Where Does It All Itch? Exploring the Characteristics of Pruritus in Small Fiber Neuropathy

IF 3.9 3区医学 Q1 CLINICAL NEUROLOGY

Journal of the Peripheral Nervous System Pub Date : 2025-06-25 DOI:10.1111/jns.70041

Dennis Kool, Janneke G. J. Hoeijmakers, Catharina G. Faber, Ingemar S. J. Merkies

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Abstract

Background

Chronic itch, or pruritus, is a common discomfort of the skin. Chronic itch has been described as a symptom of small fiber neuropathy (SFN), a disorder affecting the small myelinated Aδ- and unmyelinated C-fibers. While prior studies report itch rates in SFN ranging from 63%–68%, a distinct pattern has not been identified.

Aim

This study aimed to describe the clinical characteristics of itch in a large cohort of SFN patients.

Methods

Between May 2016 and August 2022, 1415 patients filled out an exploratory questionnaire about characteristics of their itch symptoms. 83% were diagnosed with SFN based on the Besta criteria.

Results

Itch was reported in 66% of SFN patients, mainly experienced as tickling, prickling, and tingling sensations. Itch was most common in the evening, with 98% reporting continuous or episodic symptoms during this time. The itch was predominantly localized to the distal extremities, especially the lower legs and feet (over 50% of patients), with additional reports on the back (25%) and face (27%). Unlike the typical stocking-glove distribution seen with neuropathic pain, itch showed a slightly more proximal locus. SFN patients were more likely to report itching in the hands and feet than non-SFN patients.

Interpretation

This study reveals that itch in SFN is a frequent, heterogeneous symptom that may differ from neuropathic pain in its distribution. Itch, particularly in the hands and feet, may provide diagnostic guidance and suggest SFN as a potential diagnosis. This finding warrants further research on itch mechanisms and its diagnostic value in SFN.

Abstract Image

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哪里痒？探讨小纤维神经病瘙痒的特点

背景：慢性瘙痒是一种常见的皮肤不适。慢性瘙痒被描述为小纤维神经病变（SFN）的症状，这是一种影响小髓鞘a -和无髓鞘c -纤维的疾病。虽然先前的研究报告SFN的瘙痒率在63%-68%之间，但尚未确定其独特的模式。目的本研究旨在描述一大群SFN患者瘙痒的临床特征。方法2016年5月至2022年8月，1415例患者填写瘙痒症状特征探索性问卷。83%的患者根据Besta标准诊断为SFN。结果66%的SFN患者出现瘙痒，主要表现为发痒、刺痛和麻刺感。瘙痒在晚上最常见，98%的人在这段时间报告持续或发作性症状。瘙痒主要局限于远端肢体，特别是小腿和脚（超过50%的患者），另外报告在背部（25%）和面部（27%）。与典型的长袜手套分布不同的是，神经性疼痛的发痒部位更靠近近端。SFN患者比非SFN患者更容易报告手和脚痒。本研究揭示SFN的瘙痒是一种常见的异质症状，其分布可能与神经性疼痛不同。瘙痒，特别是手和脚的瘙痒，可能提供诊断指导，并建议SFN作为潜在的诊断。这一发现为进一步研究瘙痒机制及其在SFN中的诊断价值提供了依据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the Peripheral Nervous System 医学-临床神经学

CiteScore

6.10

自引率

7.90%

发文量

审稿时长

>12 weeks

期刊介绍： The Journal of the Peripheral Nervous System is the official journal of the Peripheral Nerve Society. Founded in 1996, it is the scientific journal of choice for clinicians, clinical scientists and basic neuroscientists interested in all aspects of biology and clinical research of peripheral nervous system disorders. The Journal of the Peripheral Nervous System is a peer-reviewed journal that publishes high quality articles on cell and molecular biology, genomics, neuropathic pain, clinical research, trials, and unique case reports on inherited and acquired peripheral neuropathies. Original articles are organized according to the topic in one of four specific areas: Mechanisms of Disease, Genetics, Clinical Research, and Clinical Trials. The journal also publishes regular review papers on hot topics and Special Issues on basic, clinical, or assembled research in the field of peripheral nervous system disorders. Authors interested in contributing a review-type article or a Special Issue should contact the Editorial Office to discuss the scope of the proposed article with the Editor-in-Chief.