Peripheral Sensitization and Loss of Descending Inhibition Is a Hallmark of Chronic Pruritus
Peripheral Sensitization and Loss of Descending Inhibition Is a Hallmark of Chronic Pruritus
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DOI：
10.1016/j.jid.2019.05.029
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发表时间：
2020-01-01
影响因子：
6.5
通讯作者：
Staender, Sonja
中科院分区：
文献类型：
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作者：
Pogatzki-Zahn, Esther M.;Pereira, Manuel P.;Staender, Sonja
导致瘙痒症慢性化的神经生理机制尚未完全了解，也不知道这些机制是否在慢性瘙痒症（CP）的不同基础疾病之间存在差异。本研究旨在检测各种来源的CP中的这种机制。共有120例CP患者的炎性起源（特应性皮炎），神经性起源（肱桡瘙痒症），和慢性结节型，后者作为慢性抓挠模型，以及40名匹配的健康对照参加了这项研究。在所有患者组中，与其他物质刺激相比，用牛胆刺激诱导了更强烈的瘙痒感，但在健康对照组中没有，这表明CP中皮肤机械和热敏性C纤维的致敏性。与对照组相比，所有患者组的表皮内神经纤维密度均降低。与对照组相比，在所有患者组中观察到条件疼痛调制效应降低，表明CP中的下行抑制系统降低。总之，不同病因的CP表现出神经元改变的混合外周和中枢模式，这可能有助于瘙痒的慢性化，瘙痒实体之间没有差异。我们的研究结果可能有助于未来针对这些病理机制的治疗策略的发展。
Neurophysiological mechanisms leading to chronicity of pruritus are not yet fully understood and it is not known whether these mechanisms diverge between different underlying diseases of chronic pruritus (CP). This study aimed to detect such mechanisms in CP of various origins. A total of 120 patients with CP of inflammatory origin (atopic dermatitis), neuropathic origin (brachioradial pruritus), and chronic prurigo of nodular type, the latter as a model for chronic scratching, as well as 40 matched healthy controls participated in this study. Stimulation with cowhage induced a more intensive itch sensation compared with stimulation with other substances in all patient groups but not in healthy controls, arguing for sensitization of cutaneous mechano- and heat-sensitive C-fibers in CP. All patient groups showed a decreased intraepidermal nerve fiber density compared with controls. A decreased condition pain modulation effect was observed in all patient groups compared with controls, suggesting a reduced descending inhibitory system in CP. In sum, CP of different etiologies showed a mixed peripheral and central pattern of neuronal alterations, which might contribute to the chronicity of pruritus with no differences between pruritus entities. Our findings may contribute to the development of future treatment strategies targeting these pathomechanisms.