Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Pediatr Allergy Immunol. 2013 Sep;24(6):527-39. doi: 10.1111/pai.12115.
An effective treatment strategy for chronic pruritus in children with dermatologic disorders should consider the multidimensional aspects of pruritus, the unique challenges associated with treating pruritic skin disorders in the pediatric population, and evidence-based therapies with demonstrated antipruritic benefits and clinically relevant effects on patient/family quality of life (QoL). The Course of Advanced Learning for the Management of ITch (CALM-IT) Task Force is an interdisciplinary group of experts specializing in core aspects of pruritus treatment, integrating pediatrics, dermatology, psychotherapy, pruritus management, and sleep. CALM-IT recently convened to provide updated guidance on managing chronic pruritus associated with dermatologic diseases in pediatric patients, with a special focus on atopic dermatitis (AD) and chronic spontaneous urticaria (csU). This review highlights the updated concepts and best practices, which were built upon international PRACTALL consensus and modified for children and infants with AD and csU. CALM-IT supports the routine use of basic skin therapy and the escalation of topical medications, according to severity and focused on rapid itch control. Anti-inflammatory agents should be appropriate for infants and children (i.e., with an optimized therapeutic index) and have proven antipruritic properties, such as those demonstrated by methylprednisolone aceponate. New experimental findings do not support the use of non-sedating oral antihistamines as adjuvant antipruritic therapy for AD. In csU, oral H1 -antihistamine use is justified, consistent with the distinct pathophysiologic mechanisms of itch underlying AD and csU. All encompassing QoL assessments should consider the burden of both patient and caregiver and should address outstanding unmet clinical needs of pediatric patients. Future research areas include integrated QoL assessments and multidisciplinary treatment programs with pediatric-targeted pruritic therapies providing rapid itch control.
一种有效的皮肤科疾病相关慢性瘙痒症的治疗策略应考虑瘙痒的多维方面、儿科人群中治疗瘙痒性皮肤疾病所特有的挑战、以及具有止痒益处和对患者/家属生活质量（QoL）具有临床相关影响的循证治疗。瘙痒症治疗的核心方面包括儿科、皮肤科、心理治疗、瘙痒管理和睡眠等领域的专家组成的跨学科专业团队，即高级瘙痒管理学习课程（CALM-IT）工作组。CALM-IT 最近召开会议，就儿科患者皮肤科疾病相关慢性瘙痒症的管理提供了更新的指导，特别关注特应性皮炎（AD）和慢性自发性荨麻疹（csU）。本文重点介绍了更新的概念和最佳实践，这些概念和最佳实践是在国际 PRACTALL 共识的基础上制定的，并针对 AD 和 csU 患儿和婴儿进行了修改。CALM-IT 支持根据严重程度常规使用基础皮肤治疗和升级外用药物，以快速控制瘙痒。抗炎药物应适合婴儿和儿童（即具有优化的治疗指数），并具有止痒作用，如甲基泼尼松龙戊酸酯所证实的那样。新的实验发现不支持将非镇静性口服抗组胺药作为 AD 的辅助止痒治疗。在 csU 中，口服 H1-抗组胺药的使用是合理的，这与 AD 和 csU 潜在的瘙痒不同的病理生理机制一致。全面的 QoL 评估应考虑患者和照料者的负担，并应解决儿科患者未满足的临床需求。未来的研究领域包括综合 QoL 评估和多学科治疗计划，针对儿科患者的瘙痒症靶向治疗，以提供快速止痒。
