特应性皮炎瘙痒管理专家共识

doi:10.35541/cjd.20210056

摘要/Abstract

摘要： 【摘要】瘙痒是特应性皮炎（AD）主要的症状，也是影响疾病发生发展的重要因素，控制瘙痒是AD管理的关键环节。为完善AD综合管理方案，改善患者的生活质量，中国医师协会皮肤科医师分会过敏性疾病专业委员会、中华医学会皮肤性病学分会特应性皮炎研究中心和中国医疗保健国际交流促进会皮肤科分会邀请国内有关专家，针对AD瘙痒管理的重要性、发病机制、表现特征、严重程度评估方法、有效避免诱发因素措施、保湿剂合理使用、外用和系统药物规范治疗等达成共识。

关键词: 皮炎, 特应性, 瘙痒症, 瘙痒管理, 共识

Abstract: 【Abstract】 As the main symptom of atopic dermatitis （AD）, itch is an important factor affecting the occurrence and development of the disease, and controlling itch is a key step in AD management. To improve the comprehensive management protocols of AD and quality of life of patients, relevant Chinese experts were invited to develop this consensus for management of itch in AD by the Committee on Allergic Diseases of China Dermatologist Association, Atopic Dermatitis Research Center of Chinese Society of Dermatology, and Dermatology Branch of China International Exchange and Promotion Association for Medical and Healthcare. This consensus points out the importance of itch management in AD, and summarizes pathogenesis, manifestations and severity assessment of itch, effective measures to avoid predisposing factors for itch, rational use of moisturizers, as well as standardized topical and systemic treatment of itch.

Key words: Dermatitis, atopic, Pruritus, Pruritus management, Consensus

中国医师协会皮肤科医师分会过敏性疾病专业委员会中华医学会皮肤性病学分会特应性皮炎研究中心中国医疗保健国际交流促进会皮肤科分会. 特应性皮炎瘙痒管理专家共识[J]. 中华皮肤科杂志, 2021, 54(5): 391-396.doi:10.35541/cjd.20210056

Committee on Allergic Diseases, China Dermatologist Association, Atopic Dermatitis Research Center, Chinese Society of Dermatology, Dermatology Branch of China International Exchange and Promotion Association for Medical and Healthcare. Expert consensus for management of itch in atopic dermatitis[J]. Chinese Journal of Dermatology, 2021, 54(5): 391-396.doi:10.35541/cjd.20210056

参考文献 37

［1］	Elmariah SB. Adjunctive management of itch in atopic dermatitis［J］. Dermatol Clin, 2017,35（3）:373⁃394. doi: 10.1016/j.det.2017. 02.011.
［2］	Sidbury R, Kodama S. Atopic dermatitis guidelines: diagnosis, systemic therapy, and adjunctive care［J］. Clin Dermatol, 2018,36（5）:648⁃652. doi: 10.1016/j.clindermatol.2018.05.008.
［3］	中华医学会皮肤性病学分会免疫学组, 特应性皮炎协作研究中心. 中国特应性皮炎诊疗指南（2020版）［J］. 中华皮肤科杂志, 2020,53（2）:81⁃88. doi: 10.35541/cjd.20191000.
［4］	El Hachem M, Di Mauro G, Rotunno R, et al. Pruritus in pediatric patients with atopic dermatitis: a multidisciplinary approach ⁃ summary document from an Italian expert group［J］. Ital J Pediatr, 2020,46（1）:11. doi: 10.1186/s13052⁃020⁃0777⁃9.
［5］	Murota H, Katayama I. Exacerbating factors of itch in atopic dermatitis［J］. Allergol Int, 2017,66（1）:8⁃13. doi: 10.1016/j.alit.2016.10.005.
［6］	Chamlin SL, Mattson CL, Frieden IJ, et al. The price of pruritus: sleep disturbance and cosleeping in atopic dermatitis［J］. Arch Pediatr Adolesc Med, 2005,159（8）:745⁃750. doi: 10.1001/archpedi.159.8.745.
［7］	Huet F, Faffa MS, Poizeau F, et al. Characteristics of pruritus in relation to self⁃assessed severity of atopic dermatitis［J］. Acta Derm Venereol, 2019,99（3）:279⁃283. doi: 10.2340/00015555⁃3053.
［8］	Fujii M. Current understanding of pathophysiological mechanisms of atopic dermatitis: interactions among skin barrier dysfunction, immune abnormalities and pruritus［J］. Biol Pharm Bull, 2020,43（1）:12⁃19. doi: 10.1248/bpb.b19⁃00088.
［9］	Dawn A, Papoiu AD, Chan YH, et al. Itch characteristics in atopic dermatitis: results of a web⁃based questionnaire［J］. Br J Dermatol, 2009,160（3）:642⁃644. doi: 10.1111/j.1365⁃2133. 2008.08941.x.
［10］	Darsow U, Scharein E, Simon D, et al. New aspects of itch pathophysiology: component analysis of atopic itch using the ′Eppendorf Itch Questionnaire′［J］. Int Arch Allergy Immunol, 2001,124（1⁃3）:326⁃331. doi: 10.1159/000053748.
［11］	Ständer S, Augustin M, Reich A, et al. Pruritus assessment in clinical trials: consensus recommendations from the International Forum for the Study of Itch （IFSI） special interest group scoring itch in clinical trials［J］. Acta Derm Venereol, 2013,93（5）:509⁃514. doi: 10.2340/00015555⁃1620.
［12］	Chrostowska⁃Plak D, Salomon J, Reich A, et al. Clinical aspects of itch in adult atopic dermatitis patients［J］. Acta Derm Venereol, 2009,89（4）:379⁃383. doi: 10.2340/00015555⁃0676.
［13］	中国医师协会皮肤科分会变态反应性疾病专业委员会. 慢性瘙痒管理指南（2018版）［J］. 中华皮肤科杂志, 2018,51（7）:481⁃485. doi: 10.3760/cma.j.issn.0412⁃4030.2018.07.001.
［14］	Elman S, Hynan LS, Gabriel V, et al. The 5⁃D itch scale: a new measure of pruritus［J］. Br J Dermatol, 2010,162（3）:587⁃593. doi: 10.1111/j.1365⁃2133.2009.09586.x.
［15］	Micali G, Paternò V, Cannarella R, et al. Evidence⁃based treatment of atopic dermatitis with topical moisturizers［J］. G Ital Dermatol Venereol, 2018,153（3）:396⁃402. doi: 10.23736/S0392⁃0488.18.05898⁃4.
［16］	Pavlis J, Yosipovitch G. Management of itch in atopic dermatitis［J］. Am J Clin Dermatol, 2018,19（3）:319⁃332. doi: 10.1007/s40257⁃017⁃0335⁃4.
［17］	Senba E, Katanosaka K, Yajima H, et al. The immunosuppressant FK506 activates capsaicin⁃ and bradykinin⁃sensitive DRG neurons and cutaneous C⁃fibers［J］. Neurosci Res, 2004,50（3）:257⁃262. doi: 10.1016/j.neures.2004.07.005.
［18］	Pereira U, Boulais N, Lebonvallet N, et al. Mechanisms of the sensory effects of tacrolimus on the skin［J］. Br J Dermatol, 2010,163（1）:70⁃77. doi: 10.1111/j.1365⁃2133.2010.09757.x.
［19］	Sher LG, Chang J, Patel IB, et al. Relieving the pruritus of atopic dermatitis: a meta⁃analysis［J］. Acta Derm Venereol, 2012,92（5）:455⁃461. doi: 10.2340/00015555⁃1360.
［20］	Paller AS, Lebwohl M, Fleischer AB Jr, et al. Tacrolimus ointment is more effective than pimecrolimus cream with a similar safety profile in the treatment of atopic dermatitis: results from 3 randomized, comparative studies［J］. J Am Acad Dermatol, 2005,52（5）:810⁃822. doi: 10.1016/j.jaad.2004.12.038.
［21］	Roekevisch E, Spuls PI, Kuester D, et al. Efficacy and safety of systemic treatments for moderate⁃to⁃severe atopic dermatitis: a systematic review［J］. J Allergy Clin Immunol, 2014,133（2）:429⁃438. doi: 10.1016/j.jaci.2013.07.049.
［22］	Simon D, Bieber T. Systemic therapy for atopic dermatitis［J］. Allergy, 2014,69（1）:46⁃55. doi: 10.1111/all.12339.
［23］	Andersen HH, Elberling J, Sølvsten H, et al. Nonhistaminergic and mechanical itch sensitization in atopic dermatitis［J］. Pain, 2017,158（9）:1780⁃1791. doi: 10.1097/j.pain.0000000000000980.
［24］	Yamanaka K, Motomura E, Noro Y, et al. Olopatadine, a non⁃sedating H1 antihistamine, decreases the nocturnal scratching without affecting sleep quality in atopic dermatitis［J］. Exp Dermatol, 2015,24（3）:227⁃229. doi: 10.1111/exd.12630.
［25］	Henz BM, Metzenauer P, O′Keefe E, et al. Differential effects of new⁃generation H1⁃receptor antagonists in pruritic dermatoses［J］. Allergy, 1998,53（2）:180⁃183. doi: 10.1111/j.1398⁃9995. 1998.tb03867.x.
［26］	Matsuda KM, Sharma D, Schonfeld AR, et al. Gabapentin and pregabalin for the treatment of chronic pruritus［J］. J Am Acad Dermatol, 2016,75（3）:619⁃625.e6. doi: 10.1016/j.jaad.2016.02. 1237.
［27］	Hundley JL, Yosipovitch G. Mirtazapine for reducing nocturnal itch in patients with chronic pruritus: a pilot study［J］. J Am Acad Dermatol, 2004,50（6）:889⁃891. doi: 10.1016/j.jaad.2004. 01.045.
［28］	Malekzad F, Arbabi M, Mohtasham N, et al. Efficacy of oral naltrexone on pruritus in atopic eczema: a double⁃blind, placebo⁃controlled study［J］. J Eur Acad Dermatol Venereol, 2009,23（8）:948⁃950. doi: 10.1111/j.1468⁃3083.2009.03129.x.
［29］	Dawn AG, Yosipovitch G. Butorphanol for treatment of intractable pruritus［J］. J Am Acad Dermatol, 2006,54（3）:527⁃531. doi: 10.1016/j.jaad.2005.12.010.
［30］	Simpson EL, Bieber T, Guttman⁃Yassky E, et al. Two phase 3 trials of dupilumab versus placebo in atopic dermatitis［J］. N Engl J Med, 2016,375（24）:2335⁃2348. doi: 10.1056/NEJMoa 1610020.
［31］	Wollenberg A, Blauvelt A, Guttman⁃Yassky E, et al. Tralokinumab for moderate⁃to⁃severe atopic dermatitis: results from two 52⁃week, randomized, double⁃blind, multicentre, placebo⁃controlled phase III trials （ECZTRA 1 and ECZTRA 2）［J］. Br J Dermatol, 2020,doi: 10.1111/bjd.19574.
［32］	Ruzicka T, Hanifin JM, Furue M, et al. Anti⁃interleukin⁃31 receptor a antibody for atopic dermatitis［J］. N Engl J Med, 2017,376（9）:826⁃835. doi: 10.1056/NEJMoa1606490.
［33］	Soeberdt M, Kilic A, Abels C. Small molecule drugs for the treatment of pruritus in patients with atopic dermatitis［J］. Eur J Pharmacol, 2020,881:173242. doi: 10.1016/j.ejphar.2020.173242.
［34］	Tom WL, Van Syoc M, Chanda S, et al. Pharmacokinetic profile, safety, and tolerability of crisaborole topical ointment, 2% in adolescents with atopic dermatitis: an open⁃label phase 2a study［J］. Pediatr Dermatol, 2016,33（2）:150⁃159. doi: 10.1111/pde. 12780.
［35］	Worm M, Thyssen J, Schliemann S, et al. The topical pan⁃JAK inhibitor delgocitinib cream demonstrates dose response in a 16⁃week phase 2b trial in chronic hand eczema.2020 EADV abstract.
［36］	Nakagawa H, Nemoto O, Igarashi A, et al. Long⁃term safety and efficacy of delgocitinib ointment, a topical Janus kinase inhibitor, in adult patients with atopic dermatitis［J］. J Dermatol, 2020,47（2）:114⁃120. doi: 10.1111/1346⁃8138.15173.
［37］	中华医学会皮肤性病学分会儿童皮肤病学组. 中国儿童特应性皮炎诊疗共识（2017版）［J］. 中华皮肤科杂志, 2017,50（11）:784⁃789. doi: 10.3760/cma.j.issn.0412⁃4030.2017.11.002.

[1]	李妍徐薇李邻峰. 外用丁酸氢化可的松乳膏联合一种皮肤膏剂敷料治疗特应性皮炎的随机开放对照研究 [J]. 中华皮肤科杂志, 2021, 54(5): 452-455.
[2]	渠莉田苏惠春程波. 特应性皮炎与系统性疾病相关性的研究进展[J]. 中华皮肤科杂志, 2021, 54(5): 463-466.
[3]	中国医师协会皮肤科医师分会自身免疫病专业委员会. 甲氨蝶呤治疗免疫相关性皮肤病专家共识[J]. 中华皮肤科杂志, 2021, 54(5): 382-390.
[4]	中国医疗保健国际交流促进会皮肤科分会. 女阴硬化性苔藓诊疗专家共识[J]. 中华皮肤科杂志, 2021, 54(5): 371-375.
[5]	张锡宝董良娇叶瑞贤刘焕颜熊绮颖. 老年特应性皮炎[J]. 中华皮肤科杂志, 2021, 54(5): 447-451.
[6]	中华医学会皮肤性病学分会药物不良反应研究中心. Stevens-Johnson综合征/中毒性表皮坏死松解症诊疗专家共识[J]. 中华皮肤科杂志, 2021, 54(5): 376-381.
[7]	杨婷张考苑李子卓李旭于波窦侠. 2型固有淋巴样细胞在MC903诱导的小鼠特应性皮炎样反应中的作用[J]. 中华皮肤科杂志, 2021, 54(4): 335-341.
[8]	周杰宋志强. 特应性皮炎的临床表型和内表型[J]. 中华皮肤科杂志, 2021, 54(3): 259-263.
[9]	邓思思宋志强. 系统性接触性皮炎的临床研究进展[J]. 中华皮肤科杂志, 2021, 54(3): 270-272.
[10]	宋志强王欢. 特应性皮炎的治疗进展：新药物、新手段、新模式[J]. 中华皮肤科杂志, 2021, 54(2): 161-164.
[11]	中国中西医结合学会皮肤性病专业委员会色素病学组. 白癜风诊疗共识（2021版）[J]. 中华皮肤科杂志, 2021, 54(2): 105-109.
[12]	中国反常性痤疮/化脓性汗腺炎诊疗专家共识制订小组. 中国反常性痤疮/化脓性汗腺炎诊疗专家共识（2021版）[J]. 中华皮肤科杂志, 2021, 54(2): 97-104.
[13]	宋潇宋志强. 特应性皮炎的诊断：争议和事实[J]. 中华皮肤科杂志, 2021, 54(1): 89-92.
[14]	中国医师协会皮肤科医师分会科学委员会中国医师协会皮肤科医师分会变态反应性疾病专业委员会中国“手部湿疹科研协作组”. 中国手部湿疹诊疗专家共识（2021版）[J]. 中华皮肤科杂志, 2021, 54(1): 19-26.
[15]	梁云生刘钊. 特应性皮炎与2型炎症反应[J]. 中华皮肤科杂志, 2021, 54(1): 84-88.