RESUMO
Chronic pruritus, defined as an unpleasant sensation resulting in a need to scratch that lasts more than 6 weeks, is a prevalent and bothersome symptom associated with both cutaneous and systemic conditions. Due to complex pathogenesis and profuse contributing factors, chronic pruritus therapy remains challenging. Regardless of the well-established antipruritic properties of classic pharmacotherapy (topical therapy, phototherapy and systemic therapy), these methods often provide insufficient relief for affected individuals. Owing to the growing interest in the field of pruritic research, further experimental and clinical data have emerged, continuously supporting the possibility of instigating novel therapeutic measures. This review covers the most relevant current modalities remaining under investigation that possess promising perspectives of approval in the near future, especially opioidergic drugs (mu-opioid antagonists and kappa-opioid agonists), neurokinin-1 receptor antagonists, biologic drugs, Janus kinase inhibitors, ileal bile acid transporter inhibitors, aryl hydrocarbon receptor agonists and histamine H4 receptor antagonists.
Assuntos
Prurido/tratamento farmacológico , Analgésicos Opioides/farmacologia , Analgésicos Opioides/uso terapêutico , Antipruriginosos/uso terapêutico , Fatores de Transcrição Hélice-Alça-Hélice Básicos/agonistas , Fatores Biológicos/uso terapêutico , Doença Crônica/terapia , Ensaios Clínicos como Assunto , Humanos , Inibidores de Janus Quinases/uso terapêutico , Antagonistas dos Receptores de Neurocinina-1/uso terapêutico , Fototerapia/métodos , Prurido/etiologia , Prurido/psicologia , Qualidade de Vida , Receptores de Hidrocarboneto Arílico/agonistas , Receptores Histamínicos H4/antagonistas & inibidores , Receptores Opioides kappa/agonistas , Receptores Opioides mu/antagonistas & inibidores , Pele/inervação , Pele/patologia , Resultado do TratamentoRESUMO
Beginning from embryological development, skin and psyche are closely related to physiological state regardless of age. Altering the homeostasis of one of these components impacts on the other, thereby substantiating that the relationship between itch and psyche is bilateral. Itch has a complex pathogenesis, which involves the peripheral and central nervous systems, as well as various inflammatory mediators. This paper reviews key aspects of itch pathogenesis, relevant associations with stress, the contagiousness of itch, psychological and psychiatric considerations related to itch, and the burden of itch with respect to impairment of health-related quality of life (HRQoL) and stigmatization. Despite the fact that itch-psyche associations still pose many questions, current knowledge supports the role of a holistic, interdisciplinary approach to these patients in order to improve their well-being.
Assuntos
Adaptação Psicológica , Efeitos Psicossociais da Doença , Prurido/psicologia , Qualidade de Vida , Humanos , Preconceito , Prurido/diagnóstico , Prurido/etiologia , Prurido/terapia , Fatores de Risco , Estereotipagem , Estresse Psicológico/complicações , Estresse Psicológico/psicologiaRESUMO
Ageing is associated with numerous medical afflictions, including dermatological symptoms and diseases. Chronic itch (CI) in elderly people is a frequent symptom of diverse aetiology. This study assessed the prevalence and detailed clinical features of CI among 153 elderly patients hospitalized in the geriatric ward, including associations with comorbidities and pharmacotherapy. CI affected 35.3% of subjects, most commonly due to cutaneous conditions, mixed aetiology and neurological disorders (53.7%, 25.9% and 11.1% of pruritic subjects, respectively). The mean itch intensity assessed with the 4-Item Itch Questionnaire (4IIQ) was 6.6 ± 2.8 points. Viral hepatitis (p = 0.02), higher serum creatinine concentration (p = 0.02) and coexistent purpuric lesions (p = 0.002) were associated with higher 4IIQ scores. In logistic regression analysis CI correlated positively with female sex, atopic dermatitis, immobility, rheumatoid arthritis and ischaemic neurological diseases, while low-molecular-weight heparins, antipruritic drugs, allergy, rosacea and higher haemoglobin concentration had the contrary effect. CI is a frequent and interdisciplinary problem among elderly subjects, which requires a holistic clinical approach.
Assuntos
Prurido/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Antipruriginosos/uso terapêutico , Doença Crônica , Comorbidade , Estudos Transversais , Humanos , Polônia/epidemiologia , Prevalência , Estudos Prospectivos , Prurido/diagnóstico , Prurido/tratamento farmacológico , Qualidade de Vida , Fatores de Risco , Índice de Gravidade de DoençaRESUMO
End-stage renal disease chronic itch is a frequent symptom that bothers patients with advanced stages of chronic kidney disease. The pathogenesis of the chronic itch symptom is complex and not yet fully understood and includes many metabolic, immunologic, and neurogenic factors. A significant burden of the disease results in decreased quality of life with sleep impairment, depressive symptoms, and increased mortality of affected individuals. No treatment of choice is available; topical therapy (emollients), phototherapy (UV-B), and systemic therapy (antiepileptics, opioid agonists, and antagonists) provide significant relief in varying percentages of patients.