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Therapie des Pruritus bei inneren Erkrankungen

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Treatment of chronic itch in systemic disease

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Zusammenfassung

Chronischer Pruritus ist ein häufiges und oftmals quälendes Symptom, das bei zahlreichen internistischen Erkrankungen meist ohne primäre Hautveränderungen auftritt. Erst in der Folge können sich bei intensivem Kratzen sekundäre Kratzphänomene wie Exkoriationen, Prurigoknoten und Narben entwickeln. Die Behandlung des Pruritus ist aufgrund der weitgehend unverstandenen Pathogenese und der geringen Zahl valider Studien schwierig und meist rein symptomatisch. Fast alle eingesetzten Therapeutika sind für die Behandlung des chronischen Pruritus nicht zugelassen. Besonders häufig ist Pruritus bei fortgeschrittener Niereninsuffizienz. Die Wirksamkeit der zentralen Kalziumkanalblocker Gabapentin und Pregabalin ist am besten belegt. Auch eine Fototherapie mit UVB-Strahlung lindert in vielen Fällen den Juckreiz. Für die Wirksamkeit von Nalfurafin, einem κ-Opioidrezeptor-Agonisten, liegen kontrollierte Studien vor. Das Medikament ist allerdings in Europa noch nicht zugelassen. Beim cholestatischen Pruritus scheint neben dem Gallensäurebinder Cholestyramin insbesondere Rifampicin wirksam zu sein. Auch eine Behandlung mit µ-Opioidrezeptor-Antagonisten und Sertralin ist möglich, wenngleich meist von geringerer Effektivität. Bei therapierefraktärem Pruritus können eine nasobiliäre Sonde sowie eine Albumindialyse erwogen werden. In Bezug auf die Behandlung des Pruritus bei hämatologischen Erkrankungen existieren keine kontrollierten Studien. Hier konzentriert sich die Therapie auf die Behandlung der Grunderkrankung.

Abstract

Chronic itch (CI) is a frequent and sometimes tormenting symptom in many skin and systemic diseases. In systemic diseases, it mostly appears on primarily unaffected skin. As a sequelae of intense scratching, secondary skin lesions such as excoriations, scars, and prurigo nodularis may occur. Due to the lack of valid pathogenetic concepts and good clinical trials, the therapy of CI remains mostly symptomatic. In Europe almost all drugs used to treat CI are not approved for this indication. CI is frequent in patients with chronic kidney diseases in advanced stages. Gabapentin and pregabalin, anticonvulsants, and centrally acting calcium channel blockers have been shown to exert a profound effect in CI. Furthermore, UVB phototherapy has been proven to attenuate pruritus in uremic patients. Randomized controlled studies have recently shown that nalfurafine, a κ-opioid receptor agonist, is able to ameliorate itch in patients with uremic itch. In patients suffering from cholestatic itch, the anion exchange resin colestyramine and rifampicin are effective antipruritic drugs. Furthermore, µ-opioid receptor antagonists and sertraline may be used to alleviate CI in hepatic diseases. In refractory cases, naso-biliary drainage or albumin dialysis are effective invasive procedures. For the treatment of chronic itch in hematological diseases no controlled trials have been performed so far. The mainstay in these cases is to treat the underlying disease.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. T. Mettang: Beratungshonorar FML. S. Ständer und A.E. Kremer geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. DKD Helios Kliniken Wiesbaden, Aukammallee 33, 65191, Wiesbaden, Deutschland

    T. Mettang

  2. Kompetenzzentrum Chronischer Pruritus (KCP), Klinik für Hautkrankheiten, Universitätsklinikum Münster, Münster, Deutschland

    S. Ständer

  3. Medizinische Klinik 1 (Gastroenterologie, Pneumologie und Endokrinologie), Friedrich-Alexander-Universität Erlangen, Erlangen, Deutschland

    A.E. Kremer

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  1. T. Mettang
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Correspondence to T. Mettang.

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Mettang, T., Ständer, S. & Kremer, A. Therapie des Pruritus bei inneren Erkrankungen. Internist 56, 1369–1378 (2015). https://doi.org/10.1007/s00108-015-3755-3

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  • DOI: https://doi.org/10.1007/s00108-015-3755-3

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