Multilevel symmetric neuropathic pruritus (MSNP) presenting as recalcitrant "generalized'' pruritus

作者：Ward Rachel Elizabeth^*; Veerula Vindhya Lakshmi; Ezra Navid; Travers Jeffrey B; Mousdicas Nico

来源：Journal of the American Academy of Dermatology, 2016, 75(4): 774-781.

DOI：10.1016/j.jaad.2016.05.027

• atherosclerosis
• degenerative disc disease
• dermatomal
• gabapentin
• neuropathic
• pruritus
• symmetric

Background: Chronic itch is a disruptive and disabling condition that can lead to psychological stress and depression.
Objective: We sought to describe an entity of generalized, symmetric, neuropathic pruritus, which we term "multilevel symmetric neuropathic pruritus,'' and offer possible explanations accounting for its pathogenesis.
Methods: A case series of 14 patients was evaluated at academic institutions from 2011 to 2015.
Results: All patients exhibited detectable degenerative vertebral changes, as seen by spinal x-ray or magnetic resonance imaging. In 12 of 14 (85.7%) subjects, the radiographic imaging abnormalities directly correlated with the distribution of their cutaneous findings. Twelve of 14 (85.7%) patients had cutaneous findings along the C5 to C6 and/or C6 to C7 dermatomal distributions. Eleven of 14 (78.5%) patients were overweight or obese, and 14 of 14 (100%) patients had at least 4 risk factors for the development of atherosclerosis. Twelve of 14 (85.7%) patients noted complete or near complete resolution after treatment with gabapentin (300-1200 mg daily).
Limitations: No healthy age-matched control group without pruritus was investigated.
Conclusion: A combination of multilevel degenerative disc disease of the spine, spinal nerve root impingement, and/or nerve root traction may play a pivotal role in the cause of multilevel symmetric neuropathic pruritus.

• 出版日期2016-10