Anal pruritus:Don’t look away

Anal pruritus is a common anorectal symptom that can significantly impair a patient’s quality of life,including their mental health.It can be one of the most difficult proctological conditions to treat.Patients often delay seeking medical attention,since it is an embarrassing but non-life-threatening situation.Pruritus ani can be associated with idiopathic and secondary causes,such as anorectal diseases,cancer(anal or colorectal),dermatological and sexually transmitted diseases,fungal infections and systemic diseases.If patients are referred for a colonoscopy,this can sometimes provide the first opportunity to evaluate the perianal area.Classifications of anal pruritus are based on the abnormalities of the perianal skin,one of the most commonly used being the Washington classi-fication.A proper digital anorectal examination is important,as well as an anoscopy to help to exclude anorectal diseases or suspicious masses.Endoscopists should be aware of the common etiologies,and classification of the perianal area abnormalities should be provided in the colonoscopy report.Information on treatment possibilities and follow-up can also be provided.The treatment normally consists of a triple approach:proper hygiene,elimination of irritants,and skin care and protection.Several topical therapies have been described as possible treatments,including steroids,capsaicin,tacrolimus and methylene blue intradermal injections.

Etiologies and Associated Factors of Generalised Pruritus Sine Materia in the Dermatology-Venerology Department of CHUD-Borgou/Alibori (Benin)

Introduction: The aim was to identify the etiologies of generalised pruritus sine materia and to determine the associated factors in Parakou. Methods: This was a retrospective observational study conducted from January 2011 to June 2022. The patients included were of all ages and both sexes in whom the sine materia nature of the pruritus was noted after clinical examination. These patients had an etiological assessment available or not, complete or partial. For each patient, socio-demographic, socio-cultural, socio-economic and clinical data were collected using a pre-established survey form. They were then processed and analysed using Epi Data 3.1 and SPSS version 21 software respectively. Results: The incidence of generalised pruritus sine materia was 0.89% (73 cases/8214 consultants). The predominant etiologies were aquagenic pruritus (16.4%) and intestinal parasitosis (12.3%). After a bi-variate analysis, two risk factors were identified: frequency of towel change greater than 1 month (OR = 3.02;CI95% = 0.98 - 9.31;P = 0.0486) and use of cold water for bath (OR = 3.28;CI95% = 1.09 - 9.81;P = 0.0274). Conclusion: The etiologies and associated factors of generalised pruritus sine materia found in Parakou are varied but are linked to lifestyle. There is an urgent need to raise public awareness of the need to improve lifestyle in order to reduce the frequency of pruritus sine materia. .

Therapeutic Effect of Integrated Traditional Chinese and Western Medicine on Anal Pruritus After Anorectal Surgery

Objective:To explore the therapeutic effect of integrated traditional Chinese and western medicine on anal pruritus after anorectal surgery.Methods:Ninety-eight patients with anal pruritus after anorectal surgery in our hospital were selected as the research subjects.They were divided into two groups,the control group(50 cases)and the study group(48 cases),according to the treatment plan.The control group was under a simple western medicine treatment plan,while the study group was under an integrated traditional Chinese and western medicine treatment plan.The overall efficacy,severity of anal pruritus,time to eliminate clinical symptoms,and anxiety and depression scores of the two groups of patients under different treatment plans were compared.Results:After two weeks of treatment,the total effective rate of the study group was 95.83%,which was significantly higher than that of the control group(82.00%,P<0.05).After 7 and 14 days of treatment,the anal pruritus scores improved significantly in both the groups,but the study group was superior to the control group,with statistical difference(P<0.01).The time of disappearance of skin itching and skin damage in the study group was shorter than that in the control group.After 14 days of treatment,the anxiety and depression scores of both groups were lower than those after 7 days of treatment;however,there was statistical difference between the two groups(P<0.01).Conclusion:In the clinical treatment of anorectal postoperative diseases,such as anal pruritus,the combination of traditional Chinese and western medicine can significantly improve the symptoms of pruritus,shorten the time of disappearance of clinical symptoms,improve depression and anxiety,and create a positive clinical application value in promoting the rehabilitation of patients and improving their quality of life.

Albumin liver dialysis as pregnancy-saving procedure in cholestatic liver disease and intractable pruritus

Progressive familial intrahepatic cholestasis type 3 (PFIC3) is a rare cholestatic liver disease. Such liver disease can get worse by female hormone disorder. Albumin dialysis or Molecular Adsorbent Recirculating System (MARS) has been reported to reverse severe cholestasis-linked pruritus. Here, we report the first use of MARS during a spontaneous pregnancy and its successful outcome in a patient with PFIC3 and intractable pruritus. Albumin dialysis could be considered as a pregnancy-saving procedure in pregnant women with severe cholestasis and refractory pruritus.

Recent advances in the management of pruritus in chronic liver diseases

Pruritus is a symptom found in patients with chronic liver diseases,especially cholestatic liver diseases such as primary biliary cholangitis.This symptom impairs patient quality of life by disturbing sleep and may lead to consideration of liver transplantation.Mechanisms implicated in pruritus have been associated with the peripheral and central nervous systems,leading to the development of various therapeutic options.Little evidence for the efficacy of most of these treatments is currently available,indicating a need for further investigations.

Role of narrow band ultra violet radiation as an add-on therapy in peritoneal dialysis patients with refractory uremic pruritus

AIM To assess the role of narrow band ultraviolet B(UVB) as a treatment option in peritoneal dialysis patients with refractory uremic pruritus.METHODS In this retrospective study, 29 adult patients with end stage renal failure on peritoneal dialysis, and who had refractory uremic pruritus, were given narrow band UVB radiation as an add-on therapy to standard care for a duration of 12 wk. The response to the pruritus was assessed both weekly and at the end of the study period using a visual analogue score(VAS).RESULTS The average VAS score at the end of the study was 3.14 ± 1.59, which was significant compared to the baseline value of 7.75 ± 1.02(P < 0.05). Improvements in symptoms were noted in 19 out of 21(90.4%) patients. However, relapse occurred in six out of the 19 patients who responded. The dropout rate was high during the study period(33.3%).CONCLUSION Narrow band UVB is effective as an add-on therapy in peritoneal dialysis patients with refractory uremic pruritus. However, the present regime is cumbersome and patient compliance is poor.

Study of pruritus in chronic hepatitis C patients

AIM: To investigate the occurrence and severity of pruritus in chronic hepatitis C patients treated with or without interferon (IFN) therapy.

Hepatitis C virus-associated pruritus: Etiopathogenesis and therapeutic strategies

In addition to its contributing role in the development of chronic liver diseases, chronic hepatitis C virus (HCV) infection is associated with extrahepatic manifestations, particularly, cutaneous-based disorders including those with pruritus as a symptom. Pruritus is frequently associated with the development of chronic liver diseases such as cholestasis and chronic viral infection, and the accumulation of bile acids in patients&#x02019; sera and tissues as a consequence of liver damage is considered the main cause of pruritus. In addition to their role in dietary lipid absorption, bile acids can trigger the activation of specific receptors, such as the G protein-coupled bile acid receptor (GPBA/ TGR5). These types of receptors are known to play a crucial role in the modulation of the systemic actions of bile acids. TGR5 expression in primary sensory neurons triggers the activation of the transient receptor potential vanilloid 1 (TRPV1) leading to the induction of pruritus by an unknown mechanism. Although the pathologic phenomenon of pruritus is common, there is no uniformly effective therapy available. Understanding the mechanisms regulating the occurrence of pruritus together with the conduction of large-scale clinical and evidence-based studies, may help to create a standard treatment protocol. This review focuses on the etiopathogenesis and treatment strategies of pruritus associated with chronic HCV infection.

Presence of Obstetrics Cholestasis in Mothers Presenting with Pruritus in Pregnancy: In a Low Resource South Asian Setting

Obstetric cholestasis (also referred to as intrahepatic cholestasis of pregnancy—ICP) is a pruritic form of reversible cholestasis that is associated with significant fetal risks. There is a paucity of research regarding pregnancy outcomes of the mothers with obstetric cholestasis in the South Asian setting. Hence, the objective of this study was to determine the prevalence of obstetric cholestasis among mothers presenting with pruritus during pregnancy and to describe the characteristics and outcomes for those diagnosed with ICP in comparison with those with pruritus in the absence of ICP. Methods: All mothers presenting with pruritus to De Soyza Maternity hospital in Colombo Sri Lanka, between 1st January 2011 to 1st January 2014, were recruited for the study. A standard set of biochemical tests were used for diagnosis of ICP. An interviewer administered questionnaire and patient records were used for data collection. Presentation, characteristics and pregnancy outcomes were assessed and compared for mothers with ICP against those with pruritus in the absence of ICP. Results: The prevalence of ICP in the study population was found to be 27% (n = 27). Generalized pruritus with pruritus of the palms and soles was identified as the commonest pattern of pruritus for diagnosed with ICP. Delivery before 37 weeks (p = 0.001), meconium stained liquor (p = 0.004), placental abruption (p = 0.005), postpartum hemorrhage (p = 0.005), bleeding manifestation (p = 0.006), preterm labor (p = 0.031) and fetal distress (p = 0.035) were found to be significantly associated with the presence of ICP. Conclusions: Nearly 1/3 of mothers presenting with pruritus in pregnancy in Sri Lanka are affected by ICP which is associated with an increase in a wide range of adverse maternal and fetal outcomes compared to those with pruritus in the absence of ICP.

Acupuncture Treatment for 34 Cases of Uremic Cutaneous Pruritus

Chronic renal insufficiency is the result of renal injuries and progressive deterioration caused by various reasons. At the late stage, i.e. the period of uremia, it may be complicated with abnormalities of various systems. Along with the development and popularization of hemodialysis, the survival time of uremic patients can be prolonged, but uremic pruritus affects greatly the quality of life of the patients. For this purpose, we have treated 68 cases of the patients with acupuncture and western medicine respectively, and made clinical observations on the therapeutic results. A report follows.……

Twenty-five Cases of Intractable Cutaneous Pruritus Treated by Auricular Acupuncture

Intractable cutaneous pruritus is a commonlyencountered symptom in clinical practice.Theauthors have treated 25 cases of intractable cutaneouspruritus mainly by auricular acupuncture in recentyears,with satisfactory results as reported in thefollowing.Clinical DataAll the 50 cases in this series were outpatientsfrom the Outpatient Department of

Effect of oral naltrexone on pruritus in cholestatic patients

AIM： To determine the efficacy and potential complications of oral naltrexone used in the treatment of pruritus in cholestatic patients and to compare them with other studies.METHODS： Thirty-four enrolled cholestatic patients complaining of pruritus were studied. In the initial phase, pruritus scores during day and night were evaluated. Subsequently, patients were given a placebo for one week followed by naltrexone for one week. In each therapeutic course （placebo or naltrexone） day and night pruritus scores were distinguished by a visual analogue scale （VAS） system and recorded in patients＇ questionnaires.RESULTS： Both naltrexone and placebo decreased VAS scores significantly. Naltrexone was more effective than placebo in decreasing VAS scores. Both day and night scores of pruritus decreased by half of the value prior to therapy in thirteen patients （38%）. Daytime pruritus improved completely in two patients （5.9%）, but no improvement in the nighttime values was observed in any patient. Sixteen patients （47%） suffered from naltrexone complications, eleven （32%） of them were related to its withdrawal. Complications were often mild. In the case of withdrawal, the complication was transient （within the first 24-28 h of therapy） and self-limited. We had to cease the drug in two cases （5.9%） because of severe withdrawal symptoms. CONCLUSION： Naltrexone can be used in the treatment of pruritus in cholestatic patients and is a safe drug showing few, mild and self-limited complications.

Effects of Silk Fibroin Moisturizing Cream on Acetone/Ether-Induced Dry Skin Pruritus in Mice

Objectives: The morbidity of dry and itchy skin was high during a person’s lifetime and it had a significant negative impact. This study aimed to investigate the positive effect of silk fibroin moisturizing cream on dry skin pruritus induced by acetone/ether-water (AEW) method in mice. Method: We established a dry skin model in mice with AEW treatment, and the control group was treated with ultrapure water. The mice in AEW model group were locally administrated with silk fibroin moisturizing cream (SilkArmor)&reg;. The transepidermal water loss (TEWL), scratching behavior, condition of skin erythema, skin histology (by hematoxylin-eosin staining) and the results of electron microscopy were measured to evaluate the positive effect of SilkArmor on dry and itchy skin in mice. Results: The TEWL value, spontaneous scratching behavior and erythema score were significantly increased after AEW modeling compared with the control group. There was no significant difference in the TEWL value, scratching behavior and erythema score between the SilkArmor group and the control group (P > 0.05). Compared with the AEW group, the value of TEWL, scratching behavior and the erythema score of mice in the AEW + SilkArmor group were improved, with statistically significant differences (P < 0.05). Skin histopathology and electron microscopy also showed that SilkArmor had certain improvement and repairment on AEW-induced skin pathological changes. Conclusions: A dry skin model was successfully established in this experiment, showing that SilkArmor brought an obvious alleviation to AEW-induced dry and itchy skin in mice.

Specific Patterns of Spinal Metabolite Ratio Underlying a-Me-5-HTevoked Pruritus Compared with Compound 48/80 Based on Proton Nuclear Magnetic Resonance Spectroscopy

Summary:Mechanisms of pruritus are implicated in the dysregulation of the metabolites in the spinal cord.We investigated pruritus behavioral testing in three groups of young adult male C57B1/6 mice,including one group treated with normal saline,while the other groups intradermally injected with a-Me-5-HT(histamine-independent pruritogen),compound 48/80(histaminedependent pruritogen)at the nape skin of the neck,respectively.Proton nuclear magnetic resonance spectroscopy(MRS)was used to compare spinal metabolites from the vertebral cervical among three groups,and to study the association of spinal metabolite ratio and pruritus intensity.The MRS-measured N-acetylaspartate-to-myoinositol ratio(NAA/Ins)was significantly correlated with the number of scratches between normal saline group and 48/80 group or a-Me-5-HT group(both P<0.0001),indicating that NAA/Ins may be a robust surrogate marker of histamine-independent/dependent pruritogen.There was significant difference in Glu/Ins between normal saline group and 48/80 group(P=0.017),indicating that Glu/Ins may be a surrogate marker of histamine-dependent pruritogen,while GABA/Ins was highly significantly different between normal saline group and a-Me-5-HT group(P=0.008),suggesting that GABA/Ins may be a surrogate marker of histamineindependent pruritogen.MRS may reflect the extent of pruritus intensity elicited by a-Me-5-HT and compound 48/80 with sensitivity similar to the number of scratches,and above potential markers need to be further validated in pre-clinical and clinical treatment trials.

Clinical Observation of Zhuang Medicine Crystal Sugar Ye'An Decoction in Treating Senile Skin Pruritus and Its Effects on Serum lgE

Objective:To discuss the specific application of Zhuang Medicine Crystal Sugar Ye'An Decoction in senile skin pruritus and its effects on serum IgE detection level.Methods:90 patients with senile skin pruritus admitted to our hospital from February 2019 to April 2020 were randomly grouped.The general treatment effect,itching,secondary skin lesion severity,sernum IL-6,IgE level and adverse reactions between 45 patients treated with Chlorcyclizine Hydrochloride Tablets(The control group)and 45 patients treated with Crystal Sugar Ye'An Decoction were compared.Results:The total effective rate of the treatment in the observation group was 93.33%,much higher than that in the control group,75.56%.The difference was verified and statistically significant(P<0.05).Before the treatment,the itching area,frequency,duration and severity of secondary skin lesions were at the same level(P>0.05).After the treatment,the above data were all reduced,and the reduction of the observation group was more significant than that of the control group,indicating the difference was statistically significant(P<0.05).Before the treatment,there was no difference in serum IL-6 and IgE test data between the two groups(P>0.05).After the treatment,the tendency all declined,and that of the observation group was more obvious,indicating the difference was statistically significant(P<0.05).During the experiment,no obvious adverse reactions were observed in both groups.Conclusion:In the treatment of patients with senile pruritus,the application of Zhuang Medicine Crystal Sugar Ye’An Decoction is not only safe and reliable,but can promote the improvement of patients'symptoms,adjust the level of inflammatory factors,and enhance clinical efficacy.

Effect of lavender aromatherapy on pruritus, anxiety, and sleep quality of patients undergoing hemodialysis: a randomized controlled trial

Background:Patie nts un dergo ing hemodialysis experie nces some symptoms.Pruritus,an xiety,and sleep quality are three of the most com mon symptoms.Eve n though some pharmacological treatme nts use to cope with these symptoms,they are still experie need by the patie nts at a high level.Aim:This study aimed to determine the effect of lavender oil aromatherapy on pruritus,anxiety,and sleep quality of patients undergoing hemodialysis.Method:This randomized con trolled study was carried out betwee n December 2019 and March 2020.Eighty of 895 eligible patients were included in the study.Aromatherapy inhalation and massage together applied to the patients for six weeks.5D-Itch Scale,State Anxiety Inventory(SAI),and Richard Campbell Sleep Questio nn aire(RCSQ)were used for data collecti on.IBM SPSS 25.0 were used for statistical an alysis.Mann-Whit ney U,Wilcox on sig ned-ra nks test,and repeated measures-ANOVA tests were used to compare the difference between the groups and simple regression analysis to investigate the relationship between the dependent and independent variables.Results:Most of the patients were male(57.5%)and aged between 41 and 55 years(52.5%).There was significant difference in the mean scores of SAI(Pretest:44.02±5.33,Post-test:35.40±4.52,P=0.003),5D-Itch scale(Pretest:9.80±2.04,Post-test:7.00±2.31,P=0.001),and RCSQ(Pretest:17.11±40.30,Post-test:58.55±33.74,P=0.002)with in time in the in terve ntio n group.There was a statistically significant differenee between the groups regarding the mean scores of SAI(Intervention:35.40±4.52,Control:46.84±4.62,P=0.003),5D-Itch scale(Intervention:7.00±2.31,Control:8.96±2.05,P=0.004),and RCSQ(Intervention:58.55±33.74,Control:19.93±28.36,P=0.001)after the intervention.Conclusion:After six-weeks intervention,lavender aromatherapy was found an effective way to reduce pruritus,anxiety and to improve the sleep quality of patients undergoing hemodialysis.

扁平苔藓组织病理特征与临床表现的相关性分析

目的探讨扁平苔藓组织病理变化与临床表现的相关性。方法回顾性分析2015年至2023年在首都医科大学附属北京友谊医院皮肤科就诊,且通过组织病理学检查确诊为扁平苔藓的病例。记录患者临床资料包括性别、年龄、病程、临床初步诊断,临床分型、病损范围、是否累及口腔、临床症状、伴随疾病;组织病理切片记录淋巴细胞浸润程度、基底细胞液化程度,色素失禁程度,其他浸润细胞,是否存在Civatte小体、是否有表皮下裂隙。采用非参数Kruskal-Wallis检验、Spearman秩相关分析、Kendall's Tau-b等级相关分析等方法,分析淋巴细胞浸润程度、基底细胞液化程度、Civatte小体与年龄、病程、病变范围、症状的相关性以及各病理特征之间的相关性。结果共收集204例患者,男性100例,女性104例;平均发病年龄52.5岁,平均病程4个月;病损部位累及口腔黏膜的有89例(43.6%)。病变范围仅累及1个部位的有77例(37.7%),累及2个部位的55例(27.0%),累及3个部位的25例(12.3%),累及3个部位以上的47例(23.0%)。204例患者中,初诊医师以“扁平苔藓”作为第1诊断的病例数114例(55.9%),作为第2诊断的病例数为27例(13.2%),临床未考虑扁平苔藓47例(23.0%)。伴随疾病中,其中111例(54.4%)患者无并随疾病,在伴随疾病中,一共涉及到65种疾病。淋巴细胞浸润程度与基底细胞液化程度呈正相关(r=0.514,P<0.05),淋巴细胞浸润程度、基底细胞液化程度与Civatte小体均呈正相关(r=0.230、0.153,P<0.05)。色素失禁程度与淋巴细胞浸润程度、基底细胞液化程度无相关性(均P>0.05)。病理与临床之间的相关性:淋巴细胞浸润程度与发病年龄、临床症状呈正相关(r=0.206、0.258,P<0.05),与病程、病变范围无相关性(均P>0.05);基底细胞液化程度与发病年龄、临床症状呈正相关(r=0.176、0.140,P<0.05),与病程呈负相关(r=-0.139,P<0.05),与病变范围无相关性(均P>0.05)。色素失禁程度与发病年龄、病程、病变范围、症状均无相关性(均P>0.05)。结论扁平苔藓的病理特征与临床表现之间存在密切联系:淋巴细胞浸润以及基底细胞液化越严重往往患者发病年龄越大、临床症状越严重。

安徽省血液透析患者尿毒症瘙痒患病率调查及影响因素分析

目的探究安徽省维持性血液透析(MHD)患者尿毒症瘙痒(UP)患病率及其影响因素。方法收集在安徽省27家血透中心进行MHD的患者,并对其临床资料进行比较。结果共3025例MHD患者,UP患病率为63.3%,其中轻度UP 55.9%,中重度UP 7.4%。皖南、皖中以及皖北总UP患病率分别为75.4%、63.6%以及57.9%。年龄段在≤30岁、31~50岁、51~70岁以及≥71岁对应总UP患病率分别为53.5%、59.8%、65.4%以及65.9%。总UP和中重度UP患病率随着年龄的增加而增加(P<0.01)。UP组患者年龄、透析龄、高血压比例、25-α羟维生素D_(3)[25(OH)D_(3)]水平、使用低通量透析器比例以及使用含钙磷结合剂患者的比例高于无UP组,而UP组透析后舒张压、血红蛋白水平、血液透析滤过(>2周/次)比例低于无UP组(P<0.05)。中重度UP组患者年龄、高血压比例、糖尿病比例均高于轻度UP组,而非含钙磷结合剂使用比例低于轻度UP组(P<0.05)。二分类Logistic回归分析表明高25(OH)D_(3)水平与MHD患者UP的高风险相关(P<0.05),高通量透析器的使用与MHD患者UP的低风险相关(P<0.05)。结论安徽省维持性血液透析患者UP患病率为63.3%。皖南地区的UP患病率最高,总UP和中重度UP患病率随着年龄的增加而增加。高25(OH)D_(3)水平是MHD患者UP发生的危险因素,而高通量透析器的使用能够降低MHD患者UP风险。

四物润燥止痒合剂方治疗血虚风燥型老年皮肤瘙痒症临床研究

目的观察四物润燥止痒合剂方治疗老年皮肤瘙痒症(SP)的临床疗效和安全性。方法将120例老年SP患者按随机数字表法分为2组,治疗组60例在一般治疗的基础上采用四物润燥止痒合剂方治疗,对照组60例在一般治疗的基础上采用润燥止痒胶囊治疗,疗程4周,每2周随访1次,治疗结束后随访2个月,评估2组临床疗效和不良反应发生及复发的情况。结果治疗组58例完成全程治疗和随访,对照组56例完成全程治疗和随访。治疗2周后,2组的瘙痒程度评分较治疗前明显降低,且治疗组评分低于对照组同期(P<0.05);治疗4周后,2组的瘙痒程度评分进一步降低,治疗组仍低于对照组,但2组评分比较差异无统计学意义(P>0.05)。治疗2周,治疗组有效率68.96%(40/58),对照组有效率50.00%(28/56),治疗组有效率高于对照组(P<0.05);治疗4周,治疗组有效率82.76%(48/58),对照组有效率78.57%(44/56),2组比较差异无统计学意义(P>0.05)。治疗组止痒起效短于对照组(P<0.05)。治疗组不良反应发生率5.17%(3/58),对照组不良反应发生率3.57%(2/56),2组比较差异无统计学意义(P>0.05)。2个月后随访,治疗组复发率低于对照组(P<0.05)。结论四物润燥止痒合剂方治疗血虚风燥型老年SP疗效显著,起效快,不良反应少,能显著减少复发,值得临床推广应用。

淋巴/单核细胞比值与老年血液透析患者皮肤瘙痒的相关性分析

目的探讨淋巴/单核细胞比值(LMR)与老年维持性血液透析(MHD)患者皮肤瘙痒的相关性。方法收集74例老年MHD患者的临床资料,并计算LMR,根据中文版14-Item UP-Dial Scale量表问卷分无、轻度、中度、重度瘙痒,比较不同瘙痒组的临床资料,使用Logistic回归模型分析皮肤瘙痒患者的影响因素。结果糖尿病肾病老年患者的瘙痒评分高于其他原发病组,LMR水平在各组原发病的老年患者中差异无统计学意义(P>0.05)。无瘙痒组与瘙痒各组的老年患者的空腹血糖、糖化血红蛋白、URR、直接胆红素、LMR比较,差异具有统计学意义(P<0.05)。多因素Logistic回归分析显示,LMR为瘙痒的独立保护因素(P<0.05)。结论LMR与老年MHD患者的皮肤瘙痒有相关性。