Second Dermatology Clinic, MIDIM Department, University of Bari, Bari, Italy.
Am J Clin Dermatol. 2010 Dec 1;11(6):399-411. doi: 10.2165/11317620-000000000-00000.
Chronic pruritus is a major and distressing symptom of many cutaneous and systemic diseases and can significantly impair the patient's quality of life. Pruritus perception is the final result of a complex network involving dedicated nerve pathways and brain areas, and an increasing number of peripheral and central mediators are thought to be involved. Itch is associated with most cutaneous disorders and, in these circumstances, its management overlaps with that of the skin disease. Itch can also occur without associated skin diseases or primary skin lesions, but only with nonspecific lesions secondary to rubbing or scratching. Chronic itch with no or minimal skin changes can be secondary to important diseases, such as neurologic disorders, chronic renal failure, cholestasis, systemic infections, malignancies, and endocrine disorders, and may also result from exposure to some drugs. The search for the cause of pruritus usually requires a meticulous step-by-step assessment involving careful history taking as well as clinical examination and laboratory investigations. Few evidence-based treatments for pruritus are available. Topical therapy, oral histamine H(1) receptor antagonists, and phototherapy with UV radiation can target pruritus elicitation in the skin, whereas antiepileptic drugs, opioid receptor antagonists, and antidepressants can block signal processing in the CNS.
慢性瘙痒是许多皮肤和系统性疾病的主要且令人痛苦的症状，可显著降低患者的生活质量。瘙痒感知是涉及专用神经通路和大脑区域的复杂网络的最终结果，越来越多的外周和中枢介质被认为与之相关。瘙痒与大多数皮肤疾病有关，在这些情况下，其治疗与皮肤病的治疗相重叠。瘙痒也可能在没有相关皮肤疾病或原发性皮肤病变的情况下发生，但仅在因摩擦或搔抓引起的非特异性病变时发生。没有或仅有轻微皮肤改变的慢性瘙痒可能继发于重要疾病，如神经障碍、慢性肾衰竭、胆汁淤积、全身感染、恶性肿瘤和内分泌紊乱，也可能是由于接触某些药物引起的。瘙痒症病因的寻找通常需要进行仔细的逐步评估，包括详细的病史采集、临床检查和实验室研究。目前仅有少数瘙痒症的治疗方法有充分的证据支持。局部治疗、口服组胺 H（1）受体拮抗剂和紫外线光疗可针对皮肤瘙痒的诱发进行治疗，而抗癫痫药物、阿片受体拮抗剂和抗抑郁药可阻断中枢神经系统中的信号处理。
