Pruritus

Zusammenfassung

Einige Erkrankungen des Kindesalters sind mit Pruritus vergesellschaftet. Dabei kann akuter vom chronischen, über 6 Wochen dauernden, Pruritus unterschieden werden. Chronischer Pruritus ist mit einer Prävalenz von 2–3 % bei Kindern seltener als bei Erwachsenen, kann jedoch im Rahmen von Dermatosen schon bei Säuglingen beobachtet werden. Die Pruritusintensität und vermutlich auch die Qualität können jedoch erst von Kindern über 6 Jahren sicher angegeben werden. Akuter und auch chronischer Pruritus tritt bei Kindern am häufigsten im Rahmen von Dermatosen, wie der atopischen Dermatitis, der Psoriasis sowie bei systemischem Erkrankungen, z. B. cholestatischen Lebererkrankungen auf. Obwohl eine dialysepflichtige Niereninsuffizienz bei Erwachsenen ein häufiger Grund für chronischen Pruritus ist (Prävalenz 20 %), leiden nur ca. 9 % der dialysepflichtigen Kinder an diesem Symptom. ZNS-Tumoren sind ein seltener Grund für einen lokalisierten neuropathischen Pruritus. Seltener sind Medikamentennebenwirkungen anzulasten. Für Kinder sind anerkannte systemische antipruritische Therapien aufgrund der eingeschränkten Studienlage nicht verfügbar, wobei Naltrexon, Gabapentin und Cyclosporin A bei chronischem Pruritus im Kindesalter in kleinen Fallserien als wirksam nachgewiesen wurden.

Summary

Several childhood diseases are associated with pruritus. Acute pruritus has to be distinguished from chronic pruritus (>6 weeks). Chronic pruritus is less frequent in children (2–3 % prevalence) than in adults, but can be observed even in infants with dermatological diseases. Pruritus intensity and probably also quality can be differentiated in children by the age of 6 years. In children, acute and chronic pruritus occurs most often in different dermatoses like atopic dermatitis or psoriasis and in cholestatic liver diseases. Though renal insufficiency is a common reason for chronic pruritus in adults (prevalence 20 %), only 9 % of children with dialysis report on chronic pruritus. CNS tumours are a rare reason for localized neuropathic pruritus. Drug side effects are uncommon. Most of systemically antipruritic therapies cannot be applied in children due to a lack of studies, however, in small studies, naltrexone, gabapentine and cyclosporine have proven efficacy in small case series in children with chronic pruritus.

Schlüsselwörter

Atopische Dermatitis - akuter Pruritus - antipruritische Therapie

Keywords

Atopic dermatitis - acute pruritus - antipruritic therapy

• Literatur

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