Caccavale Stefano, Bove Domenico, Bove Rocco M, LA Montagna Maddalena
Department of Mental and Physical Health and Preventive Medicine, Second University of Naples, Naples, Italy -
G Ital Dermatol Venereol. 2016 Oct;151(5):525-9. Epub 2015 Apr 9.
Skin diseases (atopic eczema, psoriasis, idiopathic urticaria), systemic diseases (chronic hepatic or renal failure, morbus Hodgkin, diabetes mellitus) and psychiatric disorders (obsessive compulsive disorders, depression, delusions of parasitosis) can occur with itching. The aim of this review is to clarify the link between pruritus and psychiatric morbidity and emphasize the importance of a psychiatric consultation for patients with a chronic itching, without a skin disease. In the last years, there is a growing awareness regarding psychogenic itch, although these types of itch are significantly less studied in comparison to other types of pruritus. Psychogenic pruritus is usually a diagnosis of exclusion. There are not controlled studies about treatment of psychogenic itch, but the same drugs prescribed for neuropathic pain, depression, and anxiety are used. There is a strong association between pruritus and psyche; so, it is important that the dermatologist evaluates psychosomatic dimension. According to the analysis of scientific literature and our clinical experience, pruritus seems to be a rather common phenomenon in patients suffering from depression. Future works should explain the basis of psychopathology of chronic itching thanks to studies of selected groups of patients with a particular type of chronic itching, highlighting the clinical features to establish appropriate and individual targeted care, based on the several types of pruritus. Some questions still unanswered could be clarified in this way. It is really important to decrease the symptoms "itching", because the quality of life of the patient will be improved, but the goal is to identify the underlying mechanisms of itch and establish a targeted therapy, depending on the biological changes and the underlying disease.
皮肤疾病（特应性皮炎、银屑病、特发性荨麻疹）、全身性疾病（慢性肝或肾衰竭、霍奇金病、糖尿病）以及精神障碍（强迫症、抑郁症、寄生虫妄想症）都可能伴有瘙痒症状。本综述的目的是阐明瘙痒与精神疾病之间的联系，并强调对于无皮肤疾病的慢性瘙痒患者进行精神科会诊的重要性。在过去几年中，人们对心因性瘙痒的认识不断提高，尽管与其他类型的瘙痒相比，这类瘙痒的研究明显较少。心因性瘙痒通常是一种排除性诊断。目前尚无关于心因性瘙痒治疗的对照研究，但使用的药物与用于治疗神经性疼痛、抑郁症和焦虑症的药物相同。瘙痒与心理之间存在密切关联；因此，皮肤科医生评估身心层面非常重要。根据科学文献分析和我们的临床经验，瘙痒在抑郁症患者中似乎是一种相当常见的现象。未来的研究应通过对特定类型慢性瘙痒患者群体的研究来解释慢性瘙痒的精神病理学基础，突出临床特征，以便根据几种类型的瘙痒建立适当的个体化针对性护理。一些尚未解答的问题可以通过这种方式得到澄清。减轻“瘙痒”症状非常重要，因为这将改善患者的生活质量，但目标是根据生物学变化和潜在疾病确定瘙痒的潜在机制并建立针对性治疗。
