Krishnan Anjeli, Koo John
Department of Medicine, University of California, San Francisco (USCF), CA, USA.
Dermatol Ther. 2005 Jul-Aug;18(4):314-22. doi: 10.1111/j.1529-8019.2005.00038.x.
A patient's psychological condition can substantially affect the presence and severity of pruritus, a phenomenon thought to be mediated by the central nervous system's (CNS) opioid neurotransmitter system. Specific psychodermatologic disorders associated with psychogenic pruritus, including depression, anxiety, chronic tactile hallucinations, delusions of parasitosis, neurotic excoriations, and other cutaneous compulsions are likely controlled by this pathway. Therefore, in treating these conditions, medications specifically directed at the CNS can be the most effective therapies, whereas topical and supportive therapy may be important adjuncts in targeting the associated pruritus. Furthermore, the impact of an understanding clinician and a good physician-patient relationship cannot be underestimated in determining ultimate prognosis. This review will begin by discussing the relationship between the psyche and pruritus as well as the opioid neurotransmitter system. Following this, several disorders characterized by psychogenic pruritus will be described, and CNS-specific and adjunctive topical and supportive therapies for these conditions will be detailed.
患者的心理状况会显著影响瘙痒的存在及严重程度，这一现象被认为是由中枢神经系统（CNS）的阿片类神经递质系统介导的。与精神性瘙痒相关的特定心理皮肤病障碍，包括抑郁症、焦虑症、慢性触觉幻觉、寄生虫妄想症、神经性擦伤以及其他皮肤强迫行为，可能都受此途径控制。因此，在治疗这些病症时，专门针对中枢神经系统的药物可能是最有效的疗法，而局部治疗和支持性治疗可能是针对相关瘙痒的重要辅助手段。此外，在确定最终预后方面，善解人意的临床医生和良好的医患关系所产生的影响不可低估。本综述将首先讨论心理与瘙痒以及阿片类神经递质系统之间的关系。在此之后，将描述几种以精神性瘙痒为特征的病症，并详细介绍针对这些病症的中枢神经系统特异性以及辅助性局部和支持性治疗方法。
