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Neurophysiologie des Pruritus

Neurophysiology of pruritus

  • Leitthema
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Zusammenfassung

Neurophysiologische Studien zeigen, dass der Pruritus eine eigenständige Sinnesqualität ist, die mit eigenen Leitungsbahnen in der Peripherie und im zentralen Nervensystem von der Schmerzempfindung abgegrenzt werden kann. Der Pruritus ist eine sehr beeinträchtigende Sinneswahrnehmung und das am häufigsten beklagte Symptom, das vom Hautorgan ausgeht. Histamin galt lange Zeit als einziger Mediator des Pruritus. Mittlerweile ist bekannt, dass – neben Histamin – eine Vielzahl von Neuromediatoren wie Neurotrophinen, Neuropeptiden und deren Rezeptoren eine wichtige Rolle bei der Vermittlung von Pruritus spielt. Neuromediatoren werden von Mastzellen, Keratinozyten und eosinophilen Granulozyten, die in engem Kontakt zu den peripheren Nervenfasern stehen, gebildet. Durch die Entschlüsselung der neurophysiologischen Zusammenhänge des Pruritus können neue und effiziente Therapieansätze des Pruritus eröffnet werden.

Abstract

Neurophysiologic studies indicate that pruritus is a distinct sensation with its own neuronal pathways in the peripheral and central nervous system which are different from that of pain. Pruritus is a very disturbing sensation and most common skin-related symptom. Histamine was long considered to be the only mediator of pruritus. However, it has become evident that – besides histamine – a variety of neuromediators such as neurotrophins and neuropeptides as well as their receptors play an important role in pruritus. Neuromediators are produced by mast cells, keratinocytes and eosinophil granulocytes which are in close contact to sensory nerves. The discovery of these neurophysiological interactions opens new and promising therapeutic options for the treatment of pruritus.

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Literatur

  1. Baron R, Schwarz K, Kleinert A et al. (2001) Histamine-induced itch converts into pain in neuropathic hyperalgesia. Neuroreport 12(16): 3475–3478

    Article  PubMed  Google Scholar 

  2. Bernabei R, Landi F, Bonini S et al. (1999) Effect of topical application of nerve-growth factor on pressure ulcers. Lancet 354(9175): 307

    Article  Google Scholar 

  3. Bigliardi-Qi M, Lipp B, Sumanovski LT et al. (2005) Changes of epidermal mu-opiate receptor expression and nerve endings in chronic atopic dermatitis. Dermatology 210(2): 91–99

    Article  PubMed  Google Scholar 

  4. Bigliardi-Qi M, Sumanovski LT, Buchner S et al. (2004) Mu-opiate receptor and Beta-endorphin expression in nerve endings and keratinocytes in human skin. Dermatology 209(3): 183–189

    Article  PubMed  Google Scholar 

  5. Brune A, Metze D, Luger TA, Stander S (2004) Antipruritic therapy with the oral opioid receptor antagonist naltrexone. Open, non-placebo controlled administration in 133 patients. Hautarzt 55(12): 1130–1136

    Article  PubMed  Google Scholar 

  6. Dugas-Breit S, Schopf P, Dugas M et al. (2005) Baseline serum levels of mast cell tryptase are raised in hemodialysis patients and associated with severity of pruritus. J Dtsch Dermatol Ges 3(5): 343–347

    Article  PubMed  Google Scholar 

  7. Georgala S, Schulpis KH, Papaconstantinou ED, Stratigos J (1994) Raised beta-endorphin serum levels in children with atopic dermatitis and pruritus. J Dermatol Sci 8(2): 125–128

    Article  PubMed  Google Scholar 

  8. Greaves MW, Wall PD (1997) Pathophysiology of itching. Lancet 349(9045): 133

    Article  Google Scholar 

  9. Grewe M, Vogelsang K, Ruzicka T et al. (2000) Neurotrophin-4 production by human epidermal keratinocytes: increased expression in atopic dermatitis. J Invest Dermatol 114(6): 1108–1112

    Article  PubMed  Google Scholar 

  10. Groneberg DA, Serowka F, Peckenschneider N et al. (2005) Gene expression and regulation of nerve growth factor in atopic dermatitis mast cells and the human mast cell line-1. J Neuroimmunol 161(1–2): 87–92

    Google Scholar 

  11. Ikoma A, Fartasch M, Heyer G et al. (2004) Painful stimuli evoke itch in patients with chronic pruritus: central sensitization for itch. Neurology 62(2): 212–217

    Article  PubMed  Google Scholar 

  12. Ikoma A, Handwerker H, Miyachi Y, Schmelz M (2005) Electrically evoked itch in humans. Pain 113(1–2): 148–154

    Google Scholar 

  13. Ikoma A, Rukwied R, Stander S et al. (2003) Neuronal sensitization for histamine-induced itch in lesional skin of patients with atopic dermatitis. Arch Dermatol 139(11): 1455–1458

    Article  PubMed  Google Scholar 

  14. Johansson O, Liang Y, Emtestam L (2002) Increased nerve growth factor- and tyrosine kinase A-like immunoreactivities in prurigo nodularis skin – an exploration of the cause of neurohyperplasia. Arch Dermatol Res 293(12): 614–619

    Article  PubMed  Google Scholar 

  15. Johansson O, Liang Y, Marcusson JA, Reimert CM (2000) Eosinophil cationic protein- and eosinophil-derived neurotoxin/eosinophil protein X-immunoreactive eosinophils in prurigo nodularis. Arch Dermatol Res 292(8): 371–378

    Article  PubMed  Google Scholar 

  16. Kapp A (1993) The role of eosinophils in the pathogenesis of atopic dermatitis – eosinophil granule proteins as markers of disease activity. Allergy 48(1): 1–5

    Google Scholar 

  17. Kiehl P, Falkenberg K, Vogelbruch M, Kapp A (2001) Tissue eosinophilia in acute and chronic atopic dermatitis: a morphometric approach using quantitative image analysis of immunostaining. Br J Dermatol 145(5): 720–729

    Article  PubMed  Google Scholar 

  18. Kinkelin I, Motzing S, Koltenzenburg M, Brocker EB (2000) Increase in NGF content and nerve fiber sprouting in human allergic contact eczema. Cell Tissue Res 302(1): 31–37

    Article  PubMed  Google Scholar 

  19. Kinkelin I, Motzing S, Koltenzenburg M, Brocker EB (2000) Increase in NGF content and nerve fiber sprouting in human allergic contact eczema. Cell Tissue Res 302(1): 31–37

    Article  PubMed  Google Scholar 

  20. Liang Y, Marcusson JA, Johansson O (1999) Light and electron microscopic immunohistochemical observations of p75 nerve growth factor receptor-immunoreactive dermal nerves in prurigo nodularis. Arch Dermatol Res 291(1): 14–21

    Article  PubMed  Google Scholar 

  21. Nakamura M, Toyoda M, Morohashi M (2003) Pruritogenic mediators in psoriasis vulgaris: comparative evaluation of itch-associated cutaneous factors. Br J Dermatol 149(4): 718–730

    Article  PubMed  Google Scholar 

  22. Ohmura T, Hayashi T, Satoh Y et al. (2004) Involvement of substance P in scratching behaviour in an atopic dermatitis model. Eur J Pharmacol 491(2–3): 191–194

    Google Scholar 

  23. Raap U, Goltz C, Deneka N et al. (2005) Brain-derived neurotrophic factor is increased in atopic dermatitis and modulates eosinophil functions compared with that seen in nonatopic subjects. J Allergy Clin Immunol 115(6): 1268–1275

    Article  PubMed  Google Scholar 

  24. Raap U, Kapp A (2005) Neuroimmunological findings in allergic skin diseases. Curr Opin Allergy Clin Immunol 5(5): 419–424

    PubMed  Google Scholar 

  25. Rukwied R, Heyer G (1999) Administration of acetylcholine and vasoactive intestinal polypeptide to atopic eczema patients. Exp Dermatol 8(1): 39–45

    PubMed  Google Scholar 

  26. Schmelz M, Hilliges M, Schmidt R et al. (2003) Active „itch fibers“ in chronic pruritus. Neurology 61(4): 564–566

    PubMed  Google Scholar 

  27. Schmelz M, Schmidt R, Bickel A et al. (1997) Specific C-receptors for itch in human skin. J Neurosci 17(20): 8003–8008

    PubMed  Google Scholar 

  28. Solomon A, Aloe L, Pe’er J et al. (1998) Nerve growth factor is preformed in and activates human peripheral blood eosinophils. J Allergy Clin Immunol 102(3): 454–460

    Article  PubMed  Google Scholar 

  29. Stander S, Steinhoff M, Schmelz M et al. (2003) Neurophysiology of pruritus: cutaneous elicitation of itch. Arch Dermatol 139(11): 1463–1470

    Article  PubMed  Google Scholar 

  30. Steinhoff M, Vergnolle N, Young SH et al. (2000) Agonists of proteinase-activated receptor 2 induce inflammation by a neurogenic mechanism. Nat Med 6(2): 151–158

    Article  PubMed  Google Scholar 

  31. Streit M, Von F, V, Braathen LR (2002) Pruritus sine marteria. Pathophysiology, diagnostic assessment and therapy. Hautarzt 53(12): 830–849

    Article  PubMed  Google Scholar 

  32. Takano N, Sakurai T, Kurachi M (2005) Effects of anti-nerve growth factor antibody on symptoms in the NC/Nga mouse, an atopic dermatitis model. J Pharmacol Sci 99(3): 277–286

    Article  PubMed  Google Scholar 

  33. Toyoda M, Nakamura M, Makino T et al. (2002) Nerve growth factor and substance P are useful plasma markers of disease activity in atopic dermatitis. Br J Dermatol 147(1): 71–79

    Article  PubMed  Google Scholar 

  34. Urashima R, Mihara M (1998) Cutaneous nerves in atopic dermatitis – a histological, immunohistochemical and electron microscopic study. Virchows Arch Int J Pathol 432(4): 363–370

    Article  Google Scholar 

  35. Vogelgsang M, Heyer G, Hornstein OP (1995) Acetylcholine induces different cutaneous sensations in atopic and non-atopic subjects. Acta Derm Venereol 75(6): 434–436

    PubMed  Google Scholar 

  36. Walter B, Sadlo MN, Kupfer J et al. (2005) Brain activation by histamine prick test-induced itch. J Invest Dermatol 125(2): 380–382

    PubMed  Google Scholar 

  37. Zenker S, Schuh T, Degitz K (2003) Therapy of pruritus associated with skin diseases with the serotonin receptor antagonist ondansetron. J Dtsch Dermatol Ges 1(9): 705–710

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik und Poliklinik für Dermatologie und Venerologie, Medizinische Hochschule Hannover, Ricklingerstraße 5, 30449 , Hannover

    U. Raap & A. Kapp

  2. Dept. of Dermatology, Kyoto University, Japan

    A. Ikoma

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  1. U. Raap
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  2. A. Ikoma
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  3. A. Kapp
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Correspondence to U. Raap.

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Raap, U., Ikoma, A. & Kapp, A. Neurophysiologie des Pruritus. Hautarzt 57, 379–384 (2006). https://doi.org/10.1007/s00105-006-1125-8

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  • DOI: https://doi.org/10.1007/s00105-006-1125-8

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