Reduced intraepidermal nerve fibre density in lesional and nonlesional prurigo nodularis skin as a potential sign of subclinical cutaneous neuropathy
Reduced intraepidermal nerve fibre density in lesional and nonlesional prurigo nodularis skin as a potential sign of subclinical cutaneous neuropathy
复制标题
DOI：
10.1111/j.1365-2133.2011.10306.x
复制
发表时间：
2011-07-01
影响因子：
10.3
通讯作者：
Staender, S.
中科院分区：
文献类型：
--
作者：
Schuhknecht, B.;Marziniak, M.;Staender, S.
背景：结节性痒疹（PN）是一种以多发角化结节为特征的高度瘙痒性疾病。先前的免疫组织化学研究表明真皮神经纤维数量增加。考虑到瘙痒的感觉主要通过薄的无髓鞘表皮神经传递，我们的研究目的是研究表皮内神经纤维（IENF）密度。方法对53例不同来源PN患者（女性37例，男性16例，平均+/- SD年龄60.6 +/- 14.9岁）的病变和非病变皮肤活检进行蛋白基因产物9.5的免疫染色。根据欧洲神经学学会联合会的指导方针，确定了每毫米的IENF密度，并与20名健康志愿者的密度进行了比较。结果无论患者的年龄、PN的来源、瘙痒的强度或质量如何，病变和未累及的PN皮肤活检均显示IENF密度显著降低（P < 0.001）。结论表皮感觉神经发育不全与临床参数无关是PN的新发现，提示表皮神经参与PN的病理生理。到目前为止，不能排除IENF密度降低是由于反复抓挠造成的。然而，非病变性PN皮肤的发育不全提示亚临床小纤维神经病变的存在。
Background Prurigo nodularis (PN) is a highly pruritic condition characterized by multiple hyperkeratotic nodules. Previous immunohistochemical studies demonstrated increased numbers of dermal nerve fibres.Objectives Given that the sensation of pruritus is transmitted mainly by thin, unmyelinated epidermal nerves, the aim of our study was to investigate the intraepidermal nerve fibre (IENF) density.Methods Biopsies taken from lesional and nonlesional skin of 53 patients (37 women and 16 men; mean +/- SD age 60.6 +/- 14.9 years) with PN of diverse origin were immunostained for protein gene product 9.5. According to the guideline of the European Federation of Neurological Societies, the IENF density per millimetre was determined and compared with that in 20 healthy volunteers.Results Lesional and uninvolved PN skin biopsies showed significantly decreased IENF density (P < 0.001) regardless of patient age, origin of PN, intensity or quality of pruritus.Conclusions Hypoplasia of epidermal sensory nerves independently of clinical parameters is a new finding in PN and suggests involvement of epidermal nerves in PN pathophysiology. To date, it cannot be ruled out that reduced IENF density is due to repeated scratching. However, the presence of hypoplasia in nonlesional PN skin suggests the presence of a subclinical small fibre neuropathy.