抓皮症的药物治疗：最新综述

摘要(中文译文)

皮肤搔抓障碍（SPD）被定义为一种精神皮肤病性状况，涉及过度搔抓皮肤，导致生活质量显著受损，常见于皮肤科和精神科。因此，治疗干预——包括非药物和药物治疗——至关重要。鉴于SPD患病率不断上升及其对生活质量的巨大影响，亟需一篇专门针对药物治疗选择的更新综述。本范围综述旨在基于近期研究和试验的证据，提供SPD最新药物治疗的详细汇编。于2024年11月在PubMed上使用关键词“治疗”和“皮肤搔抓”或“抓痕”进行检索。文章限定为仅涉及18岁以上个体皮肤搔抓的药物治疗、过去20年内发表、英文语言、且可归类为临床试验、病例报告/系列或队列研究。从PubMed提取的192篇文章中，13项研究（289例患者）符合纳入标准。这些文章包括7篇病例报告/系列和6项随机对照试验。以下药物被评估用于SPD的治疗：选择性5-羟色胺再摄取抑制剂、谷氨酸能药物（N-乙酰半胱氨酸、美金刚）、抗癫痫药（拉莫三嗪、托吡酯）、锂盐、抗精神病药（奥氮平、阿立哌唑）、阿片类拮抗剂（纳曲酮）和米氮平。在用于SPD评估的药物中，选择性5-羟色胺再摄取抑制剂在减轻皮肤搔抓症状的严重程度和频率方面显示出最有前景的结果。尽管习惯逆转心理治疗传统上是一线治疗，但当患者出现SPD时，选择性5-羟色胺再摄取抑制剂现在越来越多地与心理治疗联合使用。N-乙酰半胱氨酸在SPD治疗中也已得到充分确立。其他已在SPD中研究的药物类别包括使用抗精神病药（常与抗抑郁药联合）和纳曲酮。需要进一步研究以扩展当前研究，并明确确立较少使用药物（如抗癫痫药）在SPD中的作用。

Abstract

Skin-picking disorder (SPD), defined as a psychocutaneous condition that involves excessive picking at the skin causing marked impairment in quality of life, is commonly seen in both dermatology and psychiatry. As such, therapeutic intervention-both nonpharmacologic and pharmacologic-is essential. Given the rising prevalence of SPD and the tremendous impact it can have on quality of life, an updated review, specifically on pharmacologic options, is very much needed. The aim of this scoping review is to provide a detailed compilation of updated pharmacologic treatments for SPD based on evidence from recent studies and trials. A search through PubMed was conducted using the key words "treatment" and "skin picking" or "excoriation" in November 2024. Articles were limited to those that solely address pharmacologic treatments in skin-picking for individuals older than 18 years, were published in the last 20 years, in the English language, and can be classified as a clinical trial, case report/series, or cohort study. Of the 192 articles extracted from PubMed, 13 studies (289 patients) met the inclusion criteria. These articles consist of 7 case reports/series and 6 randomized controlled trials. The following medications were evaluated for treatment of SPD: selective serotonin reuptake inhibitors, glutamatergic drugs (N-acetyl cysteine, memantine), antiepileptics (lamotrigine, topiramate), lithium, antipsychotics (olanzapine, aripiprazole), opioid antagonists (naltrexone), and mirtazapine. Of the medications evaluated for use in SPD, selective serotonin reuptake inhibitors show the most promising results in terms of mitigating the severity and frequency of skin-picking symptoms. Although habit-reversal psychotherapy has traditionally been first-line treatment, selective serotonin reuptake inhibitors are now increasingly being used in combination with psychotherapy when a patient presents with SPD. N-acetyl cysteine has also been well-established in the treatment of SPD. Other classes of medications that have been studied in SPD include the use of antipsychotics (often combined with antidepressants) and naltrexone. Additional studies are indicated to further expand on the current research and definitively establish the role of the less common medications, such as antiepileptics, in SPD.

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