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Chronic itch occurs in two-thirds of small fiber neuropathy patients and shows a distinct, predominantly distal distribution that differs from typical neuropathic pain patterns.
A novel large-scale study has revealed that chronic itch—long overshadowed by pain—may be one of the most defining symptoms of small fiber neuropathy (SFN), offering fresh diagnostic clues and raising fundamental questions about underlying mechanisms.
Chronic itch, or pruritus, is widely recognized as a common skin discomfort, but its neurological basis is often overlooked. SFN, a disorder impacting small myelinated Aδ fibers and unmyelinated C-fibers, has long been connected with neuropathic pain, yet its association with itch has remained under-investigated. Previous research reported itch prevalence rates of 63%–68%, but no consistent symptom pattern had been identified—until now.
In this comprehensive study, a total of 1415 patients completed an extensive questionnaire exploring the nature of their itch symptoms. Notably, 83% were diagnosed with SFN based on Besta criteria, making this one of the most robust datasets available.
Key findings
The findings emphasize itch as a heterogeneous but clinically meaningful symptom of SFN. Its unique distribution—particularly in the hands and feet—may serve as a valuable diagnostic indicator, helping physicians differentiate SFN from other neuropathic or dermatologic conditions. Researchers emphasize that understanding itch patterns could improve early detection, refine patient evaluations, and guide targeted treatments.
Journal of the Peripheral Nervous System
Where Does It All Itch? Exploring the Characteristics of Pruritus in Small Fiber Neuropathy
Dennis Kool et al.
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