Gupta Madhulika A, Vujcic Branka, Pur Daiana R, Gupta Aditya K
Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
Clin Dermatol. 2018 Nov-Dec;36(6):765-773. doi: 10.1016/j.clindermatol.2018.08.006. Epub 2018 Aug 16.
Antipsychotic drugs can be beneficial in dermatology because of their both central nervous system and peripheral effects. All antipsychotic drugs have a central postsynaptic dopamine D2 receptor blocking effect, which underlies their antipsychotic action. The antipsychotic drugs have varying degrees of histamine H1-receptor, cholinergic muscarinic receptor, and α1-adrenergic receptor blocking effects, which can affect cutaneous perception and the autonomic reactivity of the skin and can be potentially beneficial in the management of certain histamine or sympathetically mediated dermatologic manifestations (eg, urticaria, pruritus, hyperhidrosis). In addition to their antipsychotic effect, antipsychotic drugs also have a general anxiolytic effect related in part to their α1-adrenergic receptor blocking action, which can be of benefit in many dermatologic conditions, including pruritus. The antipsychotic drugs are most commonly used in dermatology for the management of a delusional disorder, somatic type, manifesting as delusional infestation, and as monotherapy or as augmentation therapy of selective serotonin reuptake inhibitor (SSRI) antidepressants, and for management of trichotillomania and skin-picking or excoriation disorder. There is earlier literature (1) on the possible beneficial effect of the phenothiazine antipsychotics in a wide range of pruritic dermatoses, and (2) the efficacy of pimozide as adjunctive therapy for metastatic melanoma, which both warrant further investigation.
抗精神病药物在皮肤科可能有益，因为它们具有中枢神经系统和外周效应。所有抗精神病药物都具有中枢突触后多巴胺D2受体阻断作用，这是其抗精神病作用的基础。抗精神病药物具有不同程度的组胺H1受体、胆碱能毒蕈碱受体和α1肾上腺素能受体阻断作用，这些作用可影响皮肤感觉和皮肤的自主反应性，在某些组胺或交感神经介导的皮肤病表现（如荨麻疹、瘙痒症、多汗症）的治疗中可能具有潜在益处。除了抗精神病作用外，抗精神病药物还具有一般的抗焦虑作用，部分与它们的α1肾上腺素能受体阻断作用有关，这在许多皮肤病中都有益处，包括瘙痒症。抗精神病药物在皮肤科最常用于治疗躯体型妄想障碍，表现为妄想性寄生虫病，以及作为选择性5-羟色胺再摄取抑制剂（SSRI）抗抑郁药的单一疗法或增强疗法，还用于治疗拔毛癖和皮肤搔抓或皮肤擦伤障碍。早期有文献（1）报道了吩噻嗪类抗精神病药物在多种瘙痒性皮肤病中可能具有的有益作用，以及（2）匹莫齐特作为转移性黑色素瘤辅助治疗的疗效，这两者都值得进一步研究。
