慢性痒疹的诊断及分型新进展

doi:10.35541/cjd.20210130

中华皮肤科杂志 ›› 2023, Vol. 56 ›› Issue (11): 1070-1073.doi: 10.35541/cjd.20210130

慢性痒疹的诊断及分型新进展

程必红窦侠

北京大学深圳医院皮肤科，深圳 518036

收稿日期:2021-02-08 修回日期:2021-09-27 发布日期:2023-11-03
通讯作者: 窦侠 E-mail:drdouxia@163.com
基金资助:
国家自然科学基金（81972930）；深圳市科技计划项目（JCYJ20190809101015502）

Diagnosis and classification of chronic prurigo

Cheng Bihong, Dou Xia

Department of Dermatology, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, China

Received:2021-02-08 Revised:2021-09-27 Published:2023-11-03
Contact: Dou Xia E-mail:drdouxia@163.com
Supported by:
National Natural Science Foundation of China （81972930）; Shenzhen Science and Technology Project （JCYJ20190809101015502）

摘要/Abstract

摘要： 【摘要】慢性痒疹是独立的慢性炎症性皮肤病，患者可能存在复杂的病因或合并症，诊断需要系统的流程，包括明确核心症状，全面采集病史和体格检查，完善必要的实验室或影像学检查，以及评估疾病严重程度。治疗慢性痒疹包括处理可能的病因和并发症，以及分阶梯式地控制瘙痒。该文主要综述慢性痒疹的临床诊断、分型和治疗。

关键词: 痒疹, 瘙痒症, 诊断, 临床分型, 慢性痒疹

Abstract: 【Abstract】 Chronic prurigo is an independent chronic inflammatory skin disease, and complex underlying etiologies or comorbidities may exist in patients. Diagnosis of chronic prurigo requires a systematic process, including identifying core symptoms, taking a comprehensive medical history, performing physical examination, completing necessary laboratory or imaging tests, and assessing disease severity. Treatments of chronic prurigo include management of possible causes and comorbidities, and stepwise control of pruritus. This review mainly summarizes clinical diagnosis, classification and treatment of chronic prurigo.

Key words: Prurigo, Pruritus, Diagnosis, Clinical types, Chronic prurigo

程必红窦侠. 慢性痒疹的诊断及分型新进展[J]. 中华皮肤科杂志, 2023,56(11):1070-1073. doi:10.35541/cjd.20210130

Cheng Bihong, Dou Xia. Diagnosis and classification of chronic prurigo[J]. Chinese Journal of Dermatology, 2023, 56(11): 1070-1073.doi:10.35541/cjd.20210130

参考文献 44

［1］	Pereira MP, Basta S, Moore J, et al. Prurigo nodularis: a physician survey to evaluate current perceptions of its classification, clinical experience and unmet need［J］. J Eur Acad Dermatol Venereol, 2018,32（12）:2224⁃2229. doi: 10.1111/jdv.15107.
［2］	Pereira MP, Zeidler C, Wallengren J, et al. Chronic nodular prurigo: a European cross⁃sectional study of patient perspectives on therapeutic goals and satisfaction［J］. Acta Derm Venereol, 2021,101（2）:adv00403. doi: 10.2340/00015555⁃3726.
［3］	Pereira MP, Hoffmann V, Weisshaar E, et al. Chronic nodular prurigo: clinical profile and burden. A European cross⁃sectional study［J］. J Eur Acad Dermatol Venereol, 2020,34（10）:2373⁃2383. doi: 10.1111/jdv.16309.
［4］	Huang AH, Canner JK, Khanna R, et al. Real⁃world prevalence of prurigo nodularis and burden of associated diseases［J］. J Invest Dermatol, 2020,140（2）:480⁃483.e4. doi: 10.1016/j.jid. 2019.07.697.
［5］	Pereira MP, Steinke S, Zeidler C, et al. European academy of dermatology and venereology European prurigo project: expert consensus on the definition, classification and terminology of chronic prurigo［J］. J Eur Acad Dermatol Venereol, 2018,32（7）:1059⁃1065. doi: 10.1111/jdv.14570.
［6］	Kwatra SG. Breaking the itch⁃scratch cycle in prurigo nodularis［J］. N Engl J Med, 2020,382（8）:757⁃758. doi: 10.1056/NEJMe 1916733.
［7］	Park K, Mori T, Nakamura M, et al. Increased expression of mRNAs for IL⁃4, IL⁃17, IL⁃22 and IL⁃31 in skin lesions of subacute and chronic forms of prurigo［J］. Eur J Dermatol, 2011,21（1）:135⁃136. doi: 10.1684/ejd.2010.1196.
［8］	Wong LS, Yen YT, Lin SH, et al. IL⁃17A induces endothelin⁃1 expression through p38 pathway in prurigo nodularis［J］. J Invest Dermatol, 2020,140（3）:702⁃706.e2. doi: 10.1016/j.jid. 2019.08.438.
［9］	Belzberg M, Alphonse MP, Brown I, et al. Prurigo nodularis is characterized by systemic and cutaneous T helper 22 immune polarization［J］. J Invest Dermatol, 2021,141（9）:2208⁃2218.e14. doi: 10.1016/j.jid.2021.02.749.
［10］	Oetjen LK, Mack MR, Feng J, et al. Sensory neurons co⁃opt classical immune signaling pathways to mediate chronic itch［J］. Cell, 2017,171（1）:217⁃228.e13. doi: 10.1016/j.cell.2017.08.006.
［11］	Zhong W, Wu X, Zhang W, et al. Aberrant expression of histamine⁃independent pruritogenic mediators in keratinocytes may be involved in the pathogenesis of prurigo nodularis［J］. Acta Derm Venereol, 2019,99（6）:579⁃586. doi: 10.2340/0001 5555⁃3150.
［12］	Pogatzki⁃Zahn EM, Pereira MP, Cremer A, et al. Peripheral sensitization and loss of descending inhibition is a hallmark of chronic pruritus［J］. J Invest Dermatol, 2020,140（1）:203⁃211.e4. doi: 10.1016/j.jid.2019.05.029.
［13］	Schuhknecht B, Marziniak M, Wissel A, et al. Reduced intraepidermal nerve fibre density in lesional and nonlesional prurigo nodularis skin as a potential sign of subclinical cutaneous neuropathy［J］. Br J Dermatol, 2011,165（1）:85⁃91. doi: 10.1111/j.1365⁃2133.2011.10306.x.
［14］	Ohanyan T, Schoepke N, Eirefelt S, et al. Role of substance P and its receptor neurokinin 1 in chronic prurigo: a randomized, proof⁃of⁃concept, controlled trial with topical aprepitant［J］. Acta Derm Venereol, 2018,98（1）:26⁃31. doi: 10.2340/00015555⁃2780.
［15］	Brune A, Metze D, Luger TA, et al. Antipruritic therapy with the oral opioid receptor antagonist naltrexone. Open, non⁃placebo controlled administration in 133 patients［J］. Hautarzt, 2004,55（12）:1130⁃1136. doi: 10.1007/s00105⁃004⁃0802⁃8.
［16］	Schedel F, Schürmann C, Metze D, et al. Prurigo. Clinical definition and classification［J］. Hautarzt, 2014,65（8）:684⁃690. doi: 10.1007/s00105⁃014⁃2753⁃z.
［17］	Pereira MP, Zeidler C, Nau T, et al. Position statement: linear prurigo is a subtype of chronic prurigo［J］. J Eur Acad Dermatol Venereol, 2019,33（2）:263⁃266. doi: 10.1111/jdv.15275.
［18］	Wallengren J. Prurigo: diagnosis and management［J］. Am J Clin Dermatol, 2004,5（2）:85⁃95. doi: 10.2165/00128071⁃200405020⁃00003.
［19］	Huang AH, Williams KA, Kwatra SG. Prurigo nodularis: epidemiology and clinical features［J］. J Am Acad Dermatol, 2020,83（6）:1559⁃1565. doi: 10.1016/j.jaad.2020.04.183.
［20］	Whang KA, Mahadevan V, Bakhshi PR, et al. Prevalence of prurigo nodularis in the United States［J］. J Allergy Clin Immunol Pract, 2020,8（9）:3240⁃3241. doi: 10.1016/j.jaip.2020.05.051.
［21］	Ständer S, Yosipovitch G, Legat FJ, et al. Trial of nemolizumab in moderate⁃to⁃severe prurigo nodularis［J］. N Engl J Med, 2020,382（8）:706⁃716. doi: 10.1056/NEJMoa1908316.
［22］	Gore Karaali M, Erdil D, Erdemir VA, et al. Evaluation of clinicopathological and treatment characteristics of 80 patients with acquired perforating dermatosis［J/OL］. Dermatol Ther, 2020,33（6）:e14465. doi: 10.1111/dth.14465.
［23］	Kestner RI, Ständer S, Osada N, et al. Acquired reactive perforating dermatosis is a variant of prurigo nodularis［J］. Acta Derm Venereol, 2017,97（2）:249⁃254. doi: 10.2340/00015555⁃2492.
［24］	韩毓梅, 胡东艳, 李明, 等. 17例获得性反应性穿通性胶原病临床分析［J］. 中国麻风皮肤病杂志, 2018,34（12）:728⁃731.
［25］	Brenaut E, Halvorsen JA, Dalgard FJ, et al. The self⁃assessed psychological comorbidities of prurigo in European patients: a multicentre study in 13 countries［J］. J Eur Acad Dermatol Venereol, 2019,33（1）:157⁃162. doi: 10.1111/jdv.15145.
［26］	Pereira MP, Ständer S. How to define chronic prurigo?［J］. Exp Dermatol, 2019,28（12）:1455⁃1460. doi: 10.1111/exd.13972.
［27］	Ständer HF, Elmariah S, Zeidler C, et al. Diagnostic and treatment algorithm for chronic nodular prurigo［J］. J Am Acad Dermatol, 2020,82（2）:460⁃468. doi: 10.1016/j.jaad.2019.07.022.
［28］	Elmariah S, Kim B, Berger T, et al. Practical approaches for diagnosis and management of prurigo nodularis: United States expert panel consensus［J］. J Am Acad Dermatol, 2021,84（3）:747⁃760. doi: 10.1016/j.jaad.2020.07.025.
［29］	Zeidler C, Pereira MP, Dugas M, et al. The burden in chronic prurigo: patients with chronic prurigo suffer more than patients with chronic pruritus on non⁃lesional skin: a comparative, retrospective, explorative statistical analysis of 4,484 patients in a real⁃world cohort［J］. J Eur Acad Dermatol Venereol, 2021,35（3）:738⁃743. doi: 10.1111/jdv.16929.
［30］	Kwon CD, Khanna R, Williams KA, et al. Diagnostic workup and evaluation of patients with prurigo nodularis［J］. Medicines （Basel）, 2019,6（4）:97. doi: 10.3390/medicines6040097.
［31］	Werbel T, Hinds BR, Cohen PR. Scabies presenting as cutaneous nodules or malar erythema: reports of patients with scabies surrepticius masquerading as prurigo nodularis or systemic lupus erythematosus［J/OL］. Dermatol Online J, 2018,24（9）:13030/qt5bn8k4vx.
［32］	Weigelt N, Metze D, Ständer S. Prurigo nodularis: systematic analysis of 58 histological criteria in 136 patients［J］. J Cutan Pathol, 2010,37（5）:578⁃586. doi: 10.1111/j.1600⁃0560.2009. 01484.x.
［33］	朱学骏, 涂平, 陈喜雪, 等. 皮肤病的组织病理学诊断［M］. 3版. 北京: 北京大学医学出版社, 2016:63, 92⁃93.
［34］	Ständer S, Holtsche MM, Schmidt E, et al. Presence of cutaneous complement deposition distinguishes between immunological and histological features of bullous pemphigoid⁃insights from a retrospective cohort study［J］. J Clin Med, 2020,9（12）:3928. doi: 10.3390/jcm9123928.
［35］	Abdel⁃Latif AA, Elshahed AR, Salama OA, et al. Comparing the diagnostic properties of skin scraping, adhesive tape, and dermoscopy in diagnosing scabies［J］. Acta Dermatovenerol Alp Pannonica Adriat, 2018,27（2）:75⁃78. doi: 10.15570/actaapa.2018. 17.
［36］	Hanumaiah B, Joseph JM. Role of dermoscopy in the diagnosis of hypertrophic lichen planus and prurigo nodularis［J］. Indian J Dermatol, 2019,64（5）:341⁃345. doi: 10.4103/ijd.IJD_123_18.
［37］	Li FZ, Chen S. Diagnostic accuracy of dermoscopy for scabies［J］. Korean J Parasitol, 2020,58（6）:669⁃674. doi: 10.3347/kjp. 2020.58.6.669.
［38］	Zeidler C, Pereira MP, Augustin M, et al. Investigator′s global assessment of chronic prurigo: a new instrument for use in clinical trials［J］. Acta Derm Venereol, 2021,101（2）:adv00401. doi: 10.2340/00015555⁃3701.
［39］	Pölking J, Zeidler C, Schedel F, et al. Prurigo activity score （PAS）: validity and reliability of a new instrument to monitor chronic prurigo［J］. J Eur Acad Dermatol Venereol, 2018,32（10）:1754⁃1760. doi: 10.1111/jdv.15040.
［40］	Boozalis E, Tang O, Patel S, et al. Ethnic differences and comorbidities of 909 prurigo nodularis patients［J］. J Am Acad Dermatol, 2018,79（4）:714⁃719.e3. doi: 10.1016/j.jaad.2018.04. 047.
［41］	Larson VA, Tang O, Stander S, et al. Association between prurigo nodularis and malignancy in middle⁃aged adults［J］. J Am Acad Dermatol, 2019,81（5）:1198⁃1201. doi: 10.1016/j.jaad.2019.03. 083.
［42］	Huang AH, Canner JK, Kang S, et al. Analysis of real⁃world treatment patterns in patients with prurigo nodularis［J］. J Am Acad Dermatol, 2020,82（1）:34⁃36. doi: 10.1016/j.jaad.2019.09. 007.
［43］	Agelopoulos K, Rülander F, Dangelmaier J, et al. Neurokinin 1 receptor antagonists exhibit peripheral effects in prurigo nodularis including reduced ERK1/2 activation［J］. J Eur Acad Dermatol Venereol, 2019,33（12）:2371⁃2379. doi: 10.1111/jdv. 15905.
［44］	Chiricozzi A, Maurelli M, Gori N, et al. Dupilumab improves clinical manifestations, symptoms, and quality of life in adult patients with chronic nodular prurigo［J］. J Am Acad Dermatol, 2020,83（1）:39⁃45. doi: 10.1016/j.jaad.2020.03.049.

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慢性痒疹的诊断及分型新进展

Diagnosis and classification of chronic prurigo

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