From Compression to Itch: Exploring the Link Between Nerve Compression and Neuropathic Pruritus.

IF 8.6 1区 医学 Q1 DERMATOLOGY American Journal of Clinical Dermatology Pub Date : 2024-10-17 DOI:10.1007/s40257-024-00898-5
Kayla D Mashoudy, Sarah G Brooks, Luis F Andrade, Jaxon D Wagner, Gil Yosipovitch
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Abstract

Neuropathic itch is a type of chronic pruritus resulting from neural dysfunction along the afferent pathway. It is often accompanied by abnormal sensations such as paresthesia, hyperesthesia, or hypoesthesia. This condition, which may involve motor or autonomic neural damage, significantly impacts patients' quality of life, causing severe itch and associated comorbidities such as depression, disrupted sleep, and social strain. Neuropathic itch accounts for 8% of chronic pruritus cases, though this may be underestimated. This comprehensive review focuses on nerve impingement as the primary pathophysiological mechanism for various forms of neuropathic itch including brachioradial pruritus (BRP), notalgia paresthetica (NP), and anogenital itch. BRP, often seen in middle-aged white women, manifests as pruritus in the dorsolateral forearms typically exacerbated by ultraviolet (UV) exposure and related to cervical spine pathology. NP, prevalent in middle-aged women, presents as pruritus in the upper back due to thoracic spine nerve compression. Anogenital pruritus, affecting 1-5% of adults, is often linked to lumbosacral spine issues after ruling out dermatologic conditions such as lichen sclerosus or lichen simplex chronicus. The pathophysiology of neuropathic itch involves both peripheral and central mechanisms, with nerve damage being a key factor. Diagnosis requires a thorough history, physical examination, and potentially imaging studies. Topical agents such as menthol, capsaicin, and lidocaine are used for mild cases, while systemic medications such as gabapentin, pregabalin, and antidepressants are prescribed for moderate to severe cases; however, no US Food and Drug Administration (FDA)-approved therapies currently exist specifically for neuropathic itch. Understanding the underlying neural dysfunction and appropriate therapeutic strategies is crucial for managing neuropathic itch effectively.

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从压迫到瘙痒:探索神经压迫与神经性瘙痒症之间的联系。
神经性瘙痒是一种慢性瘙痒症,由传入通路的神经功能紊乱引起。它通常伴有异常感觉,如麻痹、过度感觉或感觉减退。这种疾病可能涉及运动神经或自主神经损伤,严重影响患者的生活质量,导致剧烈瘙痒以及抑郁、睡眠紊乱和社交压力等相关并发症。神经性瘙痒占慢性瘙痒症病例的 8%,但这一比例可能被低估了。这篇综合性综述主要探讨神经撞击是各种神经性瘙痒症的主要病理生理机制,包括肱动脉瘙痒症(BRP)、神经性瘙痒症(NP)和肛门瘙痒症。肱动脉瘙痒症常见于中年白人女性,表现为前臂背外侧瘙痒,紫外线照射会加剧瘙痒,与颈椎病变有关。NP多见于中年女性,由于胸椎神经受压,表现为上背部瘙痒。肛门瘙痒症影响着1%-5%的成年人,在排除皮肤病(如硬化性苔藓或慢性单纯性苔藓)后,通常与腰骶部脊柱问题有关。神经性瘙痒的病理生理学涉及外周和中枢机制,其中神经损伤是一个关键因素。诊断需要详尽的病史、体格检查和可能的影像学检查。薄荷醇、辣椒素和利多卡因等外用药可用于轻度病例,而加巴喷丁、普瑞巴林和抗抑郁药等全身用药可用于中度至重度病例;但是,目前还没有美国食品药品管理局(FDA)批准的专门针对神经性瘙痒的疗法。了解潜在的神经功能障碍和适当的治疗策略对于有效控制神经性瘙痒至关重要。
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来源期刊
CiteScore
15.20
自引率
2.70%
发文量
84
审稿时长
>12 weeks
期刊介绍: The American Journal of Clinical Dermatology is dedicated to evidence-based therapy and effective patient management in dermatology. It publishes critical review articles and clinically focused original research covering comprehensive aspects of dermatological conditions. The journal enhances visibility and educational value through features like Key Points summaries, plain language summaries, and various digital elements, ensuring accessibility and depth for a diverse readership.
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