January 28, 2015
Sweating Patterns and Possible Underlying Small-Fiber Neuropathy
The British Journal of Dermatology
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TAKE-HOME MESSAGE
- The authors of this retrospective analysis included patients who underwent thermoregulatory sweat testing (TST), which examines whole-body sweating, and who had itching, burning, numbness, and tingling sensations. Because it is mediated by small nerve fibers, sweating may be a marker for small-fiber neuropathy. Of the 227 patients included, 66% had an abnormal TST and 80% had an area of anhidrosis that corresponded with the area of the abnormal cutaneous sensations.
- Patients with itching, burning, numbness, or tingling sensations may have abnormal sweating in those areas, which may be secondary to an underlying small-fiber neuropathy.
– Joshua Arbesman, MD
Abstract
BACKGROUND
Itching, burning, numbness and tingling of the skin are frequent reasons for dermatology consultation. We hypothesized that these sensations may be attributable to a small-fibre neuropathy. Sweating, which is mediated by small nerve fibres, may be a surrogate marker of small-fibre neuropathy.
OBJECTIVES
To investigate the results of thermoregulatory sweat testing (TST), which depicts and estimates whole-body sweating, in patients with itching, burning, numbness and tingling sensations.
METHODS
We retrospectively reviewed the medical records of 227 patients with itching, burning, numbness and tingling sensations involving the skin who were seen at our institution during 2008 and also underwent TST.
RESULTS
The mean age of the cohort was 54 years (range 3–89), and 58% were female. In all, 149 patients (66%) had abnormal TST results; in 119 (80%) of these patients the areas of anhidrosis on TST corresponded to their symptomatic areas. For each symptom analysed separately, the area of anhidrosis correlated with the area of symptoms in most patients.
CONCLUSIONS
Patients with burning, itching, numbness and tingling have abnormal sweating patterns and often do not sweat in the symptomatic areas. These novel findings suggest that a small-fibre neuropathy may underlie many cutaneous symptoms and that the neuropathy can be estimated using TST.