Small‐fibre neuropathy in a patient with dermatomyositis and severe scalp pruritus

Hurliman, Elisabeth; Groth, David W.; Wendelschafer‐Crabb, Gwen; Kennedy, William R.; Kavand, Sima; Ericson, Marna E.; Hordinsky, Maria

doi:10.1111/bjd.14678

Cited by 24 publications

(21 citation statements)

References 7 publications

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“…A significant decrease in the density of epidermal nerve fibers was found on confocal microscopic evaluation of a skin biopsy in a patient with dermatomyositis, scalp erythema, and scalp itch. This finding suggests that scalp pruritus in this disease may be caused by small fiber neuropathy [35] . Dermoscopic exam shows enlarged polymorphous interfollicular vessels that are very suggestive of the diagnosis [12] ( Fig.…”

Section: Red Scalp Syndromementioning

confidence: 76%

Scalp Itch: A Systematic Review

Vázquez-Herrera

Sharma

Aleid

et al. 2017

Skin Appendage Disord

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ated with a desire to scratch [1] . Just like skin pruritus, its etiology may be of dermatological or non-dermatological origin. It is common for the dermatologist to encounter patients with no evident cause of scalp pruritus, making it a distressing situation for both the clinician and the patient. The aim of this paper is to review the clinical signs of the most common causes of scalp itch and other less common causes that must be considered in a systematic approach to scalp pruritus. Materials and MethodsWe performed a MEDLINE search through PubMed (1975PubMed ( -2017, using the terms scalp itch and scalp pruritus and included clinical trials, review articles, case series, and case reports to search for the causes of scalp itch. PathophysiologyAlthough various pathogenic etiologies contribute to scalp pruritus, the scalp itself has distinct neuroanatomy and vasculature, specific neuromediators and corresponding receptors, as well as the presence of scalp sebum and microflora, which are all properties that may explain its tendency to be implicated in patients who complain of itch. Keywords Scalp · Itch · Pruritus · Seborrheic dermatitis · Contact dermatitis · Anxiety · Lichen planopilaris · Lice · Pediculosis · Psoriasis · Trichoscopy AbstractScalp itch is a frequent complaint in the dermatological setting. It is common for the dermatologist to encounter patients with no evident cause of scalp pruritus, making it a distressing situation for both the clinician and the patient. The aim of this paper is to propose a systematic approach to scalp itch, which classifies scalp pruritus into two types: (1) with or (2) without dermatological lesions, and presence or absence of hair loss. Also, it is important to think first about the most common causes and then rule out other, less common etiologies. The acronym SCALLP and the five steps for scalp evaluation (listen, look, touch, magnify, and sample) are useful tools to keep in mind for an assertive approach in these patients.

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Section: Red Scalp Syndromementioning

confidence: 76%

Scalp Itch: A Systematic Review

Vázquez-Herrera

Sharma

Aleid

et al. 2017

Skin Appendage Disord

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“…Hurliman et al . report a patient with treatment‐resistant DM and structural changes in scalp epidermal and dermal nerve fibres discovered on skin biopsy; suggesting that in DM itch may be because of abnormal epidermal and dermal nerve fibre structure …”

Section: Types Of Case Reports With Examplesmentioning

confidence: 99%

“…Premenstrual flares of pyoderma gangrenosum controlled with use of a combined oral contraceptive and antiandrogen 12 Amelioration of junctional epidermolysis bullosa due to exon skipping 13 Small-fibre neuropathy in a patient with dermatomyositis and severe scalp pruritus 14 described had recalcitrant disease despite treatment with multiple therapies. Subsequent treatment with liraglutide resulted in significant weight loss and reduction in disease burden.…”

Section: Postulate Insights Into Disease Pathophysiologymentioning

confidence: 99%

“…Hurliman et al report a patient with treatment-resistant DM and structural changes in scalp epidermal and dermal nerve fibres discovered on skin biopsy; suggesting that in DM itch may be because of abnormal epidermal and dermal nerve fibre structure. 14 A well-written case report has many benefits. It may enable greater understanding of a common disease or provide inspiration when treating a patient who has failed standard therapy.…”

Section: Postulate Insights Into Disease Pathophysiologymentioning

confidence: 99%

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Reopening the case for case reports

2020

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Case reports remain a vital tool in the early dissemination of dermatological news; from novel therapies to previously unknown conditions at an earlier stage than clinical trials or observational studies would permit. With medical journals placing an ever-increasing emphasis upon impact factors and enhancing their scientific rigour through strict methodology the well-written case report can often be overlooked. We hope that this editorial will help to justify the BJD's continued commitment to this form of manuscript. We reviewed 64 consecutive case reports published in the BJD between January 2016 and April 2018. Here we highlight a selection of recent articles that illustrate the varied purposes of the case report: new dermatological conditions and novel associations, new dermatological therapies, new adverse effects of therapies and reports that provide insight into mechanisms of disease (Table 1). Acrodermatitis chronica atrophicans (ACA) is the late cutaneous form of Lyme borreliosis. The early phase presents with bluish-red discoloration and doughy swelling of the skin. The atrophic phase presents with red discoloration, and a thin wrinkled appearance of the skin. Bauvin et al. describe a patient with a large tumorous lesion on the right sole. 1 Histology showed a granulomatous lymphohistiocytic infiltrate with plasma cells. The patient recalled tick bites 2 years previously. Borrelia burgdorferi serology was highly positive and a polymerase chain reaction analysis on the skin biopsy detected B. burgdorferi sensu lato, genospecies B. afzelii. The lesion resolved with antibiotic therapy. This novel case suggests that ACA is not the only manifestation of late cutaneous Lyme disease.

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“…In this issue of the BJD , a group from the University of Minnesota describes their discovery of a small‐fibre neuropathy of the scalp in a 42‐year‐old woman with dermatomyositis and chronic, severe scalp pruritus . How often this association occurs, and whether or not it is causal, remains to be seen.…”

mentioning

confidence: 99%