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In recent years, measurement of the intraepidermal nerve fiber (IENF) density has gained relevance in the diagnostics of chronic pruritus. This method allows the objectification and quantification of a small-fiber neuropathy, which may manifest clinically with pruritus, pain or dysesthetic sensory symptoms, such as burning, stinging and tingling sensations or numbness. Upon suspicion of a small-fiber neuropathy as a cause for chronic pruritus, targeted diagnostic procedures are essential for the early detection of the neuroanatomical changes. After a punch biopsy of the lower leg, the obtained tissue undergoes an immunofluorescence staining process with a primary antibody against the protein gene product 9.5. The IENFs can thus be detected and are quantified according to pre-determined guidelines based on an international consensus. In addition to morphological changes, functional impairment of small-fibers can be assessed using quantitative sensory testing by assessing detection and pain thresholds of various thermal and mechanic modalities. This method, however, is time-consuming and requires a specialized investigator, and thus it is not routinely used in the diagnostic investigation of chronic pruritus. Diagnosing a small-fiber neuropathy underlying chronic pruritus has therapeutic relevance. If possible, the underlying cause of the neuropathy should be treated. Alternatively, symptomatic therapy options include topical (capsaicin) and systemic (anticonvulsants and/or antidepressants) agents. Chronification processes may lead to refractory pruritus, and thus treatment should be initiated as soon as possible. The aim of this review is to present and discuss the measurement of the IENF density as a diagnostic tool and its role in the management of patients with chronic pruritus. A brief case report is presented to better illustrate the role of this diagnostic method in the clinical setting.
Ringkamp M, Meyer R. Pruriceptors. In: Carstens E, Akiyama T, editors. Itch: mechanisms and treatment. Boca Raton: CRC Press/Taylor & Francis; 2014.
Braud A, Toure B, Agbo-Godeau S, Descroix V, Boucher Y. Characteristics of pain assessed with visual analog scale and questionnaire in burning mouth syndrome patients: a pilot study. J Orofac Pain. 2013;27(3):235–42. PubMed
Ko MJ, Chiu HC, Jee SH, Hu FC, Tseng CH. Postprandial blood glucose is associated with generalized pruritus in patients with type 2 diabetes. Eur J Dermatol. 2013;23(5):688–93. PubMed
Lauria G, Hsieh ST, Johansson O, et al. European Federation of Neurological Societies/Peripheral Nerve Society Guideline on the use of skin biopsy in the diagnosis of small fiber neuropathy. Report of a joint task force of the European Federation of Neurological Societies and the Peripheral Nerve Society. Eur J Neurol. 2010;17(7):903–12, e44–9.
Tominaga M, Takamori K. Sensitization of itch signaling: itch sensitization-nerve growth factor, semaphorins. In: Carstens E, Akiyama T, editors. Itch: Mechanisms and Treatment. Boca Raton: CRC Press/Taylor & Francis; 2014.
Eisen A. The use of somatosensory evoked potentials for the evaluation of the peripheral nervous system. Neurol Clin. 1988;6(4):825–38. PubMed
Ständer S, Zeidler C, Augustin M, et al. Leitlinie: Diagnostisches und therapeutisches Vorgehen bei chronischem Pruritus (In preparation).
Boyd K, Shea SM, Patterson JW. The role of capsaicin in dermatology. Prog Drug Res. 2014;68:293–306. PubMed
- Intraepidermal Nerve Fiber Density: Diagnostic and Therapeutic Relevance in the Management of Chronic Pruritus: a Review
Manuel P. Pereira
Esther M. Pogatzki-Zahn
- Springer Healthcare
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