Current Topical and Systemic Therapies for Itch
Current Topical and Systemic Therapies for Itch
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DOI：
10.1007/978-3-662-44605-8_18
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发表时间：
2015-01-01
期刊：
影响因子：
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通讯作者：
Yosipovitch, Gil
中科院分区：
文献类型：
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作者：
Leslie, Tabi Anika;Greaves, Malcolm W.;Yosipovitch, Gil
瘙痒是一种常见的令人痛苦的症状，其可能由多因素病因引起，包括炎性皮肤病、全身性疾病、神经性病症和心因性疾病。瘙痒是与瘙痒同时使用的术语，如果持续少于6周，则定义为急性，如果持续超过6周，则定义为慢性。它对生活质量的影响与慢性疼痛相同，并且具有许多相同的病理生理学途径。根据瘙痒的病因，不同的致病机制已被假定与一些介质确定。这些包括组胺、白三烯、蛋白酶、神经肽、细胞因子和阿片样物质，其可通过神经末梢和中枢神经元通路上的受体激活外周瘙痒介导的C纤维。因此，没有单一的普遍有效的止痒治疗。瘙痒的一线治疗包括局部治疗，如润肤剂、温和清洁剂（低pH值）、局部麻醉剂、类固醇、钙调磷酸酶抑制剂和冷却剂（薄荷醇）。全身性疗法的治疗可以根据慢性瘙痒的病因而变化。非镇静抗组胺药是有益的条件，如荨麻疹的瘙痒主要是组胺介导的。虽然湿疹的瘙痒不是由组胺介导的，但在夜间服用镇静抗组胺药有助于打破瘙痒-抓挠循环。慢性瘙痒也可以用其他全身疗法治疗，如抗惊厥药、抗抑郁药以及μ-阿片拮抗剂、κ-阿片激动剂和光疗，这取决于瘙痒的原因。本文总结了局部和全身治疗与我们目前的理解瘙痒的病理生理。
Itch is a common distressing symptom which may be caused by multifactorial aetiologies including inflammatory skin diseases, systemic diseases, neuropathic conditions and psychogenic disorders. Itch is a term used synonymously with pruritus and is defined as acute if it lasts less than 6 weeks or chronic if it persists for more than 6 weeks. It can have the same impact on the quality of life as chronic pain and shares many of the same pathophysiological pathways. Depending on the aetiology of the itch, different pathogenic mechanisms have been postulated with a number of mediators identified. These include histamine, leukotrienes, proteases, neuropeptides, cytokines and opioids, which may activate peripheral itch-mediating C-fibres via receptors on the nerve terminals and central neuronal pathways. Therefore, there is no single universally effective anti-itch treatment available. First-line treatments for itch include topical therapies, such as emollients, mild cleansers (low pH), topical anaesthetics, steroids, calcineurin inhibitors and coolants (menthol). Treatment with systemic therapies can vary according to the aetiology of the chronic itch. Non-sedating antihistamines are helpful in conditions such as urticaria where the itch is primarily histamine mediated. Although the itch of eczema is not mediated by histamine, sedating antihistamines at night are helpful to break the itch-scratch cycle. Chronic itch may also be treated with other systemic therapies, such as anticonvulsants, antidepressants as well as mu-opioid antagonists, kappa-opioid agonists and phototherapy, depending on the cause of the itch. This article summarises the topical and systemic therapies available with our current understanding of the pathophysiology of itch.