Sensitive skin is a neuropathic disorder
Sensitive skin is a neuropathic disorder
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DOI：
10.1111/exd.13991
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发表时间：
2019-07-31
影响因子：
3.6
通讯作者：
Misery, Laurent
中科院分区：
文献类型：
--
作者：
Huet, Flavien;Misery, Laurent
敏感皮肤的定义是出现不愉快的感觉，如刺痛、灼烧、紧绷、瘙痒或疼痛。解释敏感皮肤的机制是有争议的，提出了许多假设。由于敏感皮肤的主要特征是多种神经病变样症状，因此皮肤的神经感觉功能障碍很可能是敏感皮肤的病理机制之一。这一假说并不排除其他解释，如角质细胞、瞬时受体电位通道、脉管系统或环境因素的作用。然而，神经系统在敏感皮肤发育中的作用是至关重要的，越来越多的证据支持这一假设。敏感皮肤患者描述的疼痛和瘙痒对应于神经性成分，其评估显示与对照组相比，神经性测量（DN-4, Douleur neuropathque 4）增加。这些感觉类似于在小纤维神经病（SFN）中观察到的感觉，这是一组影响薄神经纤维的疾病。一项关于敏感皮肤病理生理学的研究表明，敏感皮肤组表皮内神经纤维密度，特别是肽能c纤维密度较低。最近的一项研究表明，敏感皮肤患者的热痛检测阈值有所改变。所有这些结果表明，c纤维损伤有助于解释敏感皮肤。因此，神经系统的作用日益明显。然而，角化细胞和其他表皮细胞密切参与感觉传导。因此，神经生理学研究的结果应该根据这一信息来解释，即整个表皮代表一个巨大的多模伤害感受器。
Sensitive skin is defined by the occurrence of unpleasant sensations such as tingling, burning, tautness, itching or pain. Mechanisms explaining sensitive skin are controversial, and many hypotheses have been proposed. Because sensitive skin is primarily characterized by a wide variety of neuropathic-like symptoms, it is highly likely that neurosensory dysfunction in the skin represents one of the pathological mechanisms of sensitive skin. This hypothesis does not exclude other explanations like role of keratinocyte, transient receptor potential channels, vasculature or environmental factors. Nevertheless, the role of the nervous system in the development of sensitive skin is crucial, and growing evidence supports this hypothesis. Pain and pruritus described by patients with sensitive skin correspond to neuropathic component, and its assessment shows an increase in neuropathic measures (DN-4, Douleur Neuropathique 4) compared with control. These sensations are similar to the sensations observed in small-fibre neuropathy (SFN), which is a group of disorders that affect thin nerve fibres. One study on the pathophysiology of sensitive skin demonstrated that intra-epidermal nerve fibre density, especially of peptidergic C-fibres, was lower in the sensitive skin group. A recent study showed a modification in heat-pain detection threshold in patients with sensitive skin. All these results indicate that C-fibre damage can help explain sensitive skin. Consequently, the role of the nervous system is increasingly obvious. Nevertheless, keratinocytes and other epidermal cells closely participate in sensory transduction. Therefore, the results of neurophysiological studies should be interpreted in the light of this information that the whole epidermis represents a huge polymodal nociceptor.