Toyama Sumika, Tominaga Mitsutoshi, Takamori Kenji
Juntendo Itch Research Center (JIRC), Institute for Environmental and Gender-Specific Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Tomioka, Urayasu 279-0021, Chiba, Japan.
Anti-Aging Skin Research Laboratory, Juntendo University Graduate School of Medicine, 2-1-1 Tomioka, Urayasu 279-0021, Chiba, Japan.
Pharmaceuticals (Basel). 2022 Aug 19;15(8):1022. doi: 10.3390/ph15081022.
Itch (or pruritus) is an unpleasant sensation, inducing the desire to scratch. It is also a major and distressing symptom of many skin and systemic diseases. The involvement of histamine, which is a major itch mediator, has been extensively examined. Recent studies suggest that histamine-independent pathways may play roles in chronic itch. Therefore, antihistamines are not always effective in the treatment of patients with chronic itch. The development of biologics and κ-opioid receptor (KOR) agonists has contributed to advances in the treatment of itch; however, since biologics are expensive for patients to purchase, some patients may limit or discontinue their use of these agents. Furthermore, KOR agonists need to be prescribed with caution due to risks of side effects in the central nervous system. Janus kinase (JAK) inhibitors are sometimes associated with side effects, such as infection. In this review, we summarize antidepressants, antineuralgics, cyclosporine A, antibiotics, crotamiton, phosphodiesterase 4 inhibitor, botulinum toxin type A, herbal medicines, phototherapy, and acupuncture therapy as itch treatment options other than antihistamines, biologics, opioids, and JAK inhibitors; we also explain their underlying mechanisms of action.
瘙痒（或称作瘙痒症）是一种令人不适的感觉，会引发搔抓的欲望。它也是许多皮肤和全身性疾病的主要且令人苦恼的症状。组胺作为主要的瘙痒介质，其作用已得到广泛研究。近期研究表明，非组胺途径可能在慢性瘙痒中发挥作用。因此，抗组胺药在治疗慢性瘙痒患者时并不总是有效。生物制剂和κ-阿片受体（KOR）激动剂的研发推动了瘙痒治疗的进展；然而，由于生物制剂对患者来说购买成本高昂，一些患者可能会减少或停止使用这些药物。此外，由于存在中枢神经系统副作用的风险，KOR激动剂需要谨慎处方。Janus激酶（JAK）抑制剂有时会伴有副作用，如感染。在本综述中，我们总结了除抗组胺药、生物制剂、阿片类药物和JAK抑制剂之外的瘙痒治疗选择，包括抗抑郁药、抗神经痛药、环孢素A、抗生素、克罗米通、磷酸二酯酶4抑制剂、A型肉毒毒素、草药、光疗和针灸疗法；我们还解释了它们潜在的作用机制。
