Sydorova Nataliia, Vereshchaka Volodymyr, Kuts Taras
Department of Military General Practice & Family Medicine, Ukrainian Military Medical Academy, 45/1-33 Knyaziv Ostroz'kykh str., 01015, Kyiv, Ukraine.
Educational and Scientific Center "Institute of Biology and Medicine", Taras Shevchenko National University of Kyiv, 2 Hlushkova Avenue, 03127, Kyiv, Ukraine.
Acta Med Litu. 2023;30(1):74-79. doi: 10.15388/Amed.2023.30.1.8. Epub 2023 May 16.
The case of a 42-year-old female patient with pronounced itching and exanthema, mainly in the area of the trunk and lower limbs, is presented. Previously, the patient took antihistamines without effect, was treated for scabies, but the itching remained pronounced and led to rash and excoriations. From the anamnesis, it was found that the patient has a high level of stress. According to the Hospital Anxiety and Depression Scale, the anxiety of the patient reached 14 points, and depression 1 point. Functional (psychogenic) itching was suspected. Since the patient refused dermatologist consultation, therapy with the anxiolytic temgicoluril, topical antipruritic agents and nonpharmacological methods of treatment were recommended at the initial stage. The patient felt a significant relief of itching symptoms on the first day of anxiolytic usage, she withdrew topical antipruritic agents after 5 days of anxiolytic treatment, in 15 days she began to reduce the dose of temgicoluril, and at the end of the third week she stopped treatment with anxiolytic due to a significant positive effect. In three weeks, practically all elements of the rash, except for the largest wounds from scratching, disappeared. The peculiarity of the case is that functional itching was completely eliminated during anxiolytic therapy without other systemic medications, which emphasizes the importance of eliminating the component of stress and anxiety in the treatment of such patients.
本文介绍了一名42岁女性患者的病例，该患者主要在躯干和下肢部位出现明显瘙痒和皮疹。此前，患者服用抗组胺药无效，曾接受疥疮治疗，但瘙痒仍很明显，并导致皮疹和皮肤破损。通过病史询问发现，患者压力水平较高。根据医院焦虑抑郁量表，患者的焦虑评分为14分，抑郁评分为1分。怀疑为功能性（心因性）瘙痒。由于患者拒绝皮肤科医生会诊，在初始阶段建议使用抗焦虑药替米考脲、外用止痒剂及非药物治疗方法。患者在使用抗焦虑药的第一天就感到瘙痒症状明显缓解，在抗焦虑治疗5天后停用了外用止痒剂，15天后开始减少替米考脲的剂量，在第三周结束时，由于显著的积极效果，她停止了抗焦虑药治疗。三周内，除了因搔抓导致的最大伤口外，皮疹的几乎所有症状都消失了。该病例的特殊之处在于，在未使用其他全身药物的情况下，抗焦虑治疗完全消除了功能性瘙痒，这强调了在治疗此类患者时消除压力和焦虑因素的重要性。
