结节性痒疹发病机制和治疗

Pathogenesis and treatment of prurigo nodularis

结节性痒疹(PN)是一种慢性痒疹的亚型,表现为单到多个对称分布、角化过度和强烈瘙痒的丘疹和结节。PN在不同的皮肤病、内脏系统疾病、神经或精神疾病条件下,伴随慢性瘙痒发展而来。PN发病机制复杂,上皮细胞应激反应、真皮炎症反应、神经源性炎症和痒感敏化在瘙痒的发生中起重要作用。PN的治疗主要包括传统疗法[局部应用糖皮质激素及麻醉剂、系统应用免疫抑制剂、抗癫痫类药物、神经激肽-1(NK-1)受体拮抗剂、沙利度胺和μ-阿片受体(MOR)]、物理疗法(UV光疗)和新型靶向治疗(靶向IL-31受体、IL-4受体和抑瘤素Mβ受体)等。本文综述PN的发病机制和治疗进展。

Prurigo nodularis(PN)is a subtype of chronic prurigo,characterized by single to multiple papules and nodules with symmetrical distribution,hyperkeratosis,and intense pruritus.PN develops along with chronic pruritus under different conditions of skin diseases,systemic diseases,neurological or psychiatric disorders.The pathogenesis of PN is complex,with epithelial cell stress response,dermal inflammatory response,neurogenic inflammation and neuron hyperkinesis all playing important roles in its occurrence.The mainstream treatment options for PN include traditional therapy[topical application of steroids and anesthetics,systemic administration of immunosuppressants,antiepileptic drugs,neurokinin-1(NK-1)receptor antagonists,thalidomide andμ-opioid receptor(MOR)antagonists],physical therapy(ultraviolet phototherapy),and emerging therapies(inhibitors of IL-31 receptor,IL-4 receptor and oncostatin M(OSM)βreceptors).This paper reviews the pathogenesis and treatment advances of PN.