Zusammenfassung
Chronische Prurigo ist eine inflammatorische Dermatose, die definiert ist durch das Vorhandensein von chronischem Pruritus und einzelnen bis vielen symmetrisch verteilten pruriginösen Läsionen wie Knoten, Papeln und Plaques. Diverse dermatologische, systemische, neurologische und/oder psychiatrische Erkrankungen können mit chronischer Prurigo assoziiert sein. Die Versorgung der Patienten ist nicht nur wegen des multifaktoriellen Charakters, sondern auch wegen der zum Teil stark ausgeprägten reaktiven Folgeerscheinungen wie Lebensqualitätseinschränkungen mit Schlafstörungen und nicht zuletzt wegen nicht zugelassener Therapien sehr komplex. Die aktuellen leitliniengerechten Therapieempfehlungen umfassen die topische Anwendung von Steroiden, Capsaicin, Calcineurininhibitoren, Phototherapie und die systemische Gabe von Gabapentinoiden, μ‑Opioid-Rezeptor-Antagonisten, Immunsuppressiva und Dupilumab. Studienergebnisse und Fallseriendaten zu neuartigen Therapien, darunter Biologika (z. B. Nemolizumab) und Januskinaseinhibitoren, sind vielversprechend. Dieser Beitrag gibt einen Überblick zu den aktuell verfügbaren Therapieoptionen und diskutiert die neuesten Daten zur Wirksamkeit von zukünftigen Therapien.
Abstract
Chronic prurigo is an inflammatory dermatosis defined by the presence of chronic pruritus and single to multiple symmetrically distributed pruriginous lesions such as nodules, papules, and plaques. Various dermatological, systemic, neurological, and/or psychiatric diseases are associated with chronic prurigo. The care of these patients is very complex due to the multifactorial character and also because of the sometimes very pronounced consequences such as an impairment of quality of life with sleep disorders. Furthermore, there are no approved therapies. The current guideline-based treatment recommendations include topical application of steroids, capsaicin, calcineurin inhibitors, phototherapy, and systemic use of gabapentinoids, μ‑opioid receptor antagonists, immunosuppressants, or dupilumab. Results from randomized controlled trials and case series on new therapies including biologics (e.g., nemolizumab) and Janus kinase inhibitors are promising. This article provides an overview of currently available treatment options and discusses the latest data on the efficacy of future therapies.
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C. Zeidler: Prüfarzt: Galderma, GSK, Kiniksa, Menlo, Novartis, Sanofi, Trevi; Referenten‑/Reisehonorare: AbbVie, Beiersdorf, Dermasence, Novartis, Leo Pharma. M.P. Pereira: Prüfarzt: Sanofi, Trevi Therapeutics; Berater: Galderma; Referenten‑/Reisehonorare: AbbVie, Beiersdorf, Eli Lilly, Galderma, Menlo Therapeutics, Novartis, P.G. Unna Academy und Trevi Therapeutics. S. Ständer: Forschungsstipendien: Almirall, Beiersdorf, Deutsche Forschungsgemeinschaft (DFG), Europäische Akademie für Dermatologie und Venerologie (EADV), Bundesministerium für Bildung und Forschung (BMBF), Interdisziplinäres Zentrum für Klinische Forschung Münster (IZKF), Leo Pharma, Menlo, Novartis, Sanofi, Trevi; Prüfarzt: Celldex, Clexio, Dermasence, Galderma, GSK, Kiniksa, Menlo, Novartis, Sanofi, Trevi; Beratung: AbbVie, Almirall, Beiersdorf, Bellus Health, Benevolent, Bionorica, Cara, Celgene, Cello Health, Clexio, DS Biopharma, Eli Lilly, Escient, Galderma, Grünenthal, Kiniksa, Klinge Pharma, Menlo, Sanofi, Sienna, Trevi, P.G. Unna Academy, Perrigo, Pfizer, Vanda, Vifor, WebMD; Referentenhonorare: Almirall, Eli Lilly, Sanofi, Galderma, Menlo, Omnicuris, Beiersdorf, Leo Pharma, Novartis, P.G. Unna Academy, Pfizer, Pierre Fabre.
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Zeidler, C., Pereira, M.P. & Ständer, S. Update zur Therapie der chronischen Prurigo. Dermatologie 73, 614–619 (2022). https://doi.org/10.1007/s00105-022-05020-6
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DOI: https://doi.org/10.1007/s00105-022-05020-6