由于多种根本原因和不同的治疗策略,慢性瘙痒对治疗医师提出了重大挑战。几个主题,系统性,和物理方法已经尝试了不同的成功。慢性瘙痒的处方实践受医生不同知识和经验的影响,患者相关因素,和资源可用性。
这项调查的目的是观察印度皮肤科医生目前在慢性瘙痒治疗方面的实践模式,并确定实践差距,特别是在使用各种全身性药物作为止痒剂方面。
在2020年1月至2020年7月期间,向印度各地的皮肤科顾问发送了一份经过验证的调查问卷。问卷由六个问题(多项选择题和开放式问题)组成,涉及抗抑郁药的使用,环状γ-氨基丁酸(GABA)类似物,阿片类拮抗剂,抗组胺药,和治疗慢性瘙痒的替代疗法。
■总共700名皮肤科医生完成了问卷(答复率70%)。总的来说,抗组胺药是治疗慢性瘙痒最常见的药物(超过95%的受访者).其他全身性药物,如阿片类药物拮抗剂,gabapentinoids,抗抑郁药的处方占22.42%,71.85%,75.29%的受访者,分别,在慢性瘙痒中,作为单一疗法或与抗组胺药联合治疗特定类型的瘙痒。在抗抑郁药中,三环抗抑郁药(TCAs)(69.29%)是最常见的处方,其次是选择性5-羟色胺再摄取抑制剂(SSRIs)(32.29%)和5-羟色胺和去甲肾上腺素再摄取抑制剂(SNRIs)(9.14%)。其他治疗选择,如奥马珠单抗,沙利度胺,昂丹司琼,熊去氧胆酸(UDCA),10%的受访者使用利福平缓解特殊情况下的瘙痒。
■这项调查显示,在印度皮肤科医生中,无论病因如何,在慢性瘙痒中处方抗组胺药的做法都是多余的。它还揭示了一种关于使用全身药物如加巴喷丁的不同方法,阿片类拮抗剂,和抗抑郁药,在学术和非学术机构。该调查强调,由于缺乏知识和经验,在撰写阿片类药物拮抗剂和SNRIs等全身性药物处方时存在障碍,害怕副作用,和现有证据不足。
UNASSIGNED: Chronic pruritus poses a significant challenge to treating physicians due to multitude of underlying causes and varying treatment strategies. Several topical, systemic, and physical modalities have been tried with variable success. Prescription practices in chronic pruritus are influenced by differential knowledge and experience of physicians, patient-related factors, and resource availability.
UNASSIGNED: The purpose of this survey was to observe the current pattern of practice in Indian dermatologists in the management of chronic pruritus and to identify practice gaps particularly regarding the use of various systemic agents as antipruritics.
UNASSIGNED: A previously validated questionnaire was sent to consultant dermatologists across India between January 2020 and July 2020. The questionnaire was comprised of six questions (multiple-choice questions as well as open-ended questions) regarding the use of antidepressants, cyclic gamma-aminobutyric acid (GABA) analogues, opioid antagonists, antihistamines, and alternate therapies in the management of chronic pruritus.
UNASSIGNED: A total of 700 dermatologists completed the questionnaire (response rate 70%). Overall, antihistamines were the most common drug prescribed in chronic pruritus (more than 95% respondents). Other systemic agents such as opioid antagonists, gabapentinoids, and antidepressants were prescribed by 22.42%, 71.85%, and 75.29% respondents, respectively, in chronic pruritus as either monotherapy or in combination with antihistamines in specific types of itches. Among antidepressants, tricyclic antidepressants (TCAs) (69.29%) were prescribed most often, followed by selective serotonin reuptake inhibitors (SSRIs) (32.29%) and serotonin and norepinephrine reuptake inhibitors (SNRIs) (9.14%). Other treatment options such as omalizumab, thalidomide, ondansetron, ursodeoxycholic acid (UDCA), and rifampicin were used by 10% respondents to alleviate pruritus in special situations.
UNASSIGNED: This survey revealed the redundant practice of prescribing antihistamines in chronic pruritus irrespective of etiology among Indian dermatologists. It also revealed a differential approach regarding use of systemic agents such as gabapentinoids, opioid antagonists, and antidepressants, in academic and non-academic institutions. The survey emphasized a barrier in writing prescription of systemic agents such as opioid antagonist and SNRIs due to lack of knowledge and experience, fear of side effects, and inadequate available evidence.