Pruritus: An Underrecognized Symptom of Small-Fiber Neuropathies
Journal of the American Academy of Dermatology
TAKE-HOME MESSAGE
- Questionnaire responses from 41 patients with a diagnosis of small-fiber neuropathies (SFN) revealed that 68.3% had pruritus. Symptoms were worsened by fatigue, sweating, stress, xerosis, and hot ambient temperature. In contrast, symptoms were alleviated by cold water. Patients reported notable sensory symptoms; most commonly, burning, heat sensations, pain, and numbness.
- There is little known about sensory symptoms in patients with SFN, which are disorders of reduced and absent myelination in the Aδ and C fibers, respectively, that can be idiopathic or associated with diseases such as diabetes, HIV, hepatitis C infection, and autoimmune diseases. Pruritus should be recognized as a common and possibly presenting symptom of SFNs.
– Sarah Churton, MD
ACKGROUND
Small-fiber neuropathies (SFN) are diseases of small nerve fibers that are characterized by autonomic and sensory symptoms.
OBJECTIVE
We sought to evaluate sensory symptoms, especially pruritus, in patients with SFN.
METHODS
A questionnaire was given to patients with SFN.
RESULTS
In all, 41 patients responded to the questionnaire (71.9% response rate). The most frequent sensory symptoms were burning (77.5%), pain (72.5%), heat sensations (70.2%), and numbness (67.5%). Pruritus was present in 68.3% of patients. It appeared most often in the evening, and was localized to the limbs in a distal-to-proximal gradient, although the back was the most frequent location (64%). Exacerbating factors were fatigue, xerosis, sweating, hot temperature, and stress. Cold water was an alleviating factor.
LIMITATIONS
Recall bias associated with filling out the questionnaire, relatively small sample size, and the uncontrolled, retrospective nature of the study were limitations.
CONCLUSION
Pruritus occurs frequently in patients with SFN and could be recognized as a possible presenting symptom, especially if there are other sensory or autonomic symptoms.