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Pruritus bei Psoriasis

Profil und Therapie

Pruritus in psoriasis

Profile and therapy

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Zusammenfassung

Die Psoriasis ist eine der weltweit am häufigsten vorkommenden chronischen, entzündlichen Hauterkrankungen mit einer Inzidenz von 0,5–3 %. Historisch wurde sie lange Zeit als eine nicht juckende Hauterkrankung beschrieben. Diese Ansicht hat sich in den letzten Jahren jedoch grundlegend gewandelt. Mittlerweile ist anerkannt, dass 64–97 % der an Psoriasis erkrankten Patienten unter auch teilweise massivem Pruritus leiden. Dies führt neben der Belastung durch die Psoriasis selbst zu zusätzlich negativem Stress und einer deutlichen Einschränkung der Lebensqualität. Ätiologisch spielt bei der Entstehung des Pruritus bei Psoriasis neben anderem eine neurogene Entzündung eine wichtige Rolle. Darin involviert sind zahlreiche Neuropeptide wie Substanz P, „calcitonin gene related peptide“ und viele andere, die als Mediatoren fungieren. Parallel dazu scheint auch ein gestörtes Gleichgewicht zwischen κ‑ und µ‑Opioid-Rezeptoren in den Läsionen ätiologisch wichtig zu sein. Therapeutisch kommt es nach einer klinisch kompletten Abheilung der Psoriasisläsionen zu einem Verschwinden des Pruritus. Somit konzentrieren sich bis heute antipruritische Therapien eher auf die klinische Behandlung der Psoriasis. In besonders schweren Fällen des Pruritus bei Psoriasis kann zusätzlich eine gezielt antipruritische Therapie erwogen werden, wie z. B. mit oralen Antidepressiva (Mirtazapin, Doxepin und andere), Neuroleptika (Pregabalin, Gabapentin) und Präparaten, die in das κ‑ und µ‑Opioid-Rezeptor-Gleichgewicht eingreifen. Parallel mit der Einführung zahlreicher antipsoriatischer Substanzen in den letzten Jahren ist das Interesse an der Erforschung und Therapie des Pruritus bei Psoriasis deutlich gestiegen und wird erfreulicherweise im Rahmen der neuen therapeutischen Möglichkeiten auch gezielt wissenschaftlich untersucht.

Abstract

Psoriasis is a common chronic inflammatory disease with an incidence of about 0.5–3 %. Previously psoriasis was not primarily regarded to be associated with pruritus; however, this perception has changed in recent years. Meanwhile data conclusively show that between 64 and 97 % of patients report about pruritus that can be severe in a number of cases. Apart from suffering from psoriasis, the presence of pruritus causes additional stress and leads to a significant impairment of health-related quality of life. Neurogenic inflammation at least in part contributes to the development of pruritus in psoriasis skin lesions. A number of neuropeptides including substance P and calcitonin gene related peptide can act as pro-inflammatory mediators. There is evidence for a dysbalance between κ‑ and µ‑opioid receptors in lesional skin favoring inflammation and pruritus. After clearing of psoriasis lesions, pruritus is relieved as well. Therefore, specific treatment of pruritus is not necessary in general. In cases where severe pruritus is a prominent symptom, targeted therapy with mirtazapin or doxepin or neuroleptic compounds such as pregabalin or gabapentin or drugs affecting the κ‑ und µ‑opioid receptor balance can be administered. Today the importance of pruritus as a prominent symptom of psoriasis lesions has been widely accepted. In recent and running clinical trials with new drugs, pruritus at baseline and the effect of these drugs on pruritus is always assessed. This awareness also fuels basic research about pruritus in psoriasis.

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Authors and Affiliations

  1. Klinik für Hautkrankheiten, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland

    A. Tsianakas

  2. Psoriasis-Zentrum an der Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland

    U. Mrowietz

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A. Tsianakas: Beratertätigkeit für Biogen-IDEC, Celgene, Leo, Novartis, Pfizer. U. Mrowietz war in den zurückliegenden 3 Jahren als honorierter Berater und/oder Redner und/oder Empfänger von Forschungsunterstüzungen und/oder Teilnehmer an klinischen Studien für folgende Firmen tätig: Abbott/AbbVie, Almirall-Hermal, Amgen, BASF, Biogen Idec, Boehringer-Ingelheim, Celgene, Centocor, Eli Lilly, Foamix, Forward Pharma, Galderma, Janssen, Leo Pharma, Medac, MSD, Miltenyi Biotech, Novartis, Pfizer, Teva, VBL, Xenoport.

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Tsianakas, A., Mrowietz, U. Pruritus bei Psoriasis. Hautarzt 67, 601–605 (2016). https://doi.org/10.1007/s00105-016-3835-x

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