Chronischer Pruritus: Epidemiologie, Diagnostik und Behandlung

In der dermatologischen Praxis ist chronischer Pruritus ein alltägliches Symptom, das viele Patienten belastet. Diverse Dermatosen gehen mit diesem Symptom einher, jedoch liegt nicht immer eine Hauterkrankung dem Symptom des chronischen Pruritus zugrunde. Dieser Artikel gibt eine Übersicht über die verschiedenen Ursachen des chronischen Pruritus und zeigt anhand von Beispielen leitliniengerecht mögliche diagnostische und therapeutische Maßnahmen.

Abstract

Dermatologists encounter daily patients with chronic pruritus, who are severely affected by this condition. Several dermatoses induce pruritus, however a skin disease does not always underlie chronic pruritus. Pruritus is considered chronic when it lasts for at least 6 weeks. In the course of the condition and when severe scratching behavior ensues, chronic prurigo may develop in these patients. A deep understanding of the possible etiologies of chronic pruritus as well as the recommended diagnostic and therapeutic approach is of the utmost importance for dermatologists. The clinical categorization of chronic pruritus in 1) chronic pruritus on inflamed skin, 2) chronic pruritus on normal appearing skin, and 3) chronic pruritus accompanied by chronic scratch lesions is essential for diagnostic and therapeutic guidance.

This article aims to provide an overview on the different possible etiologies of chronic pruritus and resorts to clinical cases to demonstrate recommended diagnostic and therapeutic measures.

Kernaussagen

• Ab einem Zeitraum von über 6 Wochen spricht man von chronischem Pruritus und im Verlauf der Erkrankung kann sich eine chronische Prurigo bei den Patienten manifestieren.

• Der chronische Pruritus wird in drei Kategorien eingeteilt:

  • Pruritus auf entzündlicher Haut,

  • Pruritus auf unveränderter Haut und

  • Pruritus bei chronischen Kratzläsionen

• Bei der Notalgia paraesthetica und dem brachioradialen Pruritus wird ursächlich eine Nervenkompression vermutet.

• Der nephrogene Pruritus steht häufig in einem engen zeitlichen Zusammenhang mit der Dialyse.

• Jede Dermatose oder Erkrankung, die CP verursacht, kann sich zu einer CPG entwickeln.

Schlüsselwörter

chronischer Pruritus - Pathophysiologie - klinische Einteilung - Diagnostik - Therapie

Keywords

chronic pruritus - pathophysiology - clinical classification - diagnostics - therapy

• Literatur

• 1 Ständer S, Weisshaar E, Mettang T. et al. Clinical classification of itch: a position paper of the International Forum for the Study of Itch. Acta Derm Venereol 2007; 87: 291-294
• 2 Stumpf A, Ständer S, Warlich B. et al. Relations between the characteristics and psychological comorbidities of chronic pruritus differ between men and women: women are more anxious than men. Br J Dermatol 2015; 172: 1323-1328
• 3 Matterne U, Apfelbacher CJ, Vogelgsang L. et al. Incidence and determinants of chronic pruritus: a population-based cohort study. Acta Derm Venereol 2013; 93: 532-537
• 4 Ständer S, Schäfer I, Phan NQ. et al. Prevalence of chronic pruritus in Germany: results of a cross-sectional study in a sample working population of 11,730. Dermatology (Basel) 2010; 221: 229-235
• 5 Ständer S, Raap U, Weisshaar E. et al. Pathogenesis of pruritus. J Dtsch Dermatol Ges 2011; 9: 456-463
• 6 Azimi E, Reddy VB, Pereira PJS. et al. Substance P activates Mas-related G protein-coupled receptors to induce itch. J Allergy Clin Immunol 2017; 140: 447-453.e3
• 7 Raap U, Weißmantel S, Gehring M. et al. IL-31 significantly correlates with disease activity and Th2 cytokine levels in children with atopic dermatitis. Pediatr Allergy Immunol 2012; 23: 285-288
• 8 Raap U, Wichmann K, Bruder M. et al. Correlation of IL-31 serum levels with severity of atopic dermatitis. J Allergy Clin Immunol 2008; 122: 421-423
• 9 Rüdrich U, Gehring M, Papakonstantinou E. et al. Eosinophils are a Major Source of Interleukin-31 in Bullous Pemphigoid. Acta Derm Venereol 2018; 98: 766-771
• 10 Pereira MP, Mühl S, Ständer S. [Small fiber neuropathy as a possible cause for chronic pruritus]. Hautarzt 2016; 67: 615-621
• 11 Bobko S, Zeidler C, Osada N. et al. Intraepidermal Nerve Fibre Density is Decreased in Lesional and Inter-lesional Prurigo Nodularis and Reconstitutes on Healing of Lesions. Acta Derm Venereol 2016; 96: 404-406
• 12 Sonkoly E, Muller A, Lauerma AI. et al. IL-31: a new link between T cells and pruritus in atopic skin inflammation. J Allergy Clin Immunol 2006; 117: 411-417
• 13 Schmidt E, della Torre R, Borradori L. Clinical features and practical diagnosis of bullous pemphigoid. Immunol Allergy Clin North Am 2012; 32: 217-232
• 14 Ständer S, Darsow U, Mettang T. et al. S2k‐Leitlinie – Chronischer Pruritus. J Dtsch Dermatol Ges 2012; 10 (Suppl. 04) S1-S27
• 15 Weisshaar E, Dalgard F. Epidemiology of itch: adding to the burden of skin morbidity. Acta Derm Venereol 2009; 89: 339-350
• 16 Vij A, Duvic M. Prevalence and severity of pruritus in cutaneous T cell lymphoma. Int J Dermatol 2012; 51: 930-934
• 17 Welz-Kubiak K, Reich A, Szepietowski JC. Clinical Aspects of Itch in Lichen Planus. Acta Derm Venereol 2017; 97: 505-508
• 18 Schmidt E, Zillikens D. Pemphigoid diseases. The Lancet 2013; 381: 320-332
• 19 Lamberts A, Meijer JM, Jonkman MF. Nonbullous pemphigoid: A systematic review. J Am Acad Dermatol 2018; 78: 989-995.e2
• 20 Huesmann T, Cunha PR, Osada N. et al. Notalgia paraesthetica: a descriptive two-cohort study of 65 patients from Brazil and Germany. Acta Derm Venereol 2012; 92: 535-540
• 21 Pereira MP, Lüling H, Dieckhöfer A. et al. Brachioradial Pruritus and Notalgia Paraesthetica: A Comparative Observational Study of Clinical Presentation and Morphological Pathologies. Acta Derm Venereol 2018; 98: 82-88
• 22 Fleischer AB, Meade TJ, Fleischer AB. Notalgia paresthetica: successful treatment with exercises. Acta Derm Venereol 2011; 91: 356-357
• 23 Melhorn S, Staubach P. [Capsaicinoids and cayenne pepper extract]. Hautarzt 2018; 69: 964-966
• 24 Weiss M, Mettang T, Tschulena U. et al. Prevalence of chronic itch and associated factors in haemodialysis patients: a representative cross-sectional study. Acta Derm Venereol 2015; 95: 816-821
• 25 Manenti L, Tansinda P, Vaglio A. Uraemic pruritus: clinical characteristics, pathophysiology and treatment. Drugs 2009; 69: 251-263
• 26 Gilchrest BA, Rowe JW, Brown RS. et al. Relief of uremic pruritus with ultraviolet phototherapy. N Engl J Med 1977; 297: 136-138
• 27 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 Eur Acad Dermatol Venereol 2018; 32: 1059-1065
• 28 Pereira MP, Zeidler C, Nau T. et al. Position Statement: Linear prurigo is a subtype of chronic prurigo. J Eur Acad Dermatol Venereol 2019; 33: 263-266
• 29 Zeidler C, Tsianakas A, Pereira M. et al. Chronic Prurigo of Nodular Type: A Review. Acta Derm Venereol 2018; 98: 173-179
• 30 Mazza M, Guerriero G, Marano G. et al. Treatment of prurigo nodularis with pregabalin. J Clin Pharm Ther 2013; 38: 16-18
• 31 Gencoglan G, Inanir I, Gunduz K. Therapeutic hotline: Treatment of prurigo nodularis and lichen simplex chronicus with gabapentin. Dermatol Ther 2010; 23: 194-198
• 32 Siepmann D, Luger TA, Ständer S. Antipruritic effect of cyclosporine microemulsion in prurigo nodularis: results of a case series. J Dtsch Dermatol Ges 2008; 6: 941-946