Ständer S, Luger T, Metze D
Ludwig Boltzmann Institute for Cell Biology and Immunobiology of the Skin, University of Muenster, Germany.
J Am Acad Dermatol. 2001 Mar;44(3):471-8. doi: 10.1067/mjd.2001.110059.
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.
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.
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.
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.
Topical treatment of prurigo nodularis with capsaicin proved to be an effective and safe regimen resulting in clearing of the skin lesions.
结节性痒疹是一种由难以治疗的顽固性瘙痒引起的苔藓化或抓破结节性皮疹。因此，辣椒素的止痒效果似乎特别令人关注，因为这种可从红辣椒中提取的生物碱通过消耗皮肤感觉小神经中的神经肽来干扰瘙痒和疼痛的感知。
本剂量和疗程范围研究的目的是评估辣椒素在大量患者中局部治疗结节性痒疹的疗效、安全性和实用性。
总共选择33例不同病因的结节性痒疹患者，接受辣椒素（0.025%至0.3%）治疗，每天4至6次，持续2周，最长10个月。连续随访期最长6个月。7例患者在治疗前、治疗期间和治疗后取皮肤活检标本，进行组织学、免疫组织化学和超微结构检查。
所有33例患者均可评估疗效。在神经源性炎症症状（如烧灼感或红斑）消失后，所有患者在12天内瘙痒完全消除。此外，辣椒素在很大程度上有助于皮肤病变的逐渐愈合。停药后，33例患者中有16例在2个月内瘙痒复发。在超微结构水平上，辣椒素治疗期间或治疗后未发现皮肤神经的退行性改变。共聚焦激光扫描显微镜证实了P物质的消耗，从而证实了辣椒素在体内的特定作用。
辣椒素局部治疗结节性痒疹被证明是一种有效且安全的治疗方案，可使皮肤病变消退。
