Neuropathic itch caused by nerve root compression: brachioradial pruritus and notalgia paresthetica / Neuropatski pruritus (svrab) prouzrokovan kompresijom nervnih korenova - brahioradijalni pruritus i nostalgija parestetika

Open access

Abstract

Neuropathic itch (itching or pruritus) arises from a pathology located at any point along the afferent pathway of the nervous system. It may be related to damage to the peripheral nervous system, such as in postherpetic neuropathy, brachioradial pruritus or notalgia paresthetica. It has many clinical features similar to neuropathic pain. Patients complain of itching, which is associated with burning sensation, aching, and stinging. Brachioradial pruritis (BP) is an intense itching sensation of the arm, usually between the shoulder and elbow of one or both arms. It is an enigmatic condition with a controversial etiology; some authors consider BP to be a photodermatosis, whereas other authors attribute BP to compression of cervical nerve roots. Notalgia paresthetica is an isolated mononeuropathy involving the skin over or near the scapula. Patients have a pruritus on the mid-upper back. The treatment is usually difficult, but capsaicin and local analgesic agents are the options of choice. Brachioradial pruritus and notalgia paresthetica are often unrecognized neurocutaneous conditions and therefore, a thorough history and physical examination are of utmost importance to distinguish symptoms and apply accurate therapeutic options.

Sažetak

Savremeni koncept: Neuropatski pruritus (svrab) povezan je s patološkim procesom koji može da se pojavi na bilo kojoj tački duž aferentnog toka nervnog sistema, a mogu da ga prouzrokuju povrede perifernog nervnog sistema. Etiopatogeneza: Mogu da ga prouzrokuju povrede perifernog nervnog sistema, kao što je slučaj kod postherpetične neuropatije, brahioradijalni pruritus i notalgija parestetika. Kliničke osobenosti: Mnoge kliničke osobine neuropatskog svraba slične su osobinama neuropatskog bola. Bolesnici se žale na svrab udružen sa žarenjem, probadanjem i jakim bolom. Brahioradijalni pruritus: Predstavlja intenzivan svrab koji se najčečće javlja između ramena i lakta jedne ili obe ruke. To je zagonetno stanje sa kontroverznim uzrocima; neki autori smatraju da je brahioradijalni pruritus fotodermatoza, dok ga drugi smatraju posledicom kompresije cervikalnih nervnih korenova. Notalgija parestetika: Ovo je posebna mononeuropatija koja zahvata kožu iznad ili u blizini skapule. Oboleli se žale na svrab gornjeg i središnjeg dela leđa. Lečenje: Obično je teško, dok Capsaicin i lokalni analgetici predstavljaju terapiju izbora. Zaključak: Brahioradijalni pruritus i notalgija parestetika su patološka stanja koja često nisu prepoznata i zbog toga je veoma važno uzeti detaljnu istoriju bolesti i izvršiti detaljan klinički pregled radi prepoznavanja simptoma i primene odgovarajućih terapijskih opcija.

Keywords:
References
  • 1. Karnath BM. Pruritus: a sign of underlying disease. Hosp Physician 2005;41(10):25-9.

  • 2. Twycross R, Greaves MW, Handwerker H, Jones EA, Libretto SE, Szepietowski JC, et al. Itch: scratching more than surface. Q J Med 2003;96:7-26.

  • 3. Stander S, Weisshaar E, Mettang T, Szepietowski JC, Carstens E, Ikoma A, et al. Clinical classification of itch: a position paper of the International Forum for the Study of Itch. Acta Derm Venereol 2007;87:291-4.

  • 4. Yosipovitch G, Samuel SL. Neuropathic and psychogenic itch. Dermatol Ther 2008;21:32-41.

  • 5. Ikoma A, Rukwied R, Stander S, Steinhoff M, Miyachi Y, Schmelz M. Neurophysiology of pruritus: interaction of itch and pain. Arch Dermatol 2003;139:1475-8.

  • 6. Greaves MW. Recent advances in pathophysiology and current management of itch. Ann Acad Med Singapore 2007;36:788-92

  • 7. Wallengren J. Brachioradial pruritus: a recurrent solar dermopathy. J Am Acad Dermatol 1998;39:803-6.

  • 8. Wallengren J, Sundler F. Brachioradial pruritus is associated with a reduction in cutaneous innervation that normalizes during the symptom-free remissions. J Am Acad Dermatol 2005;52:142-5.

  • 9. Cohen AD, Masalha R, Medvedovsky E, Vardy DA. Brachioradial pruritus: a symptom of neuropathy. J Am Acad Dermatol 2003;48:825-8.

  • 10. Waisman M. Solar pruritus of the elbows (Brachioradial summer pruritus). Arch Dermatol 1968;98:481-5.

  • 11. Walcyk PJ, Elpern DJ. Brachioradial pruritus: a tropical dermopathy. Br J Dermatol 1986;115:177-80.

  • 12. Knight TE, Hayashi T. Solar (brachioradial) pruritus: response to capsaicin cream. Int J Dermatol 1994;33:206-9.

  • 13. Heyl T. Brachioradial pruritus. Arch Dermatol 1983;119:115-6.

  • 14. Wallengren J, Sundler F. Phototherapy induces loss of epidermal and dermal nerve fibers. Acta Derm Venereol 2004;84:111-5.

  • 15. Yosipovitch G, Maibach HI, Rowbotham MC. Effect of EMLA pre-treatment on capsaicin-induced burning and hyperalgesia. Acta Derm Venereol 1999;79:118-21.

  • 16. Astwazaturow M. Uber parsthetishe neuralgien und eine bezondere form derselben-notalgias paresthetica. Nervenarzt 1934;133:88-96.

  • 17. Savk E, Dikicioglu E, Culhaci N, Karaman G, Sendur N. Immunohistochemical findings in notalgia paresthetica. Dermatology 2002;204:88-93.

  • 18. Raison-Peyron N, Meunier L, Acevedo M, Meynadier J. Notalgia paresthetica: clinical, physiopathological and therapeutic aspects: a study of 12 cases. J Eur Acad Dermatol Venereol 1999;12:215-21.

  • 19. Springall DR, Karanth SS, Kirkham N, Darley CR, Polak JM. Symptoms of notalgia paresthetica may be explained by increased dermal innervation. J Invest Dermatol 1991;97:555-61.

  • 20. Marcusson JA, Lundh B, Siden A, Persson A. Notalgia paresthetica-puzzling posterior pigmented pruritic patch: report on two cases. Acta Derm Venereol 1990;70:452-4.

  • 21. Weinfeld PK. Successful treatment of notalgia paresthetica with botulinum toxin type A. Arch Dermatol 2007;143:980-2.

  • 22. Turk U, Ilhan S, Alp R, Sur H. Botulinum toxin and intractable trigeminal neuralgia. Clin Neuropharmacol 2005;28:161-2.

  • 23. Szepietowski JC, Wąsik G, Notalgia paresthetica: a rare manifestation of localized pruritus. Przegl Dermatol 2002;89:215-7.

Serbian Journal of Dermatology and Venereology

The Journal of Serbian Association of Dermatovenereologists (SAD)

Journal Information

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 55 55 29
PDF Downloads 7 7 6