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Хронический зуд – многоликая проблема современности
Хронический зуд – многоликая проблема современности
Пирузян А.Л., Невозинская З.А., Корсунская И.М. Хронический зуд – многоликая проблема современности. Consilium Medicum. 2020; 22 (7): 42–44. DOI: 10.26442/20751753.2020.7.200298
DOI: 10.26442/20751753.2020.7.200298
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DOI: 10.26442/20751753.2020.7.200298
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Аннотация
Хронический зуд до сих пор вызывает сложности не только у пациентов, но и у врачей. Основной причиной зуда считаются дерматологические
заболевания, однако список триггеров, вызывающих зуд, намного больше. Так, многие хронические заболевания могут сопровождаться зудом, имеющим свои особенности. При некоторых нарушениях печени (холангитах, вирусных гепатитах) часто развивается генерализованный зуд. Уремический зуд при хронической болезни почек встречается у 50% пациентов, находящихся на диализе. У пациентов с сахарным диабетом также в некоторых случаях может наблюдаться хронический зуд, усиливающийся ночью. Нейропатический зуд часто сопровождается и другими неприятными ощущениями, такими как онемение или легкая боль. Также не стоит исключать и то, что причиной зуда может стать лекарственное средство. Реакция на него может возникнуть сразу или носить отложенный характер. Ввиду такого обширного списка первопричин зуда, его диагностика и терапия становятся сложной задачей и требуют участия нескольких специалистов для подбора оптимальной терапии.
Ключевые слова: хронический зуд, печеночный зуд, уремический зуд, лекарственный зуд, нейропатический зуд, эндокринный зуд.
Key words: chronic pruritus, hepatic pruritus, uremic pruritus, drug pruritus, neuropathic pruritus, endocrine pruritus.
заболевания, однако список триггеров, вызывающих зуд, намного больше. Так, многие хронические заболевания могут сопровождаться зудом, имеющим свои особенности. При некоторых нарушениях печени (холангитах, вирусных гепатитах) часто развивается генерализованный зуд. Уремический зуд при хронической болезни почек встречается у 50% пациентов, находящихся на диализе. У пациентов с сахарным диабетом также в некоторых случаях может наблюдаться хронический зуд, усиливающийся ночью. Нейропатический зуд часто сопровождается и другими неприятными ощущениями, такими как онемение или легкая боль. Также не стоит исключать и то, что причиной зуда может стать лекарственное средство. Реакция на него может возникнуть сразу или носить отложенный характер. Ввиду такого обширного списка первопричин зуда, его диагностика и терапия становятся сложной задачей и требуют участия нескольких специалистов для подбора оптимальной терапии.
Ключевые слова: хронический зуд, печеночный зуд, уремический зуд, лекарственный зуд, нейропатический зуд, эндокринный зуд.
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Key words: chronic pruritus, hepatic pruritus, uremic pruritus, drug pruritus, neuropathic pruritus, endocrine pruritus.
Полный текст
Список литературы
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3. Misery L, Dutray S, Chastaing M et al. Psychogenic itch. Transl Psychiatry 2018; 8 (1): 52. DOI: 10.1038/s41398-018-0097-7
4. Ständer S, Pogatzki-Zahn E, Stumpf A et al. Facing the challenges of chronic pruritus: a report from a multi-disciplinary medical itch centre in Germany. Acta Derm Venereol 2015; 95: 266–71.
5. Dull MM, Kremer AE. Management of chronic hepatic itch. Dermatol Clin 2018; 36: 293–300.
6. Bergasa NV, Mehlman JK, Jones EA. Pruritus and fatigue in primary biliary cirrhosis. Baillieres Best Pract Res Clin Gast-roenterol 2000; 14: 643–55
7. Weiss M, Mettang T, Tschulena U et al. Prevalence of chronic itch and associated factors in haemodialysis patients: a representative cross-sectional study. Acta Derm Venereol 2015; 95: 816–21.
8. Rayner HC, Larkina M, Wang M et al. International comparisons of pre-valence, awareness, and treatment of pruritus in people on hemodialysis. Clin J Am Soc Nephrol 2017; 12: 2000–7.
9. Khanna D, Singal A, Kalra OP. Comparison of cutaneous manifestations in chronic kidney disease with or without dialysis. Postgrad Med J 2010; 86: 641–7.
10. Ko MJ, Chiu HC, Jee SH et al. Postprandial blood glucose is associated with generalized pruritus in patients with type 2 diabetes. Eur J Dermatol 2013; 23: 688–93
11. Yamaoka H, Sasaki H, Yamasaki H et al. Truncal pruritus of unknown origin may be a symptom of diabetic polyneuropathy. Diabetes Care 2010; 33: 150–5.
12. Marziniak M, Phan NQ, Raap U et al. Brachioradial pruritus as a result of cervical spine pathology: the results of a magnetic resonance tomography study. J Am Acad Dermatol 2011; 65: 756–62.
13. Lauria G, Bakkers M, Schmitz C et al. Intraepidermal nerve fiber density at the distal leg: a worldwide normative reference study. J Peripher Nerv Syst 2010; 15: 202–7.
14. Reich A, Ständer S, Szepietowski JC. Drug-induced pruritus: a review. Acta Derm Venereol 2009; 89 (3): 236–44. DOI: 10.2340/00015555-0650
15. Raksha MP, Marfatia YS. Clinical study of cutaneous drug eruptions in 200 patients. Indian J Dermatol Venereol Leprol 2008; 74: 80.
16. Shirin H, Schapiro JM, Arber N et al. Erythromycin base-induced rash and liver function disturbances. Ann Pharmacother 1992; 26: 1522–3.
17. Morton A, Muir J, Lim D. Rash and acute nephritic syndrome due to candesartan. BMJ 2004; 328: 25.
18. Miró N. Controlled multicenter study on chronic suppurative otitis media treated with topical applications of ciprofloxacin 0.2% solution in single-dose containers or combination of polymyxin B, neomycin, and hydrocortisone suspension. Otolaryngol Head Neck Surg 2000; 123: 617–23.
19. Szepietowski J, Reich A, Białynicki-Birula R. Itching in atopic dermatitis: clinical manifestation, pathogenesis and the role of pimecrolimus in itch reduction. Dermatol Klin 2004; 6: 173–6.
20. Abramovits W, Boguniewicz M. Adult Atopiclair Study Group A multicenter, randomized, vehicle-controlled clinical study to examine the efficacy and safety of MAS063DP (Atopiclair) in the management of mild to moderate atopic dermatitis in adults. J Drug Dermatol 2006; 5: 236–44.
21. Seiwerth J, Tasiopoulou G, Hoffmann J et al. Anti-Inflammatory Effect of a Novel Topical Herbal Composition (VEL-091604) Consisting of Gentian Root, Licorice Root and Willow Bark Extract. Planta Med 2019; 85: 608–14. DOI: 10.1055/a-0835-6806
2. Misery L et al. Neuropathic pruritus. Nat Rev Neurol 2014; 10: 408–16. DOI: 10.1038/nrneurol.2014.99
3. Misery L, Dutray S, Chastaing M et al. Psychogenic itch. Transl Psychiatry 2018; 8 (1): 52. DOI: 10.1038/s41398-018-0097-7
4. Ständer S, Pogatzki-Zahn E, Stumpf A et al. Facing the challenges of chronic pruritus: a report from a multi-disciplinary medical itch centre in Germany. Acta Derm Venereol 2015; 95: 266–71.
5. Dull MM, Kremer AE. Management of chronic hepatic itch. Dermatol Clin 2018; 36: 293–300.
6. Bergasa NV, Mehlman JK, Jones EA. Pruritus and fatigue in primary biliary cirrhosis. Baillieres Best Pract Res Clin Gast-roenterol 2000; 14: 643–55
7. Weiss M, Mettang T, Tschulena U et al. Prevalence of chronic itch and associated factors in haemodialysis patients: a representative cross-sectional study. Acta Derm Venereol 2015; 95: 816–21.
8. Rayner HC, Larkina M, Wang M et al. International comparisons of pre-valence, awareness, and treatment of pruritus in people on hemodialysis. Clin J Am Soc Nephrol 2017; 12: 2000–7.
9. Khanna D, Singal A, Kalra OP. Comparison of cutaneous manifestations in chronic kidney disease with or without dialysis. Postgrad Med J 2010; 86: 641–7.
10. Ko MJ, Chiu HC, Jee SH et al. Postprandial blood glucose is associated with generalized pruritus in patients with type 2 diabetes. Eur J Dermatol 2013; 23: 688–93
11. Yamaoka H, Sasaki H, Yamasaki H et al. Truncal pruritus of unknown origin may be a symptom of diabetic polyneuropathy. Diabetes Care 2010; 33: 150–5.
12. Marziniak M, Phan NQ, Raap U et al. Brachioradial pruritus as a result of cervical spine pathology: the results of a magnetic resonance tomography study. J Am Acad Dermatol 2011; 65: 756–62.
13. Lauria G, Bakkers M, Schmitz C et al. Intraepidermal nerve fiber density at the distal leg: a worldwide normative reference study. J Peripher Nerv Syst 2010; 15: 202–7.
14. Reich A, Ständer S, Szepietowski JC. Drug-induced pruritus: a review. Acta Derm Venereol 2009; 89 (3): 236–44. DOI: 10.2340/00015555-0650
15. Raksha MP, Marfatia YS. Clinical study of cutaneous drug eruptions in 200 patients. Indian J Dermatol Venereol Leprol 2008; 74: 80.
16. Shirin H, Schapiro JM, Arber N et al. Erythromycin base-induced rash and liver function disturbances. Ann Pharmacother 1992; 26: 1522–3.
17. Morton A, Muir J, Lim D. Rash and acute nephritic syndrome due to candesartan. BMJ 2004; 328: 25.
18. Miró N. Controlled multicenter study on chronic suppurative otitis media treated with topical applications of ciprofloxacin 0.2% solution in single-dose containers or combination of polymyxin B, neomycin, and hydrocortisone suspension. Otolaryngol Head Neck Surg 2000; 123: 617–23.
19. Szepietowski J, Reich A, Białynicki-Birula R. Itching in atopic dermatitis: clinical manifestation, pathogenesis and the role of pimecrolimus in itch reduction. Dermatol Klin 2004; 6: 173–6.
20. Abramovits W, Boguniewicz M. Adult Atopiclair Study Group A multicenter, randomized, vehicle-controlled clinical study to examine the efficacy and safety of MAS063DP (Atopiclair) in the management of mild to moderate atopic dermatitis in adults. J Drug Dermatol 2006; 5: 236–44.
21. Seiwerth J, Tasiopoulou G, Hoffmann J et al. Anti-Inflammatory Effect of a Novel Topical Herbal Composition (VEL-091604) Consisting of Gentian Root, Licorice Root and Willow Bark Extract. Planta Med 2019; 85: 608–14. DOI: 10.1055/a-0835-6806
2. Misery L et al. Neuropathic pruritus. Nat Rev Neurol 2014; 10: 408–16. DOI: 10.1038/nrneurol.2014.99
3. Misery L, Dutray S, Chastaing M et al. Psychogenic itch. Transl Psychiatry 2018; 8 (1): 52. DOI: 10.1038/s41398-018-0097-7
4. Ständer S, Pogatzki-Zahn E, Stumpf A et al. Facing the challenges of chronic pruritus: a report from a multi-disciplinary medical itch centre in Germany. Acta Derm Venereol 2015; 95: 266–71.
5. Dull MM, Kremer AE. Management of chronic hepatic itch. Dermatol Clin 2018; 36: 293–300.
6. Bergasa NV, Mehlman JK, Jones EA. Pruritus and fatigue in primary biliary cirrhosis. Baillieres Best Pract Res Clin Gast-roenterol 2000; 14: 643–55
7. Weiss M, Mettang T, Tschulena U et al. Prevalence of chronic itch and associated factors in haemodialysis patients: a representative cross-sectional study. Acta Derm Venereol 2015; 95: 816–21.
8. Rayner HC, Larkina M, Wang M et al. International comparisons of pre-valence, awareness, and treatment of pruritus in people on hemodialysis. Clin J Am Soc Nephrol 2017; 12: 2000–7.
9. Khanna D, Singal A, Kalra OP. Comparison of cutaneous manifestations in chronic kidney disease with or without dialysis. Postgrad Med J 2010; 86: 641–7.
10. Ko MJ, Chiu HC, Jee SH et al. Postprandial blood glucose is associated with generalized pruritus in patients with type 2 diabetes. Eur J Dermatol 2013; 23: 688–93
11. Yamaoka H, Sasaki H, Yamasaki H et al. Truncal pruritus of unknown origin may be a symptom of diabetic polyneuropathy. Diabetes Care 2010; 33: 150–5.
12. Marziniak M, Phan NQ, Raap U et al. Brachioradial pruritus as a result of cervical spine pathology: the results of a magnetic resonance tomography study. J Am Acad Dermatol 2011; 65: 756–62.
13. Lauria G, Bakkers M, Schmitz C et al. Intraepidermal nerve fiber density at the distal leg: a worldwide normative reference study. J Peripher Nerv Syst 2010; 15: 202–7.
14. Reich A, Ständer S, Szepietowski JC. Drug-induced pruritus: a review. Acta Derm Venereol 2009; 89 (3): 236–44. DOI: 10.2340/00015555-0650
15. Raksha MP, Marfatia YS. Clinical study of cutaneous drug eruptions in 200 patients. Indian J Dermatol Venereol Leprol 2008; 74: 80.
16. Shirin H, Schapiro JM, Arber N et al. Erythromycin base-induced rash and liver function disturbances. Ann Pharmacother 1992; 26: 1522–3.
17. Morton A, Muir J, Lim D. Rash and acute nephritic syndrome due to candesartan. BMJ 2004; 328: 25.
18. Miró N. Controlled multicenter study on chronic suppurative otitis media treated with topical applications of ciprofloxacin 0.2% solution in single-dose containers or combination of polymyxin B, neomycin, and hydrocortisone suspension. Otolaryngol Head Neck Surg 2000; 123: 617–23.
19. Szepietowski J, Reich A, Białynicki-Birula R. Itching in atopic dermatitis: clinical manifestation, pathogenesis and the role of pimecrolimus in itch reduction. Dermatol Klin 2004; 6: 173–6.
20. Abramovits W, Boguniewicz M. Adult Atopiclair Study Group A multicenter, randomized, vehicle-controlled clinical study to examine the efficacy and safety of MAS063DP (Atopiclair) in the management of mild to moderate atopic dermatitis in adults. J Drug Dermatol 2006; 5: 236–44.
21. Seiwerth J, Tasiopoulou G, Hoffmann J et al. Anti-Inflammatory Effect of a Novel Topical Herbal Composition (VEL-091604) Consisting of Gentian Root, Licorice Root and Willow Bark Extract. Planta Med 2019; 85: 608–14. DOI: 10.1055/a-0835-6806
________________________________________________
2. Misery L et al. Neuropathic pruritus. Nat Rev Neurol 2014; 10: 408–16. DOI: 10.1038/nrneurol.2014.99
3. Misery L, Dutray S, Chastaing M et al. Psychogenic itch. Transl Psychiatry 2018; 8 (1): 52. DOI: 10.1038/s41398-018-0097-7
4. Ständer S, Pogatzki-Zahn E, Stumpf A et al. Facing the challenges of chronic pruritus: a report from a multi-disciplinary medical itch centre in Germany. Acta Derm Venereol 2015; 95: 266–71.
5. Dull MM, Kremer AE. Management of chronic hepatic itch. Dermatol Clin 2018; 36: 293–300.
6. Bergasa NV, Mehlman JK, Jones EA. Pruritus and fatigue in primary biliary cirrhosis. Baillieres Best Pract Res Clin Gast-roenterol 2000; 14: 643–55
7. Weiss M, Mettang T, Tschulena U et al. Prevalence of chronic itch and associated factors in haemodialysis patients: a representative cross-sectional study. Acta Derm Venereol 2015; 95: 816–21.
8. Rayner HC, Larkina M, Wang M et al. International comparisons of pre-valence, awareness, and treatment of pruritus in people on hemodialysis. Clin J Am Soc Nephrol 2017; 12: 2000–7.
9. Khanna D, Singal A, Kalra OP. Comparison of cutaneous manifestations in chronic kidney disease with or without dialysis. Postgrad Med J 2010; 86: 641–7.
10. Ko MJ, Chiu HC, Jee SH et al. Postprandial blood glucose is associated with generalized pruritus in patients with type 2 diabetes. Eur J Dermatol 2013; 23: 688–93
11. Yamaoka H, Sasaki H, Yamasaki H et al. Truncal pruritus of unknown origin may be a symptom of diabetic polyneuropathy. Diabetes Care 2010; 33: 150–5.
12. Marziniak M, Phan NQ, Raap U et al. Brachioradial pruritus as a result of cervical spine pathology: the results of a magnetic resonance tomography study. J Am Acad Dermatol 2011; 65: 756–62.
13. Lauria G, Bakkers M, Schmitz C et al. Intraepidermal nerve fiber density at the distal leg: a worldwide normative reference study. J Peripher Nerv Syst 2010; 15: 202–7.
14. Reich A, Ständer S, Szepietowski JC. Drug-induced pruritus: a review. Acta Derm Venereol 2009; 89 (3): 236–44. DOI: 10.2340/00015555-0650
15. Raksha MP, Marfatia YS. Clinical study of cutaneous drug eruptions in 200 patients. Indian J Dermatol Venereol Leprol 2008; 74: 80.
16. Shirin H, Schapiro JM, Arber N et al. Erythromycin base-induced rash and liver function disturbances. Ann Pharmacother 1992; 26: 1522–3.
17. Morton A, Muir J, Lim D. Rash and acute nephritic syndrome due to candesartan. BMJ 2004; 328: 25.
18. Miró N. Controlled multicenter study on chronic suppurative otitis media treated with topical applications of ciprofloxacin 0.2% solution in single-dose containers or combination of polymyxin B, neomycin, and hydrocortisone suspension. Otolaryngol Head Neck Surg 2000; 123: 617–23.
19. Szepietowski J, Reich A, Białynicki-Birula R. Itching in atopic dermatitis: clinical manifestation, pathogenesis and the role of pimecrolimus in itch reduction. Dermatol Klin 2004; 6: 173–6.
20. Abramovits W, Boguniewicz M. Adult Atopiclair Study Group A multicenter, randomized, vehicle-controlled clinical study to examine the efficacy and safety of MAS063DP (Atopiclair) in the management of mild to moderate atopic dermatitis in adults. J Drug Dermatol 2006; 5: 236–44.
21. Seiwerth J, Tasiopoulou G, Hoffmann J et al. Anti-Inflammatory Effect of a Novel Topical Herbal Composition (VEL-091604) Consisting of Gentian Root, Licorice Root and Willow Bark Extract. Planta Med 2019; 85: 608–14. DOI: 10.1055/a-0835-6806
Авторы
А.Л. Пирузян1, З.А. Невозинская2, И.М. Корсунская*1
1 ФГБУН «Центр теоретических проблем физико-химической фармакологии» РАН, Москва, Россия;
2 ГБУЗ «Московский научно-практический центр дерматовенерологии и косметологии» Департамента здравоохранения г. Москвы, Москва, Россия
*marykor@bk.ru
1 Center for Theoretical Problems of Physicochemical Pharmacology, Moscow, Russia;
2 Moscow Scientific and Practical Center for Dermatovenereology and Cosmetology, Moscow, Russia
*marykor@bk.ru
1 ФГБУН «Центр теоретических проблем физико-химической фармакологии» РАН, Москва, Россия;
2 ГБУЗ «Московский научно-практический центр дерматовенерологии и косметологии» Департамента здравоохранения г. Москвы, Москва, Россия
*marykor@bk.ru
________________________________________________
1 Center for Theoretical Problems of Physicochemical Pharmacology, Moscow, Russia;
2 Moscow Scientific and Practical Center for Dermatovenereology and Cosmetology, Moscow, Russia
*marykor@bk.ru
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