a Department of Dermatology and Center for Chronic Pruritus , University Hospital Münster , Münster , Germany.
Expert Opin Pharmacother. 2018 Apr;19(5):443-450. doi: 10.1080/14656566.2018.1444752. Epub 2018 Mar 1.
The prevalence of chronic pruritus (CP) in the general population is high and increases with age. Owing to high rates of comorbidities and polypharmacy in patients aged 65 or older, the clinical management of these patients is challenging.
In this review, the authors discuss the available therapy options for patients aged ≥ 65 with CP, including emollients for dry skin, topical therapies, phototherapy and systemic agents for CP of various origins.
For multimorbid patients, topical substances and phototherapy constitute the best initial options. If systemic drugs are needed, the potential side-effects need to be closely monitored. In elderly patients, multiple possible factors for CP, including dermatological and systemic diseases, may be found, complicating the treatment of the underlying cause. In these cases, or when the origin remains unknown, a step-wise symptomatic therapy is recommended. The therapeutic choices should be made on an individual basis after carefully outweighing possible risks and benefits. Novel agents such as neurokinin-1 receptor antagonists and opioid-targeting drugs show promising antipruritic effects on refractory CP and seem to be well tolerated. They may be useful for elderly patients, who cannot tolerate conventional systemic agents.
慢性瘙痒症（CP）在普通人群中的患病率很高，并随着年龄的增长而增加。由于 65 岁或以上患者的合并症和多药治疗率较高，因此这些患者的临床管理具有挑战性。
在这篇综述中，作者讨论了≥65 岁 CP 患者的可用治疗选择，包括用于干燥皮肤的保湿剂、局部治疗、光疗和各种来源的 CP 的全身药物。
对于多合并症患者，局部物质和光疗构成了最佳的初始选择。如果需要全身药物，则需要密切监测潜在的副作用。在老年患者中，可能会发现导致 CP 的多种潜在因素，包括皮肤和系统疾病，这使得治疗潜在病因变得复杂。在这些情况下，或者当病因仍不清楚时，建议采用逐步的对症治疗。在仔细权衡可能的风险和益处后，应根据个体情况做出治疗选择。新型药物，如神经激肽-1 受体拮抗剂和针对阿片类药物的药物，对难治性 CP 具有有前途的止痒作用，且似乎耐受性良好。对于不能耐受传统全身药物的老年患者，它们可能是有用的。
