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瘙痒的诊断程序

Diagnostic Procedures of Itch.

作者信息

Reich Adam, Szepietowski Jacek C

出版信息

Curr Probl Dermatol. 2016;50:24-8. doi: 10.1159/000446013. Epub 2016 Aug 23.

Abstract

A complex and multifactorial pathogenesis of itch makes the proper diagnosis of underlying disease a difficult and challenging clinical problem. The examination of every patient with itch should be started by gathering an accurate history. During the anamnesis it is important to obtain data about the beginning of the appearance of symptoms, its location, diurnal variation, and the factors influencing itch perception. After careful anamnesis the patient should undergo a detailed physical examination, with particular attention to the skin in order to look for any signs of skin lesions. Special attention should be paid to distinguish the primary lesion from the changes resulting from scratching. In patients in whom the etiology of the itch cannot be identified on the basis of the medical examination, a panel of primary screen laboratory examination may be required, and if necessary, depending on the results of basic laboratory results and data from medical history, additional diagnostic tests should be considered. In patients in whom an organic cause of itching has not been established, itch is most likely of undetermined origin; however, psychogenic causes should also be suspected and ruled out. In conclusion, it could be stated that itch is a common symptom of many skin diseases, systemic of neurological diseases. Despite the complex etiology of the disease, an exact cause of itch should be searched for in each patient, as successful therapy is largely dependent on the determination of the cause of the itching.

摘要

瘙痒复杂且多因素的发病机制使得准确诊断潜在疾病成为一个困难且具有挑战性的临床问题。对每一位瘙痒患者的检查都应从收集准确的病史开始。在问诊过程中,获取有关症状出现的起始时间、部位、日变化以及影响瘙痒感知的因素等数据非常重要。仔细问诊后,患者应接受详细的体格检查,尤其要关注皮肤,以寻找任何皮肤病变的迹象。应特别注意区分原发性皮损与搔抓导致的变化。对于经医学检查无法确定瘙痒病因的患者,可能需要进行一组初步筛查实验室检查,如有必要,根据基础实验室检查结果和病史数据,应考虑进行额外的诊断测试。对于尚未确定瘙痒器质性病因的患者,瘙痒很可能起源不明;然而,也应怀疑并排除精神源性病因。总之,可以说瘙痒是许多皮肤疾病、全身性或神经性疾病的常见症状。尽管该疾病病因复杂,但仍应在每位患者中寻找瘙痒的确切病因,因为成功的治疗很大程度上取决于对瘙痒病因的确定。

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