Chinese Journal of Dermatology ›› 2026, Vol. 59 ›› Issue (11): 1027-1035.doi: 10.35541/cjd.20260259
• Guidelines and Consensus • Previous Articles Next Articles
Psychodermatology Group, Chinese Society of Psychosomatic Medicine; China Dermatologist Association; Chinese Association of Rehabilitation Dermatology
Received:2026-05-11
Revised:2026-10-06
Online:2026-11-15
Published:2026-11-03
Contact:
Xie Zhiqiang; Zhang Haiping; Gao Xinghua
E-mail:xiezq66@163.com; zhanghaiping@xwhosp.org; gaobarry@hotmail.com
Psychodermatology Group, Chinese Society of Psychosomatic Medicine, China Dermatologist Association, Chinese Association of Rehabilitation Dermatology. Expert consensus on the diagnosis and management of psychogenic pruritus (2026 edition)[J]. Chinese Journal of Dermatology, 2026, 59(11): 1027-1035.doi:10.35541/cjd.20260259
| [1] | Ständer S, Schmelz M, Lerner E, et al. A multidisciplinary Delphi consensus on the modern definition of pruritus: sensation and disease[J]. J Eur Acad Dermatol Venereol, 2026,40(1):59⁃66. DOI: 10.1111/jdv.20851. |
| [2] | Ständer S, Weisshaar E, Mettang T, et al. Clinical classification of itch: a position paper of the International Forum for the Study of Itch[J]. Acta Derm Venereol, 2007,87(4):291⁃294. DOI: 10.2340/00015555⁃0305. |
| [3] | 中国康复医学会皮肤病康复专业委员会, 中国中西医结合学会皮肤性病专业委员会老年皮肤病学组. 老年皮肤瘙痒症诊疗与康复专家共识(2025版)[J]. 中华皮肤科杂志, 2025,58(1):1⁃8. DOI: 10.35541/cjd.20240407. |
| [4] | Misery L, Alexandre S, Dutray S, et al. Functional itch disorder or psychogenic pruritus: suggested diagnosis criteria from the French Psychodermatology Group[J]. Acta Derm Venereol, 2007, 87(4): 341⁃344. DOI: 10.2340/00015555⁃0266. |
| [5] | Weisshaar E, Müller S, Szepietowski JC, et al. European S2k guideline on chronic pruritus[J]. Acta Derm Venereol, 2025,105:adv44220. DOI: 10.2340/actadv.v105.44220. |
| [6] | Mazeh D, Melamed Y, Cholostoy A, et al. Itching in the psychiatric ward[J]. Acta Derm Venereol, 2008,88(2):128⁃131. DOI: 10.2340/00015555⁃0406. |
| [7] | Kretzmer GE, Gelkopf M, Kretzmer G, et al. Idiopathic pruritus in psychiatric inpatients: an explorative study[J]. Gen Hosp Psychiatry, 2008,30(4):344⁃348. DOI: 10.1016/j.genhosppsych. 2008.03.006. |
| [8] | Kazmi A, Leslie T. Psychogenic pruritus[M]//Bewley A, Lepping P, Taylor R. Psychodermatology in clinical practice. Cham: Springer, 2021:303⁃315. DOI: 10.1007/978⁃3⁃030⁃54307⁃5_23. |
| [9] | 中国医师协会皮肤科医师分会. 慢性瘙痒管理指南(2024版)[J]. 中华皮肤科杂志, 2024,57(5):387⁃399. DOI: 10. 35541/cjd.20230746. |
| [10] | 谢志强, 傅君舟, 陈敢, 等. 改良川岛瘙痒严重度评价方法与视觉模拟评分法的相关性[J]. 中国医学科学院学报, 2018,40(4):539⁃542. DOI: 10.3881/j.issn.1000⁃503X.10320. |
| [11] | 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. |
| [12] | Bewley A, Taylor RE, Reichenberg JS, et al. 实用精神皮肤病学[M]. 谢志强, 岳伟华, 译. 北京: 北京大学医学出版社, 2017: 281⁃296. |
| [13] | Tong X, An D, McGonigal A, et al. Validation of the Generalized Anxiety Disorder⁃7 (GAD⁃7) among Chinese people with epilepsy[J]. Epilepsy Res, 2016,120:31⁃36. DOI: 10.1016/j.eplepsyres.2015.11.019. |
| [14] | Leung DY, Lam TH, Chan SS. Three versions of Perceived Stress Scale: validation in a sample of Chinese cardiac patients who smoke[J]. BMC Public Health, 2010,10:513. DOI: 10.1186/1471⁃2458⁃10⁃513. |
| [15] | Leising D, Grande T, Faber R. The Toronto Alexithymia Scale (TAS⁃20): a measure of general psychological distress[J]. J Res Pers, 2009, 43(4): 707⁃710. DOI: 10.1016/j.jrp.2009.03.009. |
| [16] | Bastien CH, Vallières A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research[J]. Sleep Med, 2001,2(4):297⁃307. DOI: 10.1016/s1389⁃9457(00)00065⁃4. |
| [17] | Verhoeven EW, de Klerk S, Kraaimaat FW, et al. Biopsychosocial mechanisms of chronic itch in patients with skin diseases: a review[J]. Acta Derm Venereol, 2008,88(3):211⁃218. DOI: 10.2340/00015555⁃0452. |
| [18] | Ferreira BR, Katamanin OM, Jafferany M, et al. Psychodermatology of chronic pruritus: an overview of the link between itch and distress[J]. Dermatol Ther (Heidelb), 2024,14(7):1799⁃1809. DOI: 10.1007/s13555⁃024⁃01214⁃z. |
| [19] | Zhang H, Wang M, Zhao X, et al. Role of stress in skin diseases: a neuroendocrine⁃immune interaction view[J]. Brain Behav Immun, 2024, 116: 286⁃302. DOI: 10.1016/j.bbi.2023.12.005. |
| [20] | Herman JP, Figueiredo H, Mueller NK, et al. Central mechanisms of stress integration: hierarchical circuitry controlling hypothalamo⁃pituitary⁃adrenocortical responsiveness[J]. Front Neuroendocrinol, 2003,24(3):151⁃180. DOI: 10. 1016/j.yfrne.2003.07.001. |
| [21] | Kim JE, Cho BK, Cho DH, et al. Expression of hypothalamic⁃pituitary⁃adrenal axis in common skin diseases: evidence of its association with stress⁃related disease activity[J]. Acta Derm Venereol, 2013,93(4):387⁃393. DOI: 10.2340/00015555⁃1557. |
| [22] | Golpanian RS, Kim HS, Yosipovitch G. Effects of stress on itch[J]. Clin Ther, 2020,42(5):745⁃756. DOI: 10.1016/j.clinthera. 2020.01.025. |
| [23] | 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. |
| [24] | Aberg KM, Radek KA, Choi EH, et al. Psychological stress downregulates epidermal antimicrobial peptide expression and increases severity of cutaneous infections in mice[J]. J Clin Invest, 2007,117(11):3339⁃3349. DOI: 10.1172/JCI31726. |
| [25] | Gonzalez T, Bilik SM, Burke OM, et al. Host⁃microbiome interactions in chronic itch[J]. J Clin Med, 2025, 14(16): 5633. DOI: 10.3390/jcm14165633. |
| [26] | Coccurello R. The skin microbiome and affective symptoms: neuroimmune, neuroendocrine, and sensory pathways linking inflammatory dermatoses to mood and anxiety burden[J]. Front Neuroendocrinol, 2026,81:101251. DOI: 10.1016/j.yfrne.2026. 101251. |
| [27] | Elenkov IJ. Glucocorticoids and the Th1/Th2 balance[J]. Ann N Y Acad Sci, 2004, 1024: 138⁃146. DOI: 10.1196/annals.1321. 010. |
| [28] | Khalil NB, Coscarella G, Dhabhar FS, et al. A narrative review on stress and itch: what we know and what we would like to know[J]. J Clin Med, 2024, 13(22): 6854. DOI: 10.3390/jcm13226854. |
| [29] | Heijnen CJ. Receptor regulation in neuroendocrine⁃immune communication: current knowledge and future perspectives[J]. Brain Behav Immun, 2007,21(1):1⁃8. DOI: 10.1016/j.bbi. 2006.08.008. |
| [30] | Ulrich⁃Lai YM, Herman JP. Neural regulation of endocrine and autonomic stress responses[J]. Nat Rev Neurosci, 2009,10(6):397⁃409. DOI: 10.1038/nrn2647. |
| [31] | Nakagawa Y, Yamada S. Alterations in brain neural network and stress system in atopic dermatitis: novel therapeutic interventions[J]. J Pharmacol Exp Ther, 2023,385(2):78⁃87. DOI: 10.1124/jpet.122.001482. |
| [32] | Pavlenko D, Akiyama T. Why does stress aggravate itch? A possible role of the amygdala[J]. Exp Dermatol, 2019,28(12):1439⁃1441. DOI: 10.1111/exd.13941. |
| [33] | McConnell I, Davis JM, Mishra SK. Comorbid depression in atopic dermatitis⁃the itch⁃to⁃brain circuitry theory[J]. JAMA Psychiatry, 2026,83(5):435⁃436. DOI: 10.1001/jamapsychiatry. 2026.0029. |
| [34] | Tian J, Cao Y, Li Y, et al. A sympathetic⁃eosinophil axis orchestrates psychological stress to exacerbate skin inflammation[J]. Science, 2026,391(6791):1269⁃1277. DOI: 10.1126/science. adv5974. |
| [35] | Xie X, Jiang W, Lun L, et al. Hyperactivation of sympathetic nerves fuels basophil infiltration in atopic dermatitis[J]. Immunity, 2026,59(3):598⁃617. DOI: 10.1016/j.immuni. 2026. 01.010. |
| [36] | Scott⁃Solomon E, Brielle S, Mann AO, et al. Stress⁃induced sympathetic hyperactivation drives hair follicle necrosis to trigger autoimmunity[J]. Cell, 2026,189(1):252⁃271. DOI: 10. 1016/j.cell.2025.10.042. |
| [37] | Huang L, Kang P, Chen J, et al. Sympathetic nerve aggravates autoimmune skin disease via NE⁃adrenergic receptor axis: neuroimmune cross⁃talk insights from vitiligo[J]. Sci Adv, 2026,12(10):eaea7017. DOI: 10.1126/sciadv.aea7017. |
| [38] | Qu L, Fu K, Yang J, et al. CXCR3 chemokine receptor signaling mediates itch in experimental allergic contact dermatitis[J]. Pain, 2015,156(9):1737⁃1746. DOI: 10.1097/j.pain.00000000 00000208. |
| [39] | Yu S, Xu Y, Li Y, et al. Sympathetic nerve dysfunction exacerbates skin inflammation in atopic dermatitis[J]. J Allergy Clin Immunol, 2026,157(3):677⁃692. DOI: 10.1016/j.jaci.2025. 12.994. |
| [40] | Kim HS, Yosipovitch G. An aberrant parasympathetic response: a new perspective linking chronic stress and itch[J]. Exp Dermatol, 2013,22(4):239⁃244. DOI: 10.1111/exd.12070. |
| [41] | Welcome MO. Cellular mechanisms and molecular signaling pathways in stress⁃induced anxiety, depression, and blood⁃brain barrier inflammation and leakage[J]. Inflammopharmacology, 2020,28(3):643⁃665. DOI: 10.1007/s10787⁃020⁃00712⁃8. |
| [42] | Zhang Z, Li H, Yang J, et al. Interleukin⁃17 plays a crucial role in atopic dermatitis⁃associated blood⁃brain barrier disruption and cognitive impairment[J]. Brain Behav Immun, 2026,136: 106564. DOI: 10.1016/j.bbi.2026.106564. |
| [43] | Montague⁃Cardoso K, Malcangio M. Changes in blood⁃spinal cord barrier permeability and neuroimmune interactions in the underlying mechanisms of chronic pain[J]. Pain Rep, 2021,6(1):e879. DOI: 10.1097/PR9.0000000000000879. |
| [44] | Hermans D, Houben E, Baeten P, et al. Oncostatin M triggers brain inflammation by compromising blood⁃brain barrier integrity[J]. Acta Neuropathol, 2022,144(2):259⁃281. DOI: 10.1007/s00401⁃022⁃02445⁃0. |
| [45] | Sarapultsev A, Gusev E, Komelkova M, et al. JAK⁃STAT signaling in inflammation and stress⁃related diseases: implications for therapeutic interventions[J]. Mol Biomed, 2023,4(1):40. DOI: 10.1186/s43556⁃023⁃00151⁃1. |
| [46] | Lee J, Wheeler MA. Immune⁃brain plasticity underpins stress and affective behaviors[J]. Neuron, 2026,114(1):9⁃32. DOI: 10.1016/j.neuron.2025.11.020. |
| [47] | Biazus Soares G, Mahmoud O, Yosipovitch G, et al. The mind⁃skin connection: a narrative review exploring the link between inflammatory skin diseases and psychological stress[J]. J Eur Acad Dermatol Venereol, 2024,38(5):821⁃834. DOI: 10.1111/jdv.19813. |
| [48] | Zeidler C, Kupfer J, Dalgard FJ, et al. Dermatological patients with itch report more stress, stigmatization experience, anxiety and depression compared to patients without itch: results from a European multi⁃centre study[J]. J Eur Acad Dermatol Venereol, 2024,38(8):1649⁃1661. DOI: 10.1111/jdv.19913. |
| [49] | Ishiuji Y. Addiction and the itch⁃scratch cycle: what do they have in common?[J]. Exp Dermatol, 2019,28(12):1448⁃1454. DOI: 10.1111/exd.14029. |
| [50] | Hania A, Jamil S, Jamil S. How psychological distress translates into psychogenic pruritus: alexithymia, body awareness, and coping in a Pakistani collectivistic sample[J]. J Psychosom Res, 2026,205:112607. DOI: 10.1016/j.jpsychores.2026.112607. |
| [51] | Ferreira BR, Misery L. Alexithymia and dissociation in psychogenic pruritus: clinical relevance and therapeutic implications[J]. J Eur Acad Dermatol Venereol, 2024,38(9): e813⁃e815. DOI: 10.1111/jdv.19918. |
| [52] | Faria M, Ganz A, Galkin F, et al. Psychogenic aging: a novel prospect to integrate psychobiological hallmarks of aging[J]. Transl Psychiatry, 2024,14(1):226. DOI: 10.1038/s41398⁃024⁃02919⁃7. |
| [53] | Orliaguet M, Brenaut E, Ficheux AS, et al. Psychogenic and neurogenic components in patients with psychogenic or neuropathic pruritus: PRURINEURO: a non⁃interventional single⁃centre prospective assay[J]. Skin Health Dis, 2023,3(6):e267. DOI: 10.1002/ski2.267. |
| [54] | Patel A, Jafferany M. Multidisciplinary and holistic models of care for patients with dermatologic disease and psychosocial comorbidity: a systematic review[J]. JAMA Dermatol, 2020,156(6):686⁃694. DOI: 10.1001/jamadermatol.2020.0394. |
| [55] | Buteau A, Reichenberg J. Psychogenic pruritus and its management[J]. Dermatol Clin, 2018,36(3):309⁃314. DOI: 10.1016/j.det.2018.02.015. |
| [56] | Schuch FB, Vancampfort D, Richards J, et al. Exercise as a treatment for depression: a meta⁃analysis adjusting for publication bias[J]. J Psychiatr Res, 2016,77:42⁃51. DOI: 10.1016/j.jpsychires.2016.02.023. |
| [57] | Stubbs B, Vancampfort D, Rosenbaum S, et al. An examination of the anxiolytic effects of exercise for people with anxiety and stress⁃related disorders: a meta⁃analysis[J]. Psychiatry Res, 2017,249:102⁃108. DOI: 10.1016/j.psychres.2016.12.020. |
| [58] | Ju Y, Pei H, Kang N, et al. Prevalence and potential risk factors of chronic pruritus among community middle⁃aged and older population in Beijing, China[J]. J Eur Acad Dermatol Venereol, 2022,36(7):1074⁃1079. DOI: 10.1111/jdv.18041. |
| [59] | Ghani H, Ghofrani S, Modanlo N, et al. Novel and existing therapeutic interventions in psychogenic pruritus[J]. Clin Exp Dermatol, 2026,51(6):951⁃957. DOI: 10.1093/ced/llag005. |
| [60] | Demirbas A, Diremsizoglu E, Esen M, et al. Comparative effectiveness and safety of upadacitinib, abrocitinib and dupilumab in treatment⁃resistant prurigo nodularis[J]. Clin Exp Dermatol, 2026,51(4):587⁃595. DOI: 10.1093/ced/llaf518. |
| [61] | Vahabi SM, Heidari S, Pourgholi E, et al. Janus kinase inhibitors for the treatment of prurigo nodularis: a systematic review of 211 patients[J]. J Dermatol, 2026,53(4):556⁃577. DOI: 10.1111/1346⁃8138.70150. |
| [62] | Shafiyev J, Gahramanov I. Evaluating duloxetine for pruritus and psychiatric comorbidities in lichen simplex chronicus[J]. Arch Dermatol Res, 2025,317(1):249. DOI: 10.1007/s00403⁃024⁃03775⁃7. |
| [63] | Kwatra SG, Bordeaux ZA, Parthasarathy V, et al. Efficacy and safety of abrocitinib in prurigo nodularis and chronic pruritus of unknown origin: a nonrandomized controlled trial[J]. JAMA Dermatol, 2024,160(7):717⁃724. DOI: 10.1001/jamadermatol. 2024.1464. |
| [64] | Ghani H, Ghofrani S, Jafferany M. Therapeutic challenges and novel treatment options in psychogenic pruritus[J]. Arch Dermatol Res, 2024,317(1):121. DOI: 10.1007/s00403⁃024⁃03644⁃3. |
| [65] | Ho CY, Wu HL, Dai YX, et al. Association of Janus kinase inhibitors with reduced depression in alopecia areata[J]. J Eur Acad Dermatol Venereol, 2026,40(8):1382⁃1391. DOI: 10. 1111/jdv.70184. |
| [66] | Nettis E, Cristallo M, Fiorella CS, et al. Upadacitinib is efficacious in reducing the alexithymic trait in adult patients with moderate⁃to⁃severe atopic dermatitis: a prospective multicenter real⁃life study[J]. Ital J Dermatol Venerol, 2025,160(5):398⁃405. DOI: 10.23736/S2784⁃8671.25.08228⁃3. |
| [67] | Frankel D, Ma E, Gage D, et al. Cross⁃sectional analysis of mental health comorbidities in patients with prurigo nodularis[J]. J Am Acad Dermatol, 2025, 93(1): 270⁃272. DOI: 10.1016/j.jaad.2025.03.015. |
| [68] | Ständer S, Elmariah SB, Kwatra SG, et al. Rapid improvement of itch with nemolizumab in atopic dermatitis and prurigo nodularis phase 3 studies[J]. J Eur Acad Dermatol Venereol, 2026,40(5):867⁃875. DOI: 10.1111/jdv.70250. |
| [69] | Gruzmark FS, Yosipovitch G, Lev⁃Tov HA. Resolution of lichen simplex chronicus with nemolizumab: a case report[J]. J Drugs Dermatol, 2025,24(12):1252⁃1253. DOI: 10.36849/JDD.9273. |
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