Department of Dermatology, Center for Chronic Pruritus, University Hospital Münster, Von-Esmarch-Str. 58, Münster, 48149, Germany.
Drugs. 2017 Jun;77(9):999-1007. doi: 10.1007/s40265-017-0746-9.
Chronic pruritus remains a central societal issue because of its high occurrence and the substantial decrease in quality of life it may cause to affected individuals. Not only dermatological conditions, but also systemic, neurological, or psychiatric diseases may lead to chronic pruritus. Additionally, various underlying conditions may coexist or the cause may be unknown. Due to its heterogeneity, the therapeutic approach is complex and remains a challenge for the clinician. Basic measures such as emollients to avoid xerosis and treatment of the underlying disease should be initiated regardless of the duration of the symptom. Depending on the indication, other topical (e.g., calcineurin inhibitors, topical corticosteroids, capsaicin) and systemic agents (immunosuppressive drugs, gabapentinoids, antidepressants, mu-opioid receptor antagonists) may provide further relief. Additionally, accompanying disorders such as sleep impairment, depression, or anxiety should also be treated. New insights into pathways involved in the development and maintenance of chronic pruritus have led in the past years to the development of a considerable number of novel antipruritic drugs. Several randomized controlled trials have been recently completed or are currently underway testing biological compounds with promising approaches. These include antagonists for nerve growth factor, neuropeptides, histamine 4 receptors, certain interleukin receptors, and opioid receptors.
慢性瘙痒仍是一个重要的社会问题，因为它的发病率高，可能会导致患者的生活质量大幅下降。不仅皮肤病，系统性、神经或精神疾病也可能导致慢性瘙痒。此外，各种潜在疾病可能同时存在，或者病因不明。由于其异质性，治疗方法复杂，对临床医生来说仍是一个挑战。基本措施如保湿剂以避免干燥，以及治疗潜在疾病，无论症状持续时间如何，都应开始。根据指征，其他局部（如钙调神经磷酸酶抑制剂、局部皮质类固醇、辣椒素）和全身药物（免疫抑制剂、加巴喷丁类药物、抗抑郁药、μ-阿片受体拮抗剂）可能会提供进一步的缓解。此外，还应治疗伴随的疾病，如睡眠障碍、抑郁或焦虑。近年来，对慢性瘙痒发生和维持的相关途径的深入研究，导致了相当数量的新型止痒药物的开发。最近已经完成了几项随机对照试验，或者目前正在进行测试具有前景的生物化合物的临床试验。这些包括神经生长因子、神经肽、组胺 4 受体、某些白细胞介素受体和阿片受体拮抗剂。
