Pruritus bei Kindern[*]

Zusammenfassung

Akuter und chronischer (über 6 Wochen dauernder) Pruritus kann schon im Kindesalter auftreten. Chronischer Pruritus ist bei Kindern seltener als bei Erwachsenen (ca. 2 – 3 % Prävalenz). Schon bei Säuglingen kann das Symptom im Rahmen von Dermatosen beobachtet werden; die Pruritusstärke (und vermutlich auch Qualität) kann erst ab dem 6. Lebensjahr von den Kindern angegeben werden. Akuter und auch chronischer Pruritus tritt bei Kindern am häufigstem im Rahmen von Dermatosen (z. B. atopische Dermatitis, Psoriasis), gefolgt von cholestatischen Lebererkrankungen (z. B. M. Alagille) auf. Interessanterweise geben nur ca. 9 % der dialysepflichtigen nierenerkrankten Kinder einen Pruritus an, im Gegensatz zu den Erwachsenen (ca. 20 %). Selten kann ein Tumor des ZNS, z. B. ein Neurofibrom oder Astrozytom, lokalisierten neuropathischen Pruritus bei Kindern auslösen. Viele der systemischen antipruritisch wirksamen Therapien stehen Kindern primär nicht zur Verfügung. Neuere Studien belegen die Wirksamkeit von Naltrexon, Gabapentin und auch Cyclosporin A bei chronischem Pruritus im Kindesalter.

Abstract

Acute and chronic (> 6 weeks) pruritus can be observed in children usually less frequent than in adults (around 2 – 3 % prevalence). Even infants experience pruritus along with the occurrence of dermatoses. Pruritus intensity and probably also quality is differentiated by the children by the age of 6 years. In children, acute and chronic pruritus appears most often in dermatoses (e. g., atopic dermatitis, psoriasis) followed by cholestatic liver diseases (e. g. Alagille’s syndrome). Interestingly, only 9 % of children with dialysis due to chronic kidney disease report on chronic pruritus in contrast to high rate as observed in adults (20 %). Very rarely tumours of the CNS such as neurofibroma or astrocytoma lead to localised neuropathic pruritus in children. Most of systemically antipruritic therapies can not be applied in children. Recent studies demonstrated efficacy of naltrexone, gabapentine and cyclosporin in chronic pruritus in children.

1 Gehalten als Vortrag beim 2. Wiesbadener Symposium Kinderdermatologie, 12. 11. 2008.

Literatur

• 1 Gül U, Cakmak S K, Gönül M. et al . Pediatric skin disorders encountered in a dermatology outpatient clinic in Turkey.  Pediatr Dermatol. 2008;  25 277-278
• 2 Schneider G. Psychosomatische Einflussfaktoren und psychische Störungen bei chronischem Pruritus.  In: Ständer S (ed). Pruritus. Bremen; Uni-Med Science 2008: 65-70
• 3 Eichenfield L F, Frieden I J, Esterly N B. Textbook of neonatal dermatology. Philadelphia; WB Saunders Company 2001
• 4 Wahlgren C F. Children’s rating of itch: an experimental study.  Pediatr Dermatol. 2005;  22 97-101
• 5 Prehler M, Kupfer J, Brähler E. The Giessen Symptom Questionnaire for children and adolescents.  Psychother Psychosom Med Psychol. 1992;  42 71-77
• 6 Kupfer J, Keins P, Brosig B. et al . Development of questionnaires on coping with disease and itching cognitions for children and adolescents with atopic eczema.  Dermatol Psychosom. 2003;  4 79-85
• 7 Weisshaar E, Diepgen T L, Bruckner T. et al . Itch intensity evaluated in the German Atopic Dermatitis Intervention Study (GADIS): correlations with quality of life, coping behaviour and SCORAD severity in 823 children.  Acta Derm Venereol. 2008;  88 234-239
• 8 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
• 9 Weisshaar E, Diepgen T L, Luger T A. et al . Pruritus in pregnancy and childhood – do we really consider all relevant differential diagnoses?.  Eur J Dermatol. 2005;  15 320-331
• 10 Eberlein B, Eicke C, Reinhardt H W, Ring J. Adjuvant treatment of atopic eczema: assessment of an emollient containing N-palmitoylethanolamine (Atopa Study).  JEADV. 2008;  22 73-82
• 11 Ständer S. Chronic pruritus: principals of diagnostics and therapy.  Hautarzt.. 2007;  58 627-636
• 12 Kremer A E, Beuers U, Oude-Elferink R P, Pusl T. Pathogenesis and treatment of pruritus in cholestasis.  Drugs. 2008;  68 2163-2182
• 13 Cies J J, Giamalis J N. Treatment of cholestatic pruritus in children.  Am J Health Syst Pharm. 2007;  64 1157-1162
• 14 Narkewicz M R, Smith D, Gregory C. et al . Effect of ursodeoxycholic acid therapy on hepatic function in children with intrahepatic cholestatic liver disease.  J Pediatr Gastroenterol Nutr. 1998;  26 49-55
• 15 Dinler G, Kocak N, Yuce A. et al . Ursodeoxycholic acid therapy in children with cholestatic liver disease.  Turk J Pediatr. 1999;  41 91-98
• 16 Cynamon H A, Andres J M, Iafrate R P. Rifampin relieves pruritus in children with cholestatic liver disease.  Gastroenterology. 1990;  98 1013-1016
• 17 Yerushalmi B, Sokol R J, Narkewicz M R. et al . Use of rifampin for severe pruritus in children with chronic cholestasis.  J Pediatr Gastroenterol Nutr. 1999;  29 442-447
• 18 El-Karaksy H, Mansour S, El-Sayed R. et al . Safety and efficacy of rifampicin in children with cholestatic pruritus.  Indian J Pediatr. 2007;  74 279-281
• 19 Chang Y, Golkar L. The use of naltrexone in the management of severe generalized pruritus in biliary atresia: report of a case.  Pediatr Dermatol. 2008;  25 403-404
• 20 Javouhey E, Ranchin B, Lachaux A. et al . Long-lasting extracorporeal albumin dialysis in a child with end-stage renal disease and severe cholestasis.  Pediatr Transplant. 2008;  [Epub ahead of print]
• 21 Mettang T, Pauli-Magnus C, Alscher D M. Uraemic pruritus – new perspectives and insights from recent trials.  Nephrol Dial Transplant.. 2002;  17 1558-1563
• 22 Senturk N, Ozkaya O, Aytekin S. et al . Characteristics of pruritus in children on peritoneal dialysis.  Nephron Clin Pract. 2008;  109 168-172
• 23 Pisoni R L, Wikström B, Elder S J. et al . Pruritus in haemodialysis patients: International results from the Dialysis Outcomes and Practice Patterns Study (DOPPS).  Nephrol Dial Transplant. 2006;  21 3495-3505
• 24 Naini A E, Harandi A A, Khanbabapour S. et al . Gabapentin: a promising drug for the treatment of uremic pruritus.  Saudi J Kidney Dis Transpl. 2007;  18 378-381
• 25 Mendham J E. Gabapentin for the treatment of itching produced by burns and wound healing in children: a pilot study.  Burns. 2004;  30 851-853
• 26 Summers C G, MacDonald J T. Paroxysmal facial itch: a presenting sign of childhood brainstem glioma.  J Child Neurol. 1988;  3 189-192
• 27 Magilner D. Localized cervical pruritus as the presenting symptom of a spinal cord tumor.  Pediatr Emerg Care. 2006;  22 746-747
• 28 Johnson R E, Kanigsberg N D, Jimenez C L. Localized pruritus: a presenting symptom of a spinal cord tumor in a child with features of neurofibromatosis.  J Am Acad Dermatol. 2000;  43 958-961
• 29 Hochstrasser H, Boltshauser E, Valavanis A. Brain tumors in children with von Recklinghausen neurofibromatosis.  Neurofibromatosis. 1988;  1 233-239
• 30 Halvorson H, Crooks J, Lahart D A, Farrell K P. An outbreak of itching in an elementary school – a case of mass psychogenic response.  J Sch Health. 2008;  78 294-297
• 31 Poindexter G, Morrell D S. Anogenital pruritus: lichen sclerosus in children.  Pediatr Ann. 2007;  36 785-791
• 32 van Scheppingen C, Lettinga A T, Duipmans J C. et al . Main problems experienced by children with epidermolysis bullosa: a qualitative study with semi-structured interviews.  Acta Derm Venereol. 2008;  88 143-150
• 33 Jongen J, Eberstein A, Peleikis H G. et al . Perianal streptococcal dermatitis: an important differential diagnosis in pediatric patients.  Dis Colon Rectum. 2008;  51 584-587
• 34 Schwartz R, Rehder K, Parsons D J, Morrell D S. Intense pruritus and failure to thrive in Alagille syndrome.  J Am Acad Dermatol. 2008;  58 (Suppl 2) S9-11
• 35 Choudhuri A H, Dharmani P, Kumarl N, Prakash A. Comparison of caudal epidural bupivacaine with bupivacaine plus tramadol and bupivacaine plus ketamine for postoperative analgesia in children.  Anaesth Intensive Care. 2008;  36 174-179
• 36 Leonardi S, Marchese G, Rotolo N. et al . Cyclosporin is safe and effective in severe atopic dermatitis of childhood. Report of three cases.  Minerva Pediatr. 2004;  56 231-237
• 37 Frigon C, Desparmet J. Ondansetron treatment in a child presenting with chronic intractable pruritus.  Pain Res Manag. 2006;  11 245-247

1 Gehalten als Vortrag beim 2. Wiesbadener Symposium Kinderdermatologie, 12. 11. 2008.