小剂量泼尼松联合秋水仙碱治疗结节性痒疹

结节性痒疹是以躯干、四肢发生结节伴严重瘙痒为主要特征的皮肤病,其发病机制不清楚,目前治疗尚不能取得满意的疗效。从 1998年 1月至 1999年 12月我们采用小剂量泼尼松与秋水仙碱治疗 40例中、重度结节性痒疹,临床疗效较满意,现报道如下。 一、临床资料 所有病例均为本院门诊病例。男 28例,女 12例;年龄 38～ 62岁;病程半年至 10年。皮损为豌豆至花生大小暗红色结节,结节数目约 30～ 80个,伴中、重度剧烈瘙痒。治疗前血尿常规、血压均正常。 二、治疗方法 泼尼松 20 mg/d顿服;秋水仙碱 0.5 mg每日 2次,配合外用皮质类固醇制剂,…     

联合疗法治疗结节性痒疹5例

结节性痒疹（PN）为一病因未明的慢性瘙痒性发疹性皮肤病。其特点为突出于皮面的角化过度的丘疹、结节，剧烈瘙痒，呈对称性分布。此病顽固，治疗困难，影响患者心身健康。笔者用阿维A胶囊、多塞平片口服，外用冰樟桉氟氢松贴膏、0．05％他扎罗汀凝胶、地奈德乳膏、糠酸莫米松乳膏联合治疗结节性痒疹5例，取得较好疗效，现报告如下：     

沙利度胺联合复方氟米松软膏治疗结节性痒疹疗效观察

目的观察沙利度胺联合复方氟米松软膏治疗结节性痒疹疗效。方法将87例结节性痒疹患者随机分为两组。治疗组45例,口服沙利度胺50mg,2次/d,症状改善后逐步减量50mg或25mg,1次/d维持,联合外用复方氟米松软膏,1次/d,共8周;对照组42例,口服左西替利嗪片5mg,1次/d,联合外用复方氟米松软膏1次/d,共8周。结果治疗组有效率为91.11%,对照组为69.05%,两组有效率差异有统计学意义（P〈0.05）,均无明显不良反应。结论沙利度胺联合复方氟米松软膏治疗结节性痒疹安全可靠。     

中西医结合治疗结节性痒疹40例

结节性痒疹是以躯干、四肢发生结节伴严重瘙痒为主要特征的皮肤病，其发病机制不清楚，目前治疗尚不能取得满意的疗效。我们使用自拟痒疹方与小剂量泼尼松治疗40例中、重度结节性痒疹，临床疗效较满意，现报道如下。     

神经精神功能障碍性皮肤病

20032156 小剂量泼尼松联合火把花根片治疗结节性痒疹/李文飞(山东千佛山医院皮肤科)…//中国麻风皮肤病杂志.-2003,19(1).-3 36例均为中、重度结节性痒疹。采用泼尼松20mg,1次/d,晨8时服药;火把花根片5片,3次/d;外用糖皮质激素软膏。2周为1疗程,共3疗程,随访4周。3疗程后减量(泼尼松10mg、1     

中西医结合治疗结节性痒疹临床观察

目的探讨中西医结合治疗结节性痒疹的临床疗效。方法结节性痒疹湿热证患者94例,分为西医对照组45例和治疗组49例,两组患者均以西药常规治疗,对照组外用复方地塞米松霜,治疗组加用中药止痒汤并外用中成药冰黄肤乐软膏封包治疗,均10天为1个疗程,共用4个疗程。分别于第2、4个疗程结束后观察疗效,随访半年观察复发情况。结果两组有效率比较差异无显著性意义(χ2=1.92,P>0.05),但其治愈率、近期疗效、远期复发率和副作用方面,治疗组明显优于对照组。结论在西药治疗基础上加用中药止痒汤及冰黄肤乐软膏封包治疗对结节性痒疹具有良好的疗效。     

咪唑斯汀联合30%尿素霜外用治疗结节性痒疹疗效观察

目的观察咪唑斯汀联合30%尿素霜外用治疗结节性痒疹的疗效。方法观察组患者口服咪唑斯汀10mg,对照组患者口服氯雷他定10mg,均1次/d;两组皆联合30%尿素霜外用,2次/d,连续治疗28天。结果观察组有效率为81.25%,对照组为51.43%,两组比较差异有显著性(P<0.05)。结论咪唑斯汀合并30%尿素霜外用治疗结节性痒疹临床疗效好,不良反应小。     

普瑞巴林联合沙利度胺治疗顽固性结节性痒疹疗效及安全性观察

目的 探讨普瑞巴林联合沙利度胺对顽固性结节性痒疹患者的疗效及安全性。方法 将67例中重度结节性痒疹患者随机分为观察组34例和对照组33例。两组均给予局部外用丙酸氯倍他索乳膏+硅油霜封包治疗,同时口服沙利度胺;观察组加用普瑞巴林治疗。治疗8周后观察两组疗效及药物不良反应情况。结果 观察组治疗有效率为94.12%,对照组为72.73%,两组比较差异有统计学意义(P<0.05)。结论 对结节性痒疹患者采用普瑞巴林联合沙利度胺治疗可有效提高患者的疗效和满意度。     

液氮冷冻治疗结节性痒疹临床观察

目的探讨液氮冷冻的方法治疗结节性痒疹的疗效和安全性。方法利用液体氮的低温（-196℃）作用于结节性痒疹皮损做二次冻融，使其水肿、松解、坏死、结痂、脱落；迅速减轻原有的瘙痒感觉；阻断不良刺激减少搔抓。结果单用液氮冷冻的方法治疗结节性痒疹，有效率为84％，复发率仅为7．6％。结论液氮冷冻可作为治疗结节性痒疹的一种方法。     

自制痒疹颗粒联合沙利度胺及复方丙酸氯倍他索乳膏治疗结节性痒疹的30例临床观察

目的观察自制痒疹颗粒联合沙利度胺及复方丙酸氯倍他索乳膏治疗结节性痒疹的疗效和安全性。方法将60例结节性痒疹的患者随机分为治疗组和对照组,各30例。治疗组采用自制痒疹颗粒(生地、赤芍、金银花、黄芩、红花、三陵、莪术、土茯苓、防风、蒺藜)联合沙利度胺75 mg/d内服,外涂复方丙酸氯倍他索乳膏2次/d;对照组30例采用左西替利嗪口服联合沙利度胺,外用莫米松乳膏2次/d;连续治疗4周判定疗效。结果治疗组有效率为80.0%,对照组为53.3%,两者差异有统计学意义(P0.05)。结论自制痒疹颗粒联合沙利度胺及复方丙酸氯倍他索乳膏治疗结节性痒疹是安全有效的。     

沙利度胺联合糠酸莫米松乳膏封包及紫外线照射治疗结节性痒疹的疗效观察

目的 观察沙利度胺联合糠酸莫米松乳膏封包和紫外线照射治疗结节性痒疹的疗效。 方法 采用非随机同期对照研究方法,结节性痒疹患者80例,分别入选对照组（23例）、UVA1组（32例）、UVB组（25例）,3组患者均口服沙利度胺75 mg/d每晚1次,0.1%糠酸莫米松乳膏每晚1次均匀涂抹于整个患侧肢体或躯干部位并用保鲜膜封包;UVA1组和UVB组同时分别给予UVA1和窄谱UVB照射。在治疗前、治疗后30天分别对患者病情严重程度评分。应用秩和检验比较组间皮损临床疗效与瘙痒疗效,同时对外周血嗜酸粒细胞绝对计数与瘙痒视觉评分进行关联性分析。结果 ①治疗30 d后,皮损改善的临床疗效：对照组、UVA1组、UVB组显效分别为5例（21.74%）、13例（43.33%）、9例（37.5%）,有效分别为7例（30.43%）、12例（40%）、7例（29.17%）,对照组疗效显著低于UVA1组（Z = 8.21,P ＜ 0.01）和UVB组（Z = 5.22,P ＜ 0.01）,UVA1组和UVB组疗效接近（Z = 0.50,P ＞ 0.05）;②瘙痒改善的临床疗效：治疗30 d后,对照组、UVA1组、UVB组显效分别为7例（30.43%）、18例（60.00%）、14例（58.33%）,对照组疗效低于UVA1组（Z = 4.50,P ＜ 0.01）和UVB组（Z = 4.50,P ＜ 0.01）,UVA1组与UVB组疗效接近（Z = 0.35,P ＞ 0.05）;③对患者的嗜酸粒细胞计数与瘙痒评分进行相关分析,r = 0.53,P ＜ 0.01。结论 沙利度胺联合糠酸莫米松乳膏封包,及联合紫外线照射治疗结节性痒疹均有显著疗效,且联合UVA1、UVB的疗效优于沙利度胺联合糠酸莫米松乳膏封包。     

Thalidomide treatment for prurigo nodularis in human immunodeficiency virus-infected subjects: efficacy and risk of neuropathy

OBJECTIVE: To evaluate safety and efficacy of thalidomide in the treatment of prurigo nodularis in a group of human immunodeficiency virus (HIV)-infected patients whose condition was recalcitrant to standard treatment. DESIGN: Prospective study. SETTING: Outpatient dermatology and neurology clinic, both referral settings.PATIENTS: Eight HIV-infected patients with refractory prurigo nodularis; a total of 10 met inclusion criteria, but 2 could not be followed up. INTERVENTIONS: Treatment with thalidomide, 100 mg/d. Subjects were randomized after 1 month to receive 100 or 200 mg/d. If side effects were noted, the drug was reduced to a tolerable dose or discontinued. Subjects were monitored at baseline and monthly for degree of pruritus and total area of body involvement of prurigo nodularis. Sequential neurologic assessments were performed. MAIN OUTCOME MEASURES: Efficacy and toxic effects. RESULTS: The dosage of thalidomide ranged from 33 to 200 mg/d. Eight subjects had a greater than 50% response in reduction of itch over 3.4 months (average). Seven subjects had a greater than 50% reduction of skin involvement over 5 months (average). Three subjects developed thalidomide peripheral neuropathy (TPN). There was no correlation between duration of treatment, daily or cumulative dose, and TPN. A change in the Neuropathy Impairment Score of 10 points was a good marker of TPN, as was a greater than 50% decrease in the sural sensory nerve action potential amplitude. CONCLUSIONS: Thalidomide reduced the signs and symptoms of prurigo nodularis in HIV-infected subjects. One third of subjects developed TPN, underscoring the importance of careful neurologic assessment.     

以结节性痒疹为首发表现的艾滋病3例及文献复习

结节性痒疹是艾滋病患者较为常见的皮肤表现,是多因素导致的疾病,其皮损与非艾滋病患者相似。本文3例均为男性,临床表现为全身散在丘疹、结节、表皮剥脱、结痂伴剧烈瘙痒,淋巴细胞分类计数示CD4、CD4/CD8比值降低。HIV血清抗体初筛实验及确证实验均(+)。皮损组织病理符合结节性痒疹。2例予抗组胺药物和外用糖皮质激素软膏后症状减轻,1例放弃治疗。沙利度胺是治疗艾滋病相关性结节性痒疹最有效的药物。     

Antipruritische Therapie mit dem oralen Opiatrezeptorantagonisten Naltrexon

BACKGROUND AND OBJECTIVES: The perception of pruritus is modified by endogenous and exogenous opioids via central opiate receptors and can be suppressed with opioid receptor antagonists. The aim of this investigation was to describe the efficacy and safety of naltrexone, an orally active opiate antagonist, in the treatment of severe, otherwise intractable pruritus of varying origins. PATIENTS: A total of 133 patients with pruritus caused by inflammatory skin diseases (asteatotic dermatitis, atopic dermatitis, prurigo, and psoriasis vulgaris), liver- and renal diseases, cutaneous lymphoma, as well as with pruritus of unknown origin were treated with naltrexone (Nemexin) 50 to 150 mg daily. RESULTS: A therapeutic response was achieved in 86 of the 133 (64.6%) patients. Naltrexone was most effective in prurigo nodularis, cutaneous lymphoma and pruritus of unknown origin. Tachyphylaxis occurred in 13% of the patients, but appeared late, and could be counterbalanced by raising the dosage. Adverse drug effects were restricted to the first two weeks of treatment and included mainly neurological (dizziness, headache, fatigue) and gastrointestinal (nausea, vomiting, diarrhea) symptoms. CONCLUSIONS: The oral opiate antagonists may well be an effective, well-tolerated therapy for intractable pruritus in many diseases.     

Treatment of prurigo nodularis with topical capsaicin

BACKGROUND: Prurigo nodularis is an eruption of lichenified or excoriated nodules caused by intractable pruritus that is difficult to treat. Therefore the antipruritic efficacy of capsaicin seemed to be of particular interest because this alkaloid, extractable from red pepper, interferes with the perception of pruritus and pain by depletion of neuropeptides in small sensory cutaneous nerves. OBJECTIVE: The aim of this concentration- and regimen-ranging study was to evaluate the efficacy, safety, and practicability of capsaicin in the topical treatment of prurigo nodularis in a large series of patients. METHODS: A total of 33 patients with prurigo nodularis of various origins were selected to receive capsaicin (0.025% to 0.3%) 4 to 6 times daily for 2 weeks up to 10 months. The consecutive follow-up period was up to 6 months. In 7 patients, skin biopsy specimens were taken before, during, and after therapy and investigated histologically, immunohistochemically, and ultrastructurally. RESULTS: All 33 patients could be evaluated for efficacy. After cessation of the symptoms of neurogenic inflammation, such as burning sensations or erythema, all of them experienced a complete elimination of pruritus within 12 days. In addition, capsaicin largely contributed to the gradual healing of the skin lesions. After discontinuation of the therapy, pruritus returned in 16 of 33 patients within 2 months. At the ultrastructural level, no degenerative changes of cutaneous nerves could be found during or after capsaicin therapy. Depletion of substance P was demonstrated by confocal laser scanning microscopy thus confirming the specific effect of capsaicin in vivo. CONCLUSION: Topical treatment of prurigo nodularis with capsaicin proved to be an effective and safe regimen resulting in clearing of the skin lesions.     

Clinical potential of Melanotan® (NDP-α-MSH) in skin protection – current status and future perspective

Non-histaminergic pruritus of any origin is difficult to treat and requires evaluation of new therapeutic strategies which were offered by recent neurophysiologic findings. For example, the discovery of opioid receptors on mast cells and nerve fibers enables the effective administration of opioid receptor antagonists. Up to now, 130 patients with pruritus of different origin were successfully treated with the oral opioidantagonist naltrexone. A significant therapeutic response was achieved under 50–150 mg daily in 66% of patients. In prurigo nodularis, naltrexone also contributed to healing of the skin lesions. Tachyphylaxis was infrequent, and adverse drug effects, in particular nausea, were of short duration. Only recently, the vanilloid receptor 1 (VR1) was demonstrated on nerve fibers and mast cells what explains the antipruritic efficacy of the topical application of capsaicin. Upon continual therapy with this VR1-ligand, neuropeptides are depleted and the nerve fiber is desensitized. A total of 53 patients with pruritus of different origin (prurigo nodularis, psoriasis, eczema, aquagenic pruritus, PUVA itch, hydroxyethyl starch-induced itch, and lymphoma) were selected to receive capsaicin four to six times daily in gradually increasing concentrations (0.025–0.1%). After cessation of the symptoms of neurogenic inflammation, all of the patients experienced a complete elimination of pruritus within 12 days. In addition, capsaicin largely contributed to healing of the skin lesions in prurigo nodularis.     

Efficacy and safety of naltrexone, an oral opiate receptor antagonist, in the treatment of pruritus in internal and dermatological diseases.

BACKGROUND: The perception of pruritus is modified by endogenous opiates via central opiate receptors in a histamine-independent manner. OBJECTIVE: The aim of this pilot study was to evaluate the efficacy and safety of naltrexone, an orally active opiate antagonist, in the treatment of severe, otherwise intractable pruritus of different origin in an open-label clinical trial. METHODS: A total of 50 patients with pruritus caused by internal diseases, hydroxyethyl starch, contact with water, cutaneous lymphoma, atopic dermatitis, xerosis cutis, macular amyloidosis, psoriasis, and other skin disorders as well as with pruritus of unknown origin were randomly selected to receive naltrexone 50 mg daily. The pruritus intensity was rated by the patients before and during therapy in a visual analogue scale. RESULTS: A significant therapeutic response was achieved in 35 of the 50 patients within 1 week (confidence limits of 0.55 and 0.82 at a confidence level of 0. 95). Naltrexone was of high antipruritic effect in 9 of 17 cases of prurigo nodularis and contributed to healing of the skin lesions. Tachyphylaxis was infrequent (6/50), occurred late, and could be counterbalanced by raising the dosage in 2 patients. Adverse drug effects were restricted to the first 2 weeks of treatment and included nausea (11/50), fatigue (3/50), dizziness, heartburn, and diarrhea (1/50 each). CONCLUSION: The study suggests that oral opiate antagonists might be a well-tolerated and effective therapy for pruritic symptoms in many diseases.     

Prurigo nodularis: a review

Prurigo nodularis is a chronic condition characterized by a papulonodular pruriginous eruption of unknown aetiology. This condition is a difficult disease to treat and causes frustration to both the patient and the treating doctor. A variety of systemic conditions have been reported to be associated with prurigo nodularis. The mechanism by which these disorders may trigger prurigo nodularis is unknown. Nerve growth factor has been implicated in the pathogenesis of prurigo nodularis. Calcitonin gene-related peptide and substance P immunoreactive nerves are markedly increased in prurigo nodularis when compared with normal skin. These neuropeptides may mediate the cutaneous neurogenic inflammation and pruritus in prurigo nodularis. Topical or intralesional glucocorticoids are the treatment of choice. Other topical treatments such as topical vitamin D3, and topical capsaicin have also been reported to be effective. Oral treatments such as cyclosporin and thalidomide have been shown to improve both appearance of the skin and pruritus. We review the clinical features, associations, pathology, pathogenesis and treatment of prurigo nodularis.     

Demonstration by S-100 protein staining of increased numbers of nerves in the papillary dermis of patients with prurigo nodularis.

BACKGROUND: We hypothesized that hyperplasia of papillary dermal nerves was a constant feature of prurigo nodularis. OBJECTIVE: We tested this hypothesis by examining sections from 25 cases of prurigo nodularis, 25 cases of skin lesions characterized by epidermal hyperplasia without clinical pruritus, and 22 cases of clinically pruritic dermatoses with variable degrees of epidermal response for the presence of papillary dermal nerves. METHODS: We used a standard immunohistochemical assay with an antibody to S-100 protein as a means of identification of nerves. RESULTS: In 24 of 25 cases of prurigo nodularis, papillary dermal nerves were identified by immunostaining. Cutaneous nerves were present in 1 of 22 cases of epidermal hyperplasia with pruritus and were absent in the papillary dermis in nonpruritic cases. CONCLUSION: We conclude that hypertrophy of cutaneous papillary dermal nerves is a relatively constant feature of prurigo nodularis. The presence of papillary dermal nerves suggests a neurocutaneous component in the pathogenesis of prurigo nodularis.