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Diagnostik von psychischen Faktoren bei chronischem Pruritus. Hautarzt 2020; 71:506-510. [DOI: 10.1007/s00105-020-04596-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Zusammenfassung
Hintergrund
Pruritus ist ein häufiges und quälendes Symptom in der Bevölkerung sowie in ärztlichen Praxen.
Ziel der Arbeit
Der vorliegende Beitrag gibt einen Überblick über die Systematik psychischer Faktoren in Entstehung bzw. Verlauf des Pruritus sowie Hinweise zu ihrer jeweiligen Diagnostik
Material und Methode
Es handelt sich um eine Überblicksarbeit.
Ergebnisse
Psychische Beeinträchtigungen/Störungen können als Reaktion auf chronischen Pruritus auftreten, z. B. als Anpassungsstörungen, depressive Störungen, Angststörungen. Psychische Faktoren können auch in Entstehung und Verlauf eines chronischen Pruritus eine Rolle spielen, entweder im Zusammenspiel mit organischen Ursachen oder bei deren Fehlen als somatoformer Pruritus oder Pruritus bei coenästhetischer Schizophrenie. Ferner können selbstinduzierte Kratzartefakte mit oder ohne Pruritus im Rahmen von Störungen der Impulskontrolle, Zwangsstörungen oder Artefaktstörungen auftreten. Auch eine primär unabhängige Komorbidität mit einer sonstigen psychischen oder psychosomatischen Störung kann das Management des Pruritus erschweren und den Krankheitsverlauf beeinflussen. Es werden Hinweise zur Diagnostik der genannten Faktoren gegeben.
Diskussion
Die Diagnostik psychischer Einflussfaktoren und psychischer Aspekte des chronischen Pruritus ist komplex. Das wichtigste diagnostische Werkzeug ist die gründliche Anamneseerhebung auch bezüglich psychischer Aspekte. Zusätzlich können psychometrische Instrumente zum Einsatz kommen, die das ärztliche Gespräch jedoch nicht ersetzen.
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Golpanian RS, Kim HS, Yosipovitch G. Effects of Stress on Itch. Clin Ther 2020; 42:745-756. [PMID: 32147148 DOI: 10.1016/j.clinthera.2020.01.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/25/2020] [Accepted: 01/28/2020] [Indexed: 01/21/2023]
Abstract
PURPOSE Psychological stress and ensuing modulation of the immune and nervous systems can have a significant impact on itch. Stress can exacerbate itch and vice versa, resulting in a vicious cycle that can greatly impair a patient's quality of life. This review summarizes the association between stress and itch, elucidates the mechanism by which these two phenomena influence one another, and explores treatment modalities that aim to reduce stress-induced itch. METHODS A complete search of the PubMed and Google Scholar databases was completed and literature pertinent to this review was compiled. FINDINGS Both acute and chronic stress can significantly affect itch in healthy individuals and in those diagnosed with itchy skin diseases as well as systemic diseases, thus resulting in a vicious cycle in which stress exacerbates itch and vice versa. The mechanisms by which stress induces or aggravates itch include both central and peripheral activation of the hypothalamic-pituitary-adrenal axis and sympathetic nervous system. Activation of these systems, in turn, affects the mast cells, keratinocytes, and nerves that secrete neuropeptides, such as substance P, nerve growth factor, acetylcholine, histamine, and itchy cytokines. A dysfunctional parasympathetic response is thought to be involved in the chronic stress/itch response. Brain structures associated with emotion, such as the limbic system and periaqueductal gray, which work on the descending facilitation of itch, play a significant role in stress-induced itch. IMPLICATIONS As specific brain structures are associated with stress, drug treatments targeting these areas (ie, γ-aminobutyric acid-ergic drugs, serotonin and norepinephrine reuptake inhibitors) may help to modulate itch. Stress can also be combatted using nonpharmacologic treatments such as cognitive-behavioral therapies and stress-relieving holistic approaches (eg, yoga, acupuncture).
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Affiliation(s)
- Rachel Shireen Golpanian
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hei Sung Kim
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Dermatology, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Gil Yosipovitch
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA.
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Thomas J, Saple DG, Jerajani HR, Netha NRG, Rangasamy DU, Shaikh R, Babu RP, Powar I, Mhatre S, Vase S, Srisha MM, Mehta S, Mittal R, Acharya S, Charugulla SN. Real-World, Non-Interventional, Observational Study of Hydroxyzine Hydrochloride in Chronic Pruritus: a Prospective, Non-Comparative Study. Dermatol Ther (Heidelb) 2019; 9:299-308. [PMID: 30949959 PMCID: PMC6522615 DOI: 10.1007/s13555-019-0293-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Although hydroxyzine is widely used for symptom relief in pruritus, its clinical safety and efficacy data in the Indian setting are scarce. We conducted a study to assess the effectiveness and tolerability of hydroxyzine in the management of Indian patients with chronic pruritus in a real-world setting. METHODS This was a prospective, observational, patient-reported outcomes (PRO) study in patients with chronic pruritus due to dermatological causes treated with hydroxyzine as per the clinician's discretion for a period of up to 12 weeks. The primary outcome was improvement in quality of life from baseline, assessed using the 10-point Dermatology Quality of Life Index (DLQI) at week 12 of the study period. Secondary outcomes were improvement in the pruritus scores (5-D itch scale) at 12 weeks, improvements in the DLQI and 5-D itch scores at 2, 4 and 8 weeks and safety. RESULTS The study included 400 patients (179 males, 221 females) from 7 dermatology centres across India. Of the 400 patients recruited, 391 patients completed at least 2 weeks of treatment. There was significant (p < 0.0001) improvement from baseline in the DLQI scores and 5-D itch scores at 2, 4, 8 and 12 weeks; 189/391 (48.34%) patients had symptom relief leading to early termination. Overall, the treatment was well tolerated with a total of 11 mild-to-moderate adverse events reported during the study, which included dizziness, constipation, drowsiness, dry mouth and sedation. All events resolved without any intervention. There were no serious adverse events. CONCLUSION This real-world, observational, PRO study demonstrates that hydroxyzine significantly improves symptoms of pruritus and quality of life in patients with chronic pruritus due to dermatological causes over 12 weeks. Despite the sedating potential of the drug, hydroxyzine is well tolerated in real-world settings. TRIAL REGISTRATION CTRI/2017/06/008847. FUNDING Dr. Reddy's Laboratories.
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Affiliation(s)
| | | | - Hemangi R Jerajani
- Mahatma Gandhi Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | | | | | | | - Ravindra P Babu
- Raga's Skin Care, Skin and Cosmetology Clinic, Bangalore, Karnataka, India
| | | | - Sayalee Mhatre
- Mahatma Gandhi Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | - Santosh Vase
- Gandhi Medical College, Secunderabad, Telangana, India
| | | | - Suyog Mehta
- Medical Affairs, Dr. Reddy's Laboratories Ltd., Hyderabad, Telangana, India
| | - Rajan Mittal
- Medical Affairs, Dr. Reddy's Laboratories Ltd., Hyderabad, Telangana, India
| | - Shivani Acharya
- Medical Affairs, Dr. Reddy's Laboratories Ltd., Hyderabad, Telangana, India
| | - Sujeet N Charugulla
- Medical Affairs, Dr. Reddy's Laboratories Ltd., Hyderabad, Telangana, India.
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Pavlenko D, Akiyama T. Why does stress aggravate itch? A possible role of the amygdala. Exp Dermatol 2019; 28:1439-1441. [PMID: 30991457 DOI: 10.1111/exd.13941] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 04/10/2019] [Indexed: 11/30/2022]
Abstract
Stress is the exacerbating factor of itch across patients with chronic itch due to different origins. However, the precise mechanisms behind stress-induced exacerbation of itch remain unknown. Chronic stress induces hyperexcitability of the amygdala, the centre of emotional processing. Recent findings on the itch neuronal pathways support a pivotal role of the amygdala for itch processing. We hypothesized that itch is enhanced by stress through hyperexcitation of the amygdala. Modulation of amygdala activity, therefore, may have therapeutic potential in the treatment of chronic itch.
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Affiliation(s)
- Darya Pavlenko
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami, Miami, Florida
| | - Tasuku Akiyama
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami, Miami, Florida
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