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*Only for medical professionals to read the reference article to get it~ Itching is a subjective feeling of conscious skin discomfort.
It is a bad feeling caused by skin lesions, various system diseases or psychogenic diseases.
It is manifested as a continuous strong desire to scratch, which usually lasts.
Itching over 6 weeks is defined as chronic itching, which can significantly affect the quality of life, especially sleep quality, mood and self-esteem.

Studies have shown that the incidence of pruritus in patients with malignant tumors is about 27.
1%, the incidence of pruritus in patients with colon cancer is about 30%, that of prostate cancer is about 24.
2%, that of breast cancer is about 26.
5%, and that of ovarian cancer is about 28.
%.

Tumor-induced pruritus may be related to the direct effects of the toxic products produced by the tumor itself and the body's allergic reactions to it, as well as the direct effects of the brain or nerves (brain tumors).

The itching of Hodgkin's disease usually starts in the legs, is severe at night, and quickly spreads throughout the body.

The secretion of some active factors, the release of histamine and the high levels of IgE deposited in the skin may cause itching of lymphoma.

Carcinoid syndrome can also occur with itching.

In addition, anti-tumor targeted drugs may also induce itching.

At present, there are many anti-itch drugs, so how to choose anti-itch drugs for tumor-related pruritus? Primary anti-pruritus drugs mainly include antihistamines, glucocorticoids, glycyrrhizic acid preparations, calcineurin inhibitors, cholic acid drugs, immunosuppressants, opioid μ receptor antagonists and opioid κ receptor agonists , Heparin preparations, antidepressants, antiepileptic drugs, thalidomide, calcium gluconate, vitamin C, etc.

Two medications for tumor-related pruritus ① Tumor-related pruritus can be treated with glucocorticoids, such as dexamethasone orally 4-8 mg/d.

Note: The adverse reactions of glucocorticoids are obviously related to the type, dosage, treatment course, dosage form and usage of the drug.
Close observation during use, such as metabolic disorders, infections, abnormal blood pressure, bleeding tendency, weight gain, osteoporosis, thigh For bone necrosis, etc.
, children should monitor their growth and development, and should not stop the drug abruptly, increase or decrease the dose at will, or change the number of medications.

In addition, the auxiliary material of hydrocortisone injection is alcohol, which may cause allergic reactions when used for alcohol allergy.

Use with caution in gastric ulcer, gastritis or esophagitis, high blood pressure, congestive heart failure, myasthenia gravis, diabetes, hypothyroidism, osteoporosis, hyperlipoproteinemia, epilepsy, emotional instability and tendency to psychosis, liver function Damage, kidney damage or stones, herpes simplex eye, glaucoma, diverticulitis, tuberculosis, etc.

It is contraindicated in patients with active ulcer, duodenal ulcer, recent gastrointestinal anastomosis, severe psychiatric history, severe osteoporosis, viral, bacterial, and fungal infections that have not been controlled by antimicrobial therapy, and those who have clear antimicrobial treatment People who are allergic to alcohol.

②It is known that emotional factors can adjust the "pruritus threshold", so selective serotonin inhibitors (SSRIs) can treat paraneoplastic chronic pruritus.

SSRIs Paroxetine or fluvoxamine is used for severe, chronic skin itching such as systemic lymphoma and solid cancer.

Note: Adverse reactions include nausea, vomiting, constipation, diarrhea, dry mouth, loss of appetite or increased appetite, insomnia or drowsiness, sweating, dizziness, loss of libido, etc.

People with epilepsy and active intracranial hemorrhage should be used with caution.

Combination with monoamine oxidase inhibitors and clomipramine is forbidden.

③It is reported in the literature that aprepitant (80 mg, once a day, taken for 5 days) treats refractory pruritus caused by nivolumab (immune checkpoint inhibitor).

Note: Common adverse reactions are mild headache, fatigue, weakness and belching.

Aprepitant is a CYP3A4 inhibitor, and caution should be exercised when it is used in combination with drugs that are mainly or partially metabolized by CYP3A4.

④ In addition, the commonly used drug for pruritus in the elderly is polysulfonic mucopolysaccharide (MPS), and external preparations such as vitamin E milk can also be used.

Note: Itching caused by malignant tumors is ineffective in treatment with antihistamines.

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