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Pruritus bei systemischen Erkrankungen

Häufiges und Seltenes

Pruritus in systemic diseases

Common and rare etiologies

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Zusammenfassung

Chronischer Pruritus tritt bei zahlreichen internistischen Erkrankungen auf. Im Gegensatz zu Pruritus bei Hauterkrankungen liegen bei Patienten mit internistischen Erkrankungen keine primären Hautveränderungen vor. Allerdings kann intensives Kratzen zu sekundären Hautveränderungen wie Erosionen, Exkoriationen, Krusten, Prurigo nodularis und als Folge sogar zu Narbenbildung führen. Die häufigsten internistischen Ursachen für chronischen Pruritus stellen die chronische Niereninsuffizienz, Leber- und Gallengangserkrankungen, hämatoonkologische Erkrankungen sowie Medikamentennebenwirkungen dar. Seltener tritt dieses Symptom bei Patienten mit endokrinen oder metabolischen Störungen, Malassimilationssyndromen, Infektionskrankheiten sowie soliden Tumoren auf. Die Pathogenese des Pruritus bei internistischen Erkrankungen ist noch weitgehend ungeklärt, erste Erkenntnisse liegen für den urämischen und cholestatischen Pruritus vor. Die antipruritische Behandlung ist daher meist symptomatisch und kann eine klinische Herausforderung darstellen. Bei chronischer Niereninsuffizienz ist die Wirksamkeit der Kalziumkanalblocker Gabapentin und Pregabalin am besten belegt. In Japan ist der κ‑Opioid-Rezeptor-Agonist Nalfurafin zugelassen. Eine UVB-Lichttherapie kann ebenfalls Linderung bringen. Bei hepatobiliären Erkrankungen ist neben dem Gallensalzbinder Colestyramin der Enzyminduktor Rifampicin effektiv. Ebenfalls kommen μ‑Opioid-Rezeptor-Antagonisten und Sertralin zum Einsatz. Für die Behandlung anderer internistischer Erkrankungen liegen dagegen keine randomisierten kontrollierten Studien vor, und die Behandlung richtet sich auf eine effektive Therapie der Grunderkrankung.

Abstract

Chronic pruritus is a symptom of various internal disorders. In contrast to dermatological diseases, pruritus does not present with primary skin alterations in these patients. However, intense scratching may cause secondary skin changes such as abrasion, excoriation, prurigo nodularis, or in rare cases even scaring. The most common internal medicine causes for chronic pruritus are chronic kidney disease, hepatobiliary and hematological disorders as well as adverse drug reactions. Pruritus is less commonly seen in patients with endocrine or metabolic diseases, malabsorption syndromes, infectious diseases and solid tumors. The pathogenesis of pruritus in these disorders remains largely elusive, albeit preliminary insights have been gained for uremic and cholestatic pruritus. Antipruritic treatment is therefore symptomatic in most cases and may represent a clinical challenge. The calcium channel blockers gabapentin and pregabalin have the best proven efficacy in chronic kidney disease-associated pruritus. In Japan nalfurafine, a κ-opioid receptor agonist, has been licensed for this indication. UVB light may also attenuate uremic symptoms. In patients suffering from hepatobiliary disorders the sequestrant cholestyramine and the enzyme inducer rifampicin are effective. Furthermore, μ‑opioid receptor antagonists and sertraline may be used to ameliorate cholestatic pruritus. So far, no randomized controlled trials have been performed for chronic itch in other internal medicine disorders. Antipruritic treatment is mainly based on effective therapy of the underlying disease.

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Authors and Affiliations

  1. Medizinische Klinik 1, Friedrich-Alexander Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Deutschland

    A. E. Kremer

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

    T. Mettang

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Correspondence to A. E. Kremer.

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A.E. Kremer und T. Mettang geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Kremer, A.E., Mettang, T. Pruritus bei systemischen Erkrankungen. Hautarzt 67, 606–614 (2016). https://doi.org/10.1007/s00105-016-3826-y

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