[开放获取]    特应性皮炎瘙痒管理专家共识

doi:10.35541/cjd.20210056

中华皮肤科杂志 ›› 2021, Vol. 54 ›› Issue (5): 391-396.doi: 10.35541/cjd.20210056

[开放获取] 特应性皮炎瘙痒管理专家共识

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

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

收稿日期:2021-01-20 修回日期:2021-03-09 发布日期:2021-04-29
通讯作者: 郝飞；张建中；晋红中 E-mail:haofei62@126.com;rmzjz@126.com;jinhongzhong@263.net

Expert consensus for management of itch in atopic dermatitis

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

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

Received:2021-01-20 Revised:2021-03-09 Published:2021-04-29
Contact: Hao Fei; Zhang Jianzhong; Jin Hongzhong E-mail:haofei62@126.com;rmzjz@126.com;jinhongzhong@263.net

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. [开放获取] 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.

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[开放获取] 特应性皮炎瘙痒管理专家共识

Expert consensus for management of itch in atopic dermatitis

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