1. How many patients were interviewed by phone and how many were questioned on-site? Please provide additional information. 2. Are there any data on psoriasis severity, BSA, PGA, or PASI from onsite patients? Please clarify, as this is one of the major causes of itching in psoriasis. 3. The authors determined that dry skin, heat, and humidity were key causes of itching. Please provide further information about dry skin (any measurements) and season affect (winter or summer). These can provide additional information to the reader. 4. Which locations are most affected by psoriasis itching, according to this study? 5. To increase the value of the manuscript, it should be examined by a native English speaker. 6. The author can add a published study on itch in Thai psoriasis patients, and add comparison in discussion part. Please see [Ref 1] Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? I cannot comment. A qualified statistician is required. Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Yes References 1. Junsuwan N, Likittanasombat S, Chularojanamontri L, Chaiyabutr C, et al.: Prevalence and clinical characteristics of pruritus, and the factors significantly associated with high pruritic intensity in patients with psoriasis: a cross-sectional study. Ann Med Surg (Lond) . 2023; 85 (7): 3396-3402 PubMed Abstract | Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise Photodermatology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 07 May 2025 Wiriya Mahikul, Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, 10210, Thailand Reviewer 2 Narumol Silpa-archa, Dermatology Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Mahidol University, Thailand Approved With Reservations info_outline The authors did an interesting cross-sectional study on itch and DLQI in Thai psoriasis. These are questions and comments. 1. How many patients were interviewed by phone and how many were questioned on-site? Please provide additional information. Thank you for your comments. We agree with the reviewer. Upon rechecking the data, we found that approximately 90% of participants were assessed via telephone interviews for itchiness and quality of life due to the survey being conducted during the COVID-19 pandemic, while only 10% participated in face-to-face interviews. We have clarified this in the Survey Procedures and Limitations sections, as follows: Survey procedures: ' Each patient responded to the questionnaire by telephone (90%) or face-to-face (10%) with a non-dermatologist interviewer to avoid any bias.' - line 78-79 Limitations sections: 'Lastly, this study used a telephone-based cross-sectional survey method during the COVID-19 pandemic to minimize the risk of transmission. As a result, causal relationships could not be established, and the sample was limited to individuals with telephone access. Therefore, the findings may not fully represent the entire population'- line 279-282 2. Are there any data on psoriasis severity, BSA, PGA, or PASI from onsite patients? Please clarify, as this is one of the major causes of itching in psoriasis. Thank you for your comments. However, we did not have any data on psoriasis severity, BSA, PGA, or PASI from onsite patients. We added this in the limitation as following. 'Limitations in our study include the specific patients with small sample size, population bias with mild severity of disease, and no available PASI score.' - line 281 3. The authors determined that dry skin, heat, and humidity were key causes of itching. Please provide further information about dry skin (any measurements) and season affect (winter or summer). These can provide additional information to the reader. The assessment was based on patient self-reports regarding the effects of dry skin, heat and humidity, and seasonal factors (e.g., cold environments) on their itch symptoms. We asked patients how these factors influenced their itch—whether symptoms worsened, improved, or remained unchanged. As this information is self-reported, it may not be as accurate as standardized measurements; however, this limitation has been acknowledged in the manuscript as follow; 'Our study relied on self-reported factors and itch outcomes, which should not be interpreted as confirmed clinical measurements or diagnoses' - line 281-282 4. Which locations are most affected by psoriasis itching, according to this study? We did not have data on the locations most affected by psoriasis-related itching because we did not ask participants to specify the location of their itch. Instead, we used the Itch Numeric Rating Scale (Itch NRS), which is typically used to assess overall or general itch intensity, often referring to whole-body itch. 5. To increase the value of the manuscript, it should be examined by a native English speaker. Thank you for your comments. We have had some sentences revised by a native English speaker. We thank Analisa Avila, MPH, ELS, of Edanz (www.edanz.com/ac) for editing a draft of this manuscript. 6. The author can add a published study on itch in Thai psoriasis patients, and add comparison in discussion part. Please see [Ref 1] : 1. Junsuwan N, Likittanasombat S, Chularojanamontri L, Chaiyabutr C, et al.: Prevalence and clinical characteristics of pruritus, and the factors significantly associated with high pruritic intensity in patients with psoriasis: a cross-sectional study. Ann Med Surg (Lond) . 2023; 85 (7): 3396-3402 PubMed Abstract | Publisher Full Text Thank you for your advice. We have added this reference in the Introduction and included a comparison in the Discussion section as follows: In introduction as 'A previous study conducted in Thailand extracted pruritus data from medical records of patients attending an outpatient psoriasis clinic between 2020 and 2021, revealing an overall prevalence of 81.2% 3 ' - line 57-59 In discussion as ' Our study results revealed itching in 99% of patients or almost all the patients, which was surprisingly high compared to previous data of 64%–97% 3, 4 ' . - line 184 Reference 1. Lin TY, See LC, Shen YM, Liang CY, Chang HN, Lin YK. Quality of life in patients with psoriasis in northern Taiwan. Chang Gung Med J. 2011 Mar-Apr;34(2):186-96. PubMed PMID: 21539761. Epub 2011/05/05. 2. Consultation WHOE. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004 Jan 10;363(9403):157-63. PubMed PMID: 14726171. Epub 2004/01/17. 3. Junsuwan N, Likittanasombat S, Chularojanamontri L, Chaiyabutr C, Wongpraparut C, Silpa-Archa N. Prevalence and clinical characteristics of pruritus, and the factors significantly associated with high pruritic intensity in patients with psoriasis: a cross-sectional study. Ann Med Surg (Lond). 2023 Jul;85(7):3396-402. PubMed PMID: 37427235. Pubmed Central PMCID: PMC10328595. Epub 2023/07/10. eng. 4. Tsianakas A, Mrowietz U. [Pruritus in psoriasis : Profile and therapy]. Hautarzt. 2016 Aug;67(8):601-5. PubMed PMID: 27376751. Epub 2016/07/05. Pruritus bei Psoriasis : Profil und Therapie. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Silpa-archa N. Peer Review Report For: Associations Between Factors Affecting Itching and Quality of Life in Thai Patients with Psoriasis: A Cross-Sectional Study [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2025, 13 :1242 ( https://doi.org/10.5256/f1000research.172051.r371560) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-1242/v1#referee-response-371560 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Tovanabutra N. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 28 Feb 2025 | for Version 1 Napatra Tovanabutra , Chiang Mai University, Chiang Mai, Chiang Mai, Thailand 0 Views copyright © 2025 Tovanabutra N. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Overall, this is a well-written manuscript which evaluates the association between factors affecting itch and quality of life in Thai patient with psoriasis. The result of the analysis seems accurate. The following are minor comments which need to be addressed and revised. Due to this study allowing the patient response to the questionnaire by telephone, it would be good if the authors can report the number of patients who response by the different methods and whether the difference of the results between these two methods. Authors should demonstrate the sample-size calculations. According to the study involved Thai patients, Asian-Pacific BMI should be used instead of WHO BMI. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? I cannot comment. A qualified statistician is required. Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Dermatologist I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 04 Mar 2025 Wiriya Mahikul, Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, 10210, Thailand Reviewer 1 Napatra Tovanabutra, Chiang Mai University, Chiang Mai, Chiang Mai, Thailand Approved With Reservations info_outline Overall, this is a well-written manuscript which evaluates the association between factors affecting itch and quality of life in Thai patient with psoriasis. The result of the analysis seems accurate. The following are minor comments which need to be addressed and revised. Thank you for the positive reviews on our manuscript and for the reviewers’ comments on how to improve the publication. Due to this study allowing the patient response to the questionnaire by telephone, it would be good if the authors can report the number of patients who response by the different methods and whether the difference of the results between these two methods. Thank you for your comments. We agree with the reviewer. Upon rechecking the data, we found that approximately 90% of participants were assessed via telephone interviews for itchiness and quality of life due to the survey being conducted during the COVID-19 pandemic, while only 10% participated in face-to-face interviews. This small proportion of face-to-face interviews was insufficient to perform a subgroup analysis comparing the two methods. We have clarified this in the Survey Procedures and Limitations sections, as follows: Survey procedures: ' Each patient responded to the questionnaire by telephone (90%) or face-to-face (10%) with a non-dermatologist interviewer to avoid any bias.' - line 78-79 Limitation: 'Lastly, this study used a telephone-based cross-sectional survey method during the COVID-19 pandemic to minimize the risk of transmission. As a result, causal relationships could not be established, and the sample was limited to individuals with telephone access. Therefore, the findings may not fully represent the entire population.' - line 286-289 Authors should demonstrate the sample-size calculations. Thank you for your comments. We have provided the sample size calculation as follows: 'To estimate the sample size, we used the infinite population proportion formula: n = Z²p(1-p)/d². Based on the assumption that 67% of patients reported a moderate to extremely large impact on their quality of life (DLQI > 6) 1 , a 10% precision (d), a 95% confidence level, and accounting for a 10% non-response rate, the minimum calculated sample size was 95. The response rate was determined by dividing the number of respondents by the total number invited to the study. For example, 100 out of 125 individuals responded, yielding an 80% response rate. However, the total number of respondents still exceeds the sample size required to ensure sufficient statistical power for the study.' - line 68-75 According to the study involved Thai patients, Asian-Pacific BMI should be used instead of WHO BMI. We agree with the reviewer. Therefore, we changed the BMI classification from the WHO BMI to the Asian-Pacific BMI, as the study involved Thai patients, as follows: 'Patients mean body mass index (BMI) was 25.0 ± 4.4 kg/m 2 , which is classified as obese (BMI ≥25 kg/m 2 according to Asia Pacific guidelines) 2 . Of the total, 45% of participants had a BMI of ≥ 25.0 kg/m 2 , which is recognized as obese (BMI ≥ 25 kg/m 2 ) 2 .' - line 117-119 and Table 1 Table 1. Demographic data of patients (N = 100) Variables N = % BMI (kg/m 2 ) Mean ± SD 25.0 ± 4.4 < 18.5 (Underweight) 2 18.5–22.9 (Normal) 35 23–24.9 (Overweight) 18 ≥ 25.0 (Obese) 45 However, this change does not affect our main results, as there is still no significant difference between BMI and DLQI. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? I cannot comment. A qualified statistician is required. Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Dermatologist I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Reference 1. Lin TY, See LC, Shen YM, Liang CY, Chang HN, Lin YK. Quality of life in patients with psoriasis in northern Taiwan. Chang Gung Med J. 2011 Mar-Apr;34(2):186-96. PubMed PMID: 21539761. Epub 2011/05/05. 2. Consultation WHOE. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004 Jan 10;363(9403):157-63. PubMed PMID: 14726171. Epub 2004/01/17. View more View less Competing Interests Non-Financial Competing Interests reply Respond Report a concern Tovanabutra N. Peer Review Report For: Associations Between Factors Affecting Itching and Quality of Life in Thai Patients with Psoriasis: A Cross-Sectional Study [version 2; peer review: 2 approved, 1 approved with reservations] . F1000Research 2025, 13 :1242 ( https://doi.org/10.5256/f1000research.172051.r364699) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-1242/v1#referee-response-364699 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Adjust parameters to alter display View on desktop for interactive features Includes Interactive Elements View on desktop for interactive features Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. 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