Itch: scratching more than the surface

被引:258
|
作者
Twycross, R
Greaves, MW
Handwerker, H
Jones, EA
Libretto, SE
Szepietowski, JC
Zylicz, Z
机构
[1] Churchill Hosp, Oxford OX3 7LJ, England
[2] St Thomas Hosp, St Johns Inst Dermatol, London, England
[3] Univ Erlangen Nurnberg, Inst Psychol Expt Pathophysiol, Erlangen, Germany
[4] Univ Amsterdam, Acad Med Ctr, Dept Gastrointestinal & Liver Dis, NL-1105 AZ Amsterdam, Netherlands
[5] Janssen Cilag Ltd, High Wycombe, Bucks, England
[6] Univ Med, Dept Dermatol & Venereol, Wroclaw, Poland
[7] Hospice Rozenheuvel, Rozendaal, Netherlands
[8] Ludwik Rydygier Univ, Palliat Care Dept, Bydgoszcz, Poland
关键词
D O I
10.1093/qjmed/hcg002
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
In origin, itch can be cutaneous ('pruritoceptive', e.g. dermatitis), neuropathic (e.g. multiple sclerosis), neurogenic (e.g. cholestasis), mixed (e.g. uraemia) or psychogenic. Although itch of cutaneous origin shares a common neural pathway with pain, the afferent C-fibres subserving this type of itch are a functionally distinct subset: they respond to histamine, acetylcholine and other pruritogens, but are insensitive to mechanical stimuli. Histamine is the main mediator for itch in insect bite reactions and in most forms of urticaria, and in these circumstances the itch responds well to H-1-antihistamines. However, in most dermatoses and in systemic disease, low-sedative H-1-antihistamines are ineffective. Opioid antagonists relieve itch caused by spinal opioids, cholestasis and, possibly, uraemia. Ondansetron relieves itch caused by spinal opioids (but not cholestasis and uraemia). Other drug treatments for itch include rifampicin, colestyramine and 17-alpha alkyl androgens (cholestasis), thalidomide (uraemia), cimetidine and corticosteroids (Hodgkin's lymphoma), paroxetine (paraneoplastic itch), aspirin and paroxetine (polycythaemia vera) and indometacin (some HIV+ patients). if the remedies specified fail, paroxetine and mirtazapine should be considered. Ultraviolet B therapy, particularly narrow-band UVB, may be superior to drug treatment for itch in uraemia.
引用
收藏
页码:7 / 26
页数:20
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