Female-specific pruritus from childhood to postmenopause: clinical features, hormonal factors, and treatment considerations
Female-specific pruritus from childhood to postmenopause: clinical features, hormonal factors, and treatment considerations
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DOI：
10.1111/dth.12034
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发表时间：
2013-03-01
影响因子：
3.6
通讯作者：
Yosipovitch, Gil
中科院分区：
文献类型：
--
作者：
Rimoin, Lauren P.;Kwatra, Shawn G.;Yosipovitch, Gil
近年来，我们对瘙痒的病理生理学有了相当大的了解。这篇综述的目的是强调女性的瘙痒实体，特别是不同年龄段的女性经历的瘙痒性外阴皮肤病。独特的时间变化可能是许多此类疾病的病因之一。这些变化会导致皮肤基本成分的周期性变化。具体地说，已经在角质形成细胞上检测到雌激素受体，这些细胞对雌激素水平的上升和下降做出反应。这些受体导致皮肤水合、胶原蛋白含量和形成皮肤屏障的糖胺聚糖浓度的变化。此外，与月经周期相关的激素pH变化可能是瘙痒加重的一个重要因素，因为众所周知，pH升高会激活已知的瘙痒介质--蛋白酶激活的受体-2。将讨论的女性常见瘙痒情况包括特应性和刺激性皮炎、牛皮癣、硬化性苔藓、感染性外阴阴道炎、外阴阴道念珠菌病、萎缩性外阴阴道炎、鳞状细胞癌、慢性单纯性苔藓和神经性瘙痒。我们还检查了与妊娠相关的瘙痒情况，包括类天疱疮、妊娠多形性皮疹、妊娠肝内胆汁淤积症和特应性妊娠皮疹。最后，检查可接受和禁忌的妊娠期止痒药物。
There have been considerable advances in our understanding of the pathophysiology of pruritus in recent years. The purpose of this review was to highlight itch entities in women, and in particular pruritic vulvar dermatoses that women experience among different age groups. Unique temporal shifts may contribute to the etiology of many of these conditions. These changes lead to cyclical changes in the skin's basic composition. Specifically, estrogen receptors have been detected on keratinocytes that respond to rising and falling levels of estrogen. These receptors lead to changes in skin hydration, collagen content, and in the concentration of glycosaminoglycans that form the skin barrier. In addition, hormonal pH changes associated with the menstrual cycle may be an important factor in the aggravation of itch as increasing pH is known to activate the proteinase-activated receptor-2, a well-known itch mediator. Common pruritic conditions in women that will be discussed include atopic and irritant dermatitis, psoriasis, lichen sclerosus, infectious vulvovaginitis, vulvovaginal candidiasis, atrophic vulvovaginitis, squamous cell carcinoma, lichen simplex chronicus, and neuropathic itch. We also examine pruritic conditions associated with pregnancy including pemphigoid gestationis, polymorphic eruption of pregnancy, intrahepatic cholestasis of pregnancy and atopic eruption of pregnancy. Finally, acceptable and contraindicated antipruritic agents in pregnancy are examined.