Greaves Malcolm W
National Skin Centre, Singapore.
Dermatol Ther. 2005 Jul-Aug;18(4):323-7. doi: 10.1111/j.1529-8019.2005.00036.x.
A new pathophysiologically based classification of itch is proposed, which should help the clinician adopt a rational approach to diagnosis and management of generalized itch. Focusing on neurogenic itch (itch without visible rash), common causes are reviewed and guidelines for laboratory and radiologic investigation are proposed. A stepwise approach to the management of generalized itch resulting from systemic disease is recommended. Specifically, the relative merits of broad versus narrowband ultraviolet B (UVB) are discussed and the pros and cons of doxepin, opioid antagonists, and selective serotonin reuptake inhibitors (SSRIs) such as paroxetine are considered. Attention is drawn to some novel approaches, including bright-light phototherapy and molecular adsorbent recirculating system (MARS) for selected patients with intractable itch caused by hepatic failure, and mirtazapine for nocturnal itch.
本文提出了一种基于病理生理学的瘙痒新分类方法，这将有助于临床医生对全身性瘙痒的诊断和管理采取合理的方法。聚焦于神经源性瘙痒（无可见皮疹的瘙痒），本文回顾了常见病因，并提出了实验室和放射学检查的指导原则。建议采用逐步方法来管理由全身性疾病引起的全身性瘙痒。具体而言，本文讨论了宽带与窄带紫外线B（UVB）的相对优缺点，并考虑了多塞平、阿片类拮抗剂以及帕罗西汀等选择性5-羟色胺再摄取抑制剂（SSRI）的利弊。本文还关注了一些新方法，包括针对某些因肝衰竭导致顽固性瘙痒的患者的强光光疗和分子吸附再循环系统（MARS），以及用于夜间瘙痒的米氮平。
