银屑病伴瘙痒的临床特点、发病机制及治疗研究进展

doi:10.35541/cjd.20190683

中华皮肤科杂志 ›› 2020, Vol. 53 ›› Issue (12): 1029-1032.doi: 10.35541/cjd.20190683

银屑病伴瘙痒的临床特点、发病机制及治疗研究进展

郭智玮晋红中

中国医学科学院北京协和医学院北京协和医院皮肤科 100730

收稿日期:2019-06-21 修回日期:2020-02-10 发布日期:2020-12-02
通讯作者: 晋红中 E-mail:jinhongzhong@263.net
基金资助:
国家自然科学基金（81773331）；第六期中央保健科研课题资助（W2017BJ21）

Pruritus in psoriasis: clinical characteristics, pathogenesis and treatment

Guo Zhiwei, Jin Hongzhong

Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China

Received:2019-06-21 Revised:2020-02-10 Published:2020-12-02
Contact: Jin Hongzhong E-mail:jinhongzhong@263.net
Supported by:
National Natural Science Foundation of China （81773331）; Central Health Care Research Fund of China （W2017BJ21）

摘要/Abstract

摘要： 【摘要】以往认为银屑病属于非瘙痒性皮肤病，近年来，人们逐渐认识到瘙痒是加重银屑病患者疾病负担的因素之一。本文主要阐述瘙痒在银屑病中的临床特点，关注神经源性炎症中神经肽异常表达和神经末梢异常分布在瘙痒发病机制中作用，介绍治疗银屑病对瘙痒症状缓解的影响。

关键词: 银屑病, 瘙痒, 神经源性炎症, 神经肽

Abstract: 【Abstract】 In the past, psoriasis was considered as a non-pruritic skin disease. In recent years, it has been gradually realized that pruritus is one of the factors that aggravate the disease burden of patients with psoriasis. This review mainly elaborates epidemiologic and clinical characteristics of pruritus in psoriasis, focuses on the role of abnormal expression of neuropeptides and abnormal distribution of nerve endings in neurogenic inflammation in the pathogenesis of pruritus, and introduces the effect of treatment of psoriasis on the relief of pruritus.

Key words: Psoriasis, Pruritus, Neurogenic inflammation, Neuropeptides

郭智玮晋红中. 银屑病伴瘙痒的临床特点、发病机制及治疗研究进展[J]. 中华皮肤科杂志, 2020,53(12):1029-1032. doi:10.35541/cjd.20190683

Guo Zhiwei, Jin Hongzhong. Pruritus in psoriasis: clinical characteristics, pathogenesis and treatment[J]. Chinese Journal of Dermatology, 2020, 53(12): 1029-1032.doi:10.35541/cjd.20190683

参考文献 43

［1］	Krueger G, Koo J, Lebwohl M, et al. The impact of psoriasis on quality of life: results of a 1998 national psoriasis foundation patient⁃membership survey［J］. Arch Dermatol, 2001,137（3）:280⁃284.
［2］	Damiani G, Cazzaniga S, Conic RR, et al. Pruritus characteristics in a large Italian cohort of psoriatic patients［J］. J Eur Acad Dermatol Venereol, 2019,33（7）:1316⁃1324. doi: 10.1111/jdv. 15539.
［3］	O′Neill JL, Chan YH, Rapp SR, et al. Differences in itch characteristics between psoriasis and atopic dermatitis patients: results of a web⁃based questionnaire［J］. Acta Derm Venereol, 2011,91（5）:537⁃540. doi: 10.2340/00015555⁃1126.
［4］	Gisondi P, Girolomoni G. Patients′ perspectives in the management of psoriasis: the Italian results of the Multinational Assessment of Psoriasis and Psoriatic Arthritis （MAPP） survey［J］. J Dermatolog Treat, 2017,28（5）:390⁃393. doi: 10.1080/09546634. 2016.1255308.
［5］	Golbari NM, Porter ML, Kimball AB. Discordance between patient reported motivations to seek treatment for psoriasis compared to television advertisements［J］. J Drugs Dermatol, 2018,17（8）:886⁃887.
［6］	Strober BE, van der Walt JM, Armstrong AW, et al. Clinical goals and barriers to effective psoriasis care［J］. Dermatol Ther （Heidelb）, 2019,9（1）:5⁃18. doi: 10.1007/s13555⁃018⁃0279⁃5.
［7］	van de Kerkhof PC, Reich K, Kavanaugh A, et al. Physician perspectives in the management of psoriasis and psoriatic arthritis: results from the population⁃based multinational assessment of psoriasis and psoriatic arthritis survey［J］. J Eur Acad Dermatol Venereol, 2015,29（10）:2002⁃2010. doi: 10.1111/ jdv.13150.
［8］	Wang Y, Coyne K, Sofen H, et al. Qualitative analysis and reproducibility assessment of the scalp itch numeric rating scale among patients with moderate to severe plaque psoriasis of the scalp［J］. J Dermatolog Treat, 2019,30（8）:775⁃783. doi: 10. 1080/09546634.2019.1577546.
［9］	Moore C, Gupta R, Jordt SE, et al. Regulation of pain and itch by TRP channels［J］. Neurosci Bull, 2018,34（1）:120⁃142. doi: 10.1007/s12264⁃017⁃0200⁃8.
［10］	Reich A, Mędrek K, Szepietowski JC. Interplay of itch and psyche in psoriasis: an update［J］. Acta Derm Venereol, 2016,96（217）:55⁃57. doi: 10.2340/00015555⁃2374.
［11］	Reich A, Welz⁃Kubiak K, Szepietowski JC. Pruritus differences between psoriasis and lichen planus［J］. Acta Derm Venereol, 2011,91（5）:605⁃606. doi: 10.2340/00015555⁃1129.
［12］	Nigam R, El⁃Nour H, Amatya B, et al. GABA and GABA（A） receptor expression on immune cells in psoriasis: a pathophysiological role［J］. Arch Dermatol Res, 2010,302（7）:507⁃515. doi: 10.1007/s00403⁃010⁃1052⁃5.
［13］	Nakamura M, Toyoda M, Morohashi M. Pruritogenic mediators in psoriasis vulgaris: comparative evaluation of itch⁃associated cutaneous factors［J］. Br J Dermatol, 2003,149（4）:718⁃730. doi: 10.1046/j.1365⁃2133.2003.05586.x.
［14］	Arck P, Paus R. From the brain⁃skin connection: the neuroendocrine⁃immune misalliance of stress and itch［J］. Neuroimmunomodulation, 2006,13（5⁃6）:347⁃356. doi: 10.1159/000104863.
［15］	Gupta K, Harvima IT. Mast cell⁃neural interactions contribute to pain and itch［J］. Immunol Rev, 2018,282（1）:168⁃187. doi: 10.1111/imr.12622.
［16］	Zhou Y, Follansbee T, Wu X, et al. TRPV1 mediates inflammation and hyperplasia in imiquimod （IMQ）⁃induced psoriasiform dermatitis （PsD） in mice［J］. J Dermatol Sci, 2018,92（3）:264⁃271. doi: 10.1016/j.jdermsci.2018.11.009.
［17］	Chang SE, Han SS, Jung HJ, et al. Neuropeptides and their receptors in psoriatic skin in relation to pruritus［J］. Br J Dermatol, 2007,156（6）:1272⁃1277. doi: 10.1111/j.1365⁃2133. 2007.07935.x.
［18］	Nattkemper LA, Tey HL, Valdes⁃Rodriguez R, et al. The genetics of chronic itch: gene expression in the skin of patients with atopic dermatitis and psoriasis with severe itch［J］. J Invest Dermatol, 2018,138（6）:1311⁃1317. doi: 10.1016/j.jid.2017.12. 029.
［19］	Sakai K, Sanders KM, Youssef MR, et al. Role of neurturin in spontaneous itch and increased nonpeptidergic intraepidermal fiber density in a mouse model of psoriasis［J］. Pain, 2017,158（11）:2196⁃2202. doi: 10.1097/j.pain.0000000000001025.
［20］	Kupczyk P, Reich A, Gajda M, et al. UCHL1/PGP 9.5 dynamic in neuro⁃immune⁃cutaneous milieu: focusing on axonal nerve terminals and epidermal keratinocytes in psoriatic itch［J］. Biomed Res Int, 2018,2018:7489316. doi: 10.1155/2018/748 9316.
［21］	Kim TW, Shim WH, Kim JM, et al. Clinical characteristics of pruritus in patients with scalp psoriasis and their relation with intraepidermal nerve fiber density［J］. Ann Dermatol, 2014,26（6）:727⁃732. doi: 10.5021/ad.2014.26.6.727.
［22］	Roblin D, Yosipovitch G, Boyce B, et al. Topical TrkA kinase inhibitor CT327 is an effective, novel therapy for the treatment of pruritus due to psoriasis: results from experimental studies, and efficacy and safety of CT327 in a Phase 2b clinical trial in patients with psoriasis［J］. Acta Derm Venereol, 2015,95（5）:542⁃548. doi: 10.2340/00015555⁃2047.
［23］	Taneda K, Tominaga M, Negi O, et al. Evaluation of epidermal nerve density and opioid receptor levels in psoriatic itch［J］. Br J Dermatol, 2011,165（2）:277⁃284. doi: 10.1111/j.1365⁃2133. 2011.10347.x.
［24］	Kou K, Nakamura F, Aihara M, et al. Decreased expression of semaphorin⁃3A, a neurite⁃collapsing factor, is associated with itch in psoriatic skin［J］. Acta Derm Venereol, 2012,92（5）:521⁃528. doi: 10.2340/00015555⁃1350.
［25］	Hunter HJ, Hinz R, Gerhard A, et al. Brain inflammation and psoriasis: a ［11 C］⁃（R）⁃PK11195 positron emission tomography study［J］. Br J Dermatol, 2016,175（5）:1082⁃1084. doi: 10.1111/bjd.13788.
［26］	Takahashi N, Tominaga M, Kosaka R, et al. Involvement of µ⁃opioid receptors and κ⁃opioid receptors in itch⁃related scratching behaviour of imiquimod⁃induced psoriasis⁃like dermatitis in mice［J］. Acta Derm Venereol, 2017,97（8）:928⁃933. doi: 10.2340/00015555⁃2704.
［27］	Kupczyk P, Reich A, Hołysz M, et al. Opioid receptors in psoriatic skin: relationship with itch［J］. Acta Derm Venereol, 2017,97（5）:564⁃570. doi: 10.2340/00015555⁃2595.
［28］	Aizawa N, Ishiuji Y, Tominaga M, et al. Relationship between the degrees of itch and serum lipocalin⁃2 levels in patients with psoriasis［J］. J Immunol Res, 2019,2019:8171373. doi: 10.1155/2019/8171373.
［29］	Wiśnicka B, Szepietowski J C, Reich A, et al. Histamine, substance P and calcitonin gene⁃related peptide plasma concentration and pruritus in patients suffering from psoriasis［J］. Dermatol Psychosom, 2004,5（2）:73⁃78. doi: 10.1159/0000 79211.
［30］	Prignano F, Ricceri F, Pescitelli L, et al. Itch in psoriasis: epidemiology, clinical aspects and treatment options［J］. Clin Cosmet Investig Dermatol, 2009,2:9⁃13. doi: 10.2147/ccid.s4465.
［31］	Elewski B, Alexis AF, Lebwohl M, et al. Itch: an under⁃recognized problem in psoriasis［J］. J Eur Acad Dermatol Venereol, 2019,33（8）:1465⁃1476. doi: 10.1111/jdv.15450.
［32］	Théréné C, Brenaut E, Barnetche T, et al. Efficacy of systemic treatments of psoriasis on pruritus: a systemic literature review and meta⁃analysis［J］. J Invest Dermatol, 2018,138（1）:38⁃45. doi: 10.1016/j.jid.2017.05.039.
［33］	Stull C, Grossman S, Yosipovitch G. Current and emerging therapies for itch management in psoriasis［J］. Am J Clin Dermatol, 2016,17（6）:617⁃624. doi: 10.1007/s40257⁃016⁃0213⁃5.
［34］	Bulur I, Erdogan HK, Aksu AE, et al. The efficacy and safety of phototherapy in geriatric patients: a retrospective study［J］. An Bras Dermatol, 2018,93（1）:33⁃38. doi: 10.1590/abd1806⁃4841. 20185468.
［35］	Väkevä L, Niemelä S, Lauha M, et al. Narrowband ultraviolet B phototherapy improves quality of life of psoriasis and atopic dermatitis patients up to 3 months: results from an observational multicenter study［J］. Photodermatol Photoimmunol Photomed, 2019,35（5）:332⁃338. doi: 10.1111/phpp.12479.
［36］	Rodríguez⁃Granados MT, Estany⁃Gestal A, Pousa⁃Martínez M, et al. Is it useful to calculate minimal erythema dose before narrowband UV⁃B phototherapy?［J］. Actas Dermosifiliogr, 2017,108（9）:852⁃858. doi: 10.1016/j.ad.2017.05.009.
［37］	Smith CH, Jabbar⁃Lopez ZK, Yiu ZZ, et al. British association of dermatologists guidelines for biologic therapy for psoriasis 2017［J］. Br J Dermatol, 2017,177（3）:628⁃636. doi: 10.1111/bjd.15665.
［38］	Zachariae C, Gordon K, Kimball AB, et al. Efficacy and safety of ixekizumab over 4 years of open⁃label treatment in a phase 2 study in chronic plaque psoriasis［J］. J Am Acad Dermatol, 2018,79（2）:294⁃301.e6. doi: 10.1016/j.jaad.2018.03.047.
［39］	Menter A, Gordon K, Carey W, et al. Efficacy and safety observed during 24 weeks of efalizumab therapy in patients with moderate to severe plaque psoriasis［J］. Arch Dermatol, 2005,141（1）:31⁃38. doi: 10.1001/archderm.141.1.31.
［40］	Puig L, Augustin M, Blauvelt A, et al. Effect of secukinumab on quality of life and psoriasis⁃related symptoms: a comparative analysis versus ustekinumab from the CLEAR 52⁃week study［J］. J Am Acad Dermatol, 2018,78（4）:741⁃748. doi: 10.1016/j.jaad.2017.10.025.
［41］	Ständer S, Luger T, Cappelleri JC, et al. Validation of the itch severity item as a measurement tool for pruritus in patients with psoriasis: results from a phase 3 tofacitinib program［J］. Acta Derm Venereol, 2018,98（3）:340⁃345. doi: 10.2340/00015555⁃2856.
［42］	Dickison P, Swain G, Peek JJ, et al. Itching for answers: Prevalence and severity of pruritus in psoriasis［J］. Australas J Dermatol, 2018,59（3）:206⁃209. doi: 10.1111/ajd.12747.
［43］	D′Erme AM, Zanieri F, Campolmi E, et al. Therapeutic implications of adding the psychotropic drug escitalopram in the treatment of patients suffering from moderate⁃severe psoriasis and psychiatric comorbidity: a retrospective study［J］. J Eur Acad Dermatol Venereol, 2014,28（2）:246⁃249. doi: 10.1111/j.1468⁃3083.2012.04690.x.

[1]	刘小扬赵琰蔡林张建中. 银屑病患者白细胞介素17拮抗剂治疗后出现特应性皮炎样皮疹4例分析与文献回顾[J]. 中华皮肤科杂志, 2023, 56(9): 845-848.
[2]	付丹丹李佳林付修宇张芯育胡华宋向凤田中伟. S100A10蛋白在银屑病皮损的表达及对小鼠银屑病样皮炎模型的影响[J]. 中华皮肤科杂志, 2023, 56(9): 839-844.
[3]	陈小敏张景展丁媛康晓静. 二甲双胍治疗银屑病的研究进展[J]. 中华皮肤科杂志, 2023, 56(8): 799-802.
[4]	蒋晓妍高敏张晓艳刘宁远. 白细胞介素17和白细胞介素23拮抗剂治疗脓疱型银屑病研究进展[J]. 中华皮肤科杂志, 2023, 56(7): 689-692.
[5]	闪莹常晓彤左亚刚. 自身免疫性疱病的表位扩展现象[J]. 中华皮肤科杂志, 2023, 56(7): 702-705.
[6]	唐志铭荆梦晴陆鹭单霄张翠侠张晓宇孟飒. 犀地凉血方通过LncRNA NEAT1/miR-485-5p/ STAT3调控网络对HaCaT细胞增殖、凋亡影响的研究[J]. 中华皮肤科杂志, 2023, 56(7): 642-650.
[7]	中华医学会皮肤性病学分会银屑病专业委员会. 中国银屑病诊疗指南（2023版）[J]. 中华皮肤科杂志, 2023, 56(7): 573-625.
[8]	中国医师协会皮肤科医师分会中华医学会皮肤性病学分会空军军医大学西京医院中国银屑病患者饮食指南制订工作组. 中国银屑病患者饮食管理指南（2023）[J]. 中华皮肤科杂志, 2023, 56(5): 389-401.
[9]	金利平朱武鲁艳刘盼盼谭敏佳王英杨晶徐黎聪胡琨匡叶红. 饮食干预治疗银屑病的相关进展[J]. 中华皮肤科杂志, 2023, 56(4): 357-360.
[10]	连盼盼刘军苏忠兰王宏伟. 过氧化物酶体增殖物激活受体γ对皮肤生理功能和病理过程的影响[J]. 中华皮肤科杂志, 2023, 56(4): 365-368.
[11]	何谐栗玉珍. 靶向JAK-STAT信号通路治疗银屑病的研究进展[J]. 中华皮肤科杂志, 2023, 56(3): 273-278.
[12]	中华医学会皮肤性病学分会银屑病专业委员会. 银屑病生物制剂达标治疗专家共识[J]. 中华皮肤科杂志, 2023, 56(3): 191-203.
[13]	周健俞晨王刚. 司库奇尤单抗治疗13例难治性局限性脓疱型银屑病的临床疗效与安全性观察[J]. 中华皮肤科杂志, 2023, 56(3): 247-251.
[14]	胡琨杨晶王巧林陈军臣张谧朱武张斌窦冠珅 Wendong Chen, 匡叶红. [开放获取] 依奇珠单抗治疗银屑病短期疗效的单中心病例回顾性研究[J]. 中华皮肤科杂志, 2023, 56(3): 210-215.
[15]	陈良宏孙艳王敬玉吴严. 本维莫德在皮肤病中的研究进展[J]. 中华皮肤科杂志, 2023, 0(2): 20210875-e20210875.

银屑病伴瘙痒的临床特点、发病机制及治疗研究进展

Pruritus in psoriasis: clinical characteristics, pathogenesis and treatment

PDF

PDF (Mobile)

可视化

摘要/Abstract

引用本文

使用本文

参考文献 43

相关文章 15

Metrics

本文评价

推荐阅读 10