The itch – the most common symptom of a dermal disease can be also best of all defined as an unpleasant boring which leads to desire to scratch. But the itch can be the leading symptom of general and mental diseases. All human beings throughout the life have experience of an itch therefore it is important to carry out difference between acute an itch which is limited to time period in the range from several seconds to one week. Such itch is bound to acute reaction on sting, and chronic an itch which lasts within more than 6 weeks. The itch makes deep impact on quality of life through the disturbances bound to a dream, attention and sexual function. Researches showed that among patients with an itch on a hemodialysis there is a raised mortality. The chronic itch is a huge burden for society through the expenses bound to not effective treatment. Treatment of an itch is a complex challenge, especially when the main etiology is obscure. Due to the bad comprehension of a pathophysiology, development of effective methods of treatment for an itch was especially difficult. There is no standard therapy of an itch now. In treatment of an itch individual approach prevails.
– Atopic dermatitis
– Chronic renal nedostaochnost
– Chronic diseases of a liver
– Hematological disturbances for example lymphoma
– Endocrine disturbances
Diseases of sensory nerves
The moisturizing, softening and protective creams
The moisturizing, softening and protective creams are a cornerstone of antipruritic treatment, they often leads to decrease of an itch for the account
risings of barrier function of an epithelium. Transepidermal loss of water reflects functions of an epidermal barrier and is bound to intensity of an itch at patients with an atopic dermatitis. Transepidermal loss of water is enlarged at night and, thus, the drugs forming occlusal Membranulas are especially useful to topical treatment of a night itch, the same drugs are useful at a dry or atopic skin.
Recent researches showed, serinovy proteases, through activation of a protease of the activating receptor 2 (PAR 2) located on the terminations From fibers can play an important role in maintenance an itch. Drugs with a low rn can reduce an itch due to decrease of the activity the serinovykh of proteases, such as
tryptases of mast cells (endogenic PAR 2 agonist). The same drugs optimize barrier function of a skin by maintenance of normal acidic reaction of a surface of a skin.
Urgent corticosteroids should be used only for the assistance at an itch bound to inflammatory diseases of a skin, such as an atopic dermatitis and a psoriasis. However, they shouldn’t be used for treatment of a chronic generalized itch or an itch during long time. Corticosteroids not immediate antipruritic, is considered that they exert beneficial influence on an itch through depression of a skin inflammation by them.
Though stronger corticosteroids have larger efficiency, but is
also increased risk of side effects (for example, an atrophy of a skin, a teleangiectasia and overwhelming action on an axis a hypothalamus pituitary body).
Urgent inhibitors of a kaltsinevrin are effective at depression of an itch at patients with an atopic dermatitis.
Inhibitors of a kaltsinevrin are effective at a chronic dermatitis, reaction a graft against the owner, sleroziruyushchy herpes, an anogenitalny itch and uzlovovaty пруриго. The cumulative side effects of these drugs – a temporary burning sensation. The mechanism which is the cornerstone of depression of an itch is unclear.
Doksepin, a tritsiklichesky antidepressant, is
in potent N 1 and N 2nd antagonist. Doksepin of 5% cream considerably reduces an itch at patients with an atopic dermatitis, chronic simple herpes, a contact dermatitis and a nodulose dermatitis. Doksepin causes a sleepiness because of systemic absorption in 20-25% of patients that limits its use especially for children.
Mentholum use separately or in a combination as local antipruritic a current of many centuries. Mentholum causes a cool feeling, in concentration of 1-3% time is widely used for simplification of an itch while higher doses can cause a boring.
The urgent capsaicine affects sensory nerves of a skin, promotes remission of neuropeptids, and has the antipruritic effect. Salutary action of a capsaicine is noted at chronic, localized itching states, especially neyropatichesky parentage, and also at uzovaty пруриг, the itch bound to chronic diseases of kidneys. Initial use causes intensive a burning sensation in a site of application that can lead to the premature termination of its use. However, this side effect usually undergoes later use of medicine within several days or with use of local anesthetic.
Urgent local anesthetics of 5% Lidocainum and the eutectic admixture of Lidocainum of 2,5% have antipruritic effect at patients with a chronic cholestasia.
The combination of 5% of urea and 3% of a polidokanol considerably reduces an itch at
patients with an atopic dermatitis, contact a dermatitis and a psoriasis.
Urgent salicylic acid
Acetylsalicylic acid, cyclooxygenase inhibitor, considerably reduces an itch at chronic simple deprives. The mechanism action – blockade of cyclooxygenase and depression of formation of Prostaglandinums.
Both the kannabinoidnykh of a receptor of CB1 and CB2 express on dermal sensory nervous fibers, mast cells and
keratinotsitakh. Agonists the kannabinoidnykh of receptors of N-palmitoiletanolamin as a part of creams facilitate an itch at patients with an atopic dermatitis, simple it is deprived, nodulose пруриго and a chronic renal failure.