本文由小咖机器人翻译整理

期刊来源：JAMA

原文链接：https://doi.org/10.1001/jama.2024.4899

摘要内容如下：

重要性

慢性瘙痒症，定义为经历6周或更长时间的瘙痒，影响大约22%的人的一生。大约1%的医生就诊主要是因为慢性瘙痒症。慢性瘙痒症与不良后果相关，包括睡眠受损和生活质量下降。

观察

慢性瘙痒可根据病因分为炎症性瘙痒、神经性瘙痒或炎症性瘙痒和神经性瘙痒的组合。大约60%的慢性瘙痒是由于炎症引起的，可能是由湿疹、银屑病或脂溢性皮炎引起的。大约25%的慢性瘙痒症是由于神经性或混合性病因引起的。慢性瘙痒症的神经性原因包括带状疱疹后神经痛和感觉异常性背痛，通常是由于局部或全身神经失调所致。大约15%的慢性瘙痒症患者有其他原因，包括全身性疾病引起的继发性瘙痒，如尿毒症瘙痒和胆汁淤积性瘙痒，药物引起的瘙痒，如免疫治疗引起的瘙痒，以及感染性病因，如体癣和疥疮。当很少出现原发性改变时，应进行全面的病史、症状回顾和实验室评估，特别是对于慢性瘙痒持续不到1年的患者。临床医生应考虑以下检查：全血细胞计数、全代谢检查和甲状腺功能检查，以评估恶性血液病、肝脏疾病、肾脏疾病或甲状腺疾病。炎症性慢性瘙痒的一线治疗包括局部抗炎治疗，如氢化可的松（2.5%）、曲安奈德（0.1%）或他克莫司软膏。大约10%的患者对局部治疗没有反应。在这些患者中，可以考虑转诊至皮肤科和全身口服或注射治疗，如dupilumab或甲氨蝶呤。当未发现与瘙痒相关的潜在系统性疾病时，患者可能患有神经性慢性瘙痒或混合病因，如不明原因的慢性瘙痒。在这些患者中，神经性局部治疗如薄荷醇、普拉莫辛或利多卡因可单独使用或与免疫调节剂如局部类固醇联合使用。神经性瘙痒的其他有效疗法包括加巴喷丁、抗抑郁药（如舍曲林或多虑平）或阿片受体激动剂/拮抗剂（如纳曲酮或布托啡诺）。

结论和相关性

慢性瘙痒可对生活质量产生不利影响，可分为炎症性、神经性或联合病因。一线治疗是针对炎症原因的局部类固醇，如氢化可的松（2.5%）或曲安奈德（0.1%）；用于神经性病因的局部神经性药物，如薄荷醇或普拉莫辛；以及用于慢性瘙痒症的混合病因的这些疗法的组合。

英文原文如下：

Abstracts

Importance  Chronic pruritus, defined as itch experienced for 6 weeks or longer, affects approximately 22% of people in their lifetime. Approximately 1% of physician visits are for the chief concern of chronic pruritus. Chronic pruritus is associated with adverse outcomes, including impaired sleep and reduced quality of life.

Observations  Chronic pruritus can be categorized by etiology into inflammatory, neuropathic, or a combination of inflammatory and neuropathic pruritus. Chronic pruritus is due to inflammation in approximately 60% of patients and may be caused by eczema, psoriasis, or seborrheic dermatitis. Chronic pruritus is due to a neuropathic or mixed etiology in approximately 25% of patients. Neuropathic causes of chronic pruritus include postherpetic neuralgia and notalgia paresthetica and are typically due to localized or generalized nerve dysregulation. Approximately 15% of people with chronic pruritus have other causes including systemic diseases with secondary itch, such as uremic pruritus and cholestatic pruritus, medication-induced pruritus such as pruritus due to immunotherapy, and infectious etiologies such as tinea corporis and scabies. When few primary changes are present, a thorough history, review of symptoms, and laboratory evaluation should be performed, particularly for people with chronic pruritus lasting less than 1 year. Clinicians should consider the following tests: complete blood cell count, complete metabolic panel, and thyroid function testing to evaluate for hematologic malignancy, liver disease, kidney disease, or thyroid disease. First-line treatment for inflammatory chronic pruritus includes topical anti-inflammatory therapies such as hydrocortisone (2.5%), triamcinolone (0.1%), or tacrolimus ointment. Approximately 10% of patients do not respond to topical therapies. In these patients, referral to dermatology and systemic oral or injectable treatments such as dupilumab or methotrexate may be considered. When no underlying systemic disease associated with pruritus is identified, patients are likely to have neuropathic chronic pruritus or mixed etiology such as chronic pruritus of unknown origin. In these patients, neuropathic topical treatments such as menthol, pramoxine, or lidocaine can be used either alone or in combination with immunomodulatory agents such as topical steroids. Other effective therapies for neuropathic pruritus include gabapentin, antidepressants such as sertraline or doxepin, or opioid receptor agonist/antagonists such as naltrexone or butorphanol.

Conclusions and Relevance  Chronic pruritus can adversely affect quality of life and can be categorized into inflammatory, neuropathic, or a combined etiology. First-line therapies are topical steroids for inflammatory causes, such as hydrocortisone (2.5%) or triamcinolone (0.1%); topical neuropathic agents for neuropathic causes, such as menthol or pramoxine; and combinations of these therapies for mixed etiologies of chronic pruritus.

-----------分割线---------

点击链接：https://www.mediecogroup.com/community/user/vip/categories/ ，成为医咖会员，获取12项专属权益。