Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany.
Department of Dermatology, Venereology and Leprology, RNT Medical College, Udaipur, Rajasthan, India.
Curr Opin Pharmacol. 2019 Jun;46:1-6. doi: 10.1016/j.coph.2018.11.007. Epub 2018 Dec 6.
Chronic pruritus is a highly prevalent, debilitating disease, which is often refractory to conventional therapies. A step-wise, guideline-driven approach should be adopted in the management of these patients. Emollients as well as topical corticosteroids if appropriate should be initiated whilst looking for the cause underlying the pruritus. If these measures fail, and the origin of the pruritus remains unknown, cannot be treated or does not respond to therapy, systemic therapies as for example gabapentinoids, antidepressants, mu-opioid-receptor antagonists or, in case of inflammatory conditions, immunosuppressive drugs should be recommended. Novel agents, especially systemic monoclonal antibodies, neurokinin-1 receptor antagonists and opioid receptor modulators, are promising in providing relief in refractory cases.
慢性瘙痒是一种普遍存在且使人虚弱的疾病，通常对传统疗法有抗性。在管理这些患者时，应采用逐步、基于指南的方法。在寻找瘙痒的根本原因的同时，应开始使用保湿剂以及局部皮质类固醇（如适用）。如果这些措施失败，并且瘙痒的根源仍然未知、无法治疗或对治疗没有反应，则应推荐全身性治疗，例如加巴喷丁类药物、抗抑郁药、μ-阿片受体拮抗剂，或者在炎症情况下，应推荐使用免疫抑制剂。新型药物，特别是全身性单克隆抗体、神经激肽-1 受体拮抗剂和阿片受体调节剂，在治疗难治性病例方面具有很大的应用前景。
