夜间皮肤瘙痒及治疗进展

瘙痒是皮肤科最常见的临床症状。国内外对其发生机制进行了大量的研究,提出瘙痒的发生主要由无髓C纤维介导,其对组胺及热敏感,并与一系列瘙痒介质的参与有关［1］。临床工作中发现,瘙痒常在夜间发作或明显加重［２］,患者通常描述瘙痒位于原有皮损处或全身性发作,无明确定位。Yosipovitch等［1］报道,65%的炎症性皮肤病患者夜间感觉瘙痒加重,其中包括银屑病、特应性皮炎及慢性特发性荨麻疹。另外,系统性疾病的患者,如慢性肾功能衰竭及造血系统疾病患者等也感觉夜间皮肤瘙痒加重［２－３］。夜间皮肤瘙痒的认识和处理成为临床工作的重要内容……     

瘙痒的发生机制、分型和治疗

瘙痒是一种常见的使人产生不愉快的感觉，常伴发搔抓。瘙痒可发生于任何年龄和性别，可以呈急性或慢性经过，可局限也可累及全身。其程度可分为轻、中、重度。瘙痒可以由许多皮肤病和内科疾病引起，可严重影响患者的身心健康，降低生活质量。     

Butorphanol for treatment of intractable pruritus

Severe chronic itch and intractable pruritus are encountered frequently by dermatologists. Recent data suggest that generalized pruritus may result from an imbalance between the mu and kappa opioid systems, and kappa-agonists have been shown to inhibit pruritus in both animals and human beings. These findings led us to use butorphanol, a commercially available kappa-opioid agonist and mu-opioid antagonist. We present a case series of 5 patients with intractable pruritus associated with inflammatory skin diseases or systemic diseases who demonstrated rapid and marked improvement when treated with intranasal butorphanol. Because of the small, open-label nature of this study, butorphanol should be investigated further in a larger, randomized controlled trial.     

Neurophysiological and neurochemical basis of modern pruritus treatment

Abstract:  Chronic pruritus of any origin is a frequent discomfort in daily medical practice, and its therapy is challenging. Frequently, the underlying origin may not be identified and symptomatic therapy is necessary. Conventional treatment modalities such as antihistamines often lack efficacy, and hence new therapeutic strategies are necessary. The neuronal mechanisms underlying chronic pruritus have been partly identified during the past years and offer new therapeutic strategies. For example, mast cell degranulation, activation of neuroreceptors on sensory nerve fibres and neurogenic inflammation have been identified to be involved in induction and chronification of the symptom. Accordingly, controlling neuroreceptors such as cannabinoid receptors by agonists or antagonists showed high antipruritic efficacy. Pruritus is transmitted to the central nervous system by specialized nerve fibres and sensory receptors. It has been demonstrated that pruritus and pain have their own neuronal pathways with broad interactions. Accordingly, classical analgesics for neuropathic pain (gabapentin, antidepressants) also exhibit antipruritic efficacy upon clinical use. In summary, these recent developments show that highlighting the basis of pruritus offers modern neurophysiological and neurochemical therapeutic models and the possibility to treat patients with refractory itching of different origin.     

加巴喷丁和普瑞巴林用于治疗慢性瘙痒

<正>瘙痒持续6周可定义为慢性瘙痒,慢性瘙痒是一种难以治疗的自主症状。当局部治疗和口服抗组胺药物对患者无效时,临床医师需考虑使用神经活性药物等其他治疗手段。加巴喷丁和普瑞巴林最初作为抗癫痫药物用于治疗神经性疼痛,如带状疱疹后遗神经痛、糖尿病性神经病变,这两种药物作用于痛觉和痒觉的信号传导途径,也被用于探索性治疗缓解慢性瘙痒。该文通过归纳和分析迄     

An approach to the treatment of anogenital pruritus

The anogenital area is a common location for pruritic complaints. Specific terms for chronic itch in this location have included pruritus vulvae, pruritus ani, lichen simplex chronicus, and neurodermatitis. A male counterpart to pruritus vulvae, pruritus scroti, is less common. Acute anogenital pruritus is usually caused by infections or contact dermatitis. In chronic pruritus, inflammatory dermatoses and malignancies must be ruled out. In idiopathic anogenital pruritus or neurodermatitis, the skin findings should be limited to lichenification and excoriations. Skin findings may be entirely absent. When treating anogenital pruritus, topic irritants and potential sensitizers must be eliminated. Cleansing and toilet habits must be addressed. A short course of a high-potency topical steroid should bring moderate to complete relief. Sedating antihistamines may limit nighttime symptoms. In some patients, psychotropic agents are required to achieve adequate sedation. Antidepressants may be required in patients refractory to treatment or with underlying psychiatric disorders.     

Topical capsaicin for treatment of hemodialysis-related pruritus.

Pruritus is a significant problem for many patients undergoing long-term hemodialysis. Topical capsaicin depletes and prevents the reaccumulation of substance P in peripheral sensory neurons. Substance P functions in the transmission of pain and probably itch sensations. An open-label, uncontrolled trial and a double-blind, vehicle-controlled trial were conducted to evaluate the efficacy and safety of capsaicin 0.025% cream in the treatment of localized areas of pruritus in patients undergoing long-term hemodialysis. Eight of nine evaluable patients in the open-label trial reported marked relief or complete resolution of itching during the study period, and two of five evaluable patients in the double-blind trial reported complete resolution of itching in the capsaicin-treated arm with no or minimal improvement in the vehicle-treated arm. Twelve patients in the open-label trial and two in the double-blind trial were unevaluable. No serious treatment-related adverse reactions occurred.     

Pregabalin treatment of three cases with brachioradial pruritus

Brachioradial pruritus (BRP) is a rare type of chronic pruritus that usually localized at the dorsolateral part of the forearms. Itching, burning, or pain are common symptoms at the involved areas. The etiological factors are still unknown but sun exposure and/or cervical spine lesions seem to be trigerring or precipiting factors. Neuropathogenic mechanism plays role in etiopathogenesis of BRP, therefore, antiepileptic drugs such as gabapentin, oxcarbazepine. and pregabalin are suggested medications for BRP. Herein, we report three cases with BRP successfully treated with pregabaline.     

银屑病瘙痒机制及治疗研究进展

瘙痒是银屑病患者的一种常见症状,严重影响患者的生活质量.但其瘙痒的机制尚不清楚,许多常规治疗瘙痒的药物并不能有效缓解银屑病的瘙痒.目前认为,银屑病皮损中神经分布异常增多和敏感性增加,炎症细胞在病灶中聚集、活化并释放炎症介质是银屑病瘙痒的主要原因.抗组胺药不能有效控制银屑病瘙痒,而神经肽受体拮抗剂、免疫抑制剂及光疗等为治疗银屑病瘙痒的有效方法.

Abstract：

Pruritus is an important symptom of psoriasis.It seriously affects the quality of life of psoriatic patients,but its pathogenesis remains unanswered.Many routine treatments cannot relieve the pruritus in psoriasis effectively.It has been demonstrated that the pruritus in psoriasis is mainly attributed to the abnormally increased innervation and sensitivity of sensory nerves,as well as the aggregation,activation of and release of inflammatory mediators by inflammatory cells.Antihistamine drugs are usually ineffective for the treatment of pruritus in psoriasis,while antagonists of neuropeptide receptors,immunosuppressants and phototherapy have shown favorable efficacy.     

Management of chronic pruritus with a UV filtering topical cream

Chronic pruritus is a common dermatological condition affecting 10–13% of the general population. UVB phototherapy has been demonstrated to be effective in relieving the symptoms of pruritus. However, phototherapy is rarely administered because the treatment is time‐consuming and expensive, when compared to other topical drugs. In previous works, it has been reported that a topical cream, which selectively filters solar UVB can be used as a convenient alternative to traditional phototherapy. Here, we report the results of a pilot study aimed at assessing the effectiveness of the cream for treating pruritus. Seven patients with pruritus symptoms were included in the study. After 3 months of treatment (3 sessions per week), all patients noted improvement in pruritus symptoms. These preliminary results demonstrate that the novel topical cream could provide a convenient, low cost treatment for chronic pruritus patients.