Pruritus: An underrecognized symptom of small-fiber neuropathies

BackgroundSmall-fiber neuropathies (SFN) are diseases of small nerve fibers that are characterized by autonomic and sensory symptoms.ObjectiveWe sought to evaluate sensory symptoms, especially pruritus, in patients with SFN.MethodsA questionnaire was given to patients with SFN.ResultsIn all, 41 patients responded to the questionnaire (71.9% response rate). The most frequent sensory symptoms were burning (77.5%), pain (72.5%), heat sensations (70.2%), and numbness (67.5%). Pruritus was present in 68.3% of patients. It appeared most often in the evening, and was localized to the limbs in a distal-to-proximal gradient, although the back was the most frequent location (64%). Exacerbating factors were fatigue, xerosis, sweating, hot temperature, and stress. Cold water was an alleviating factor.LimitationsRecall bias associated with filling out the questionnaire, relatively small sample size, and the uncontrolled, retrospective nature of the study were limitations.ConclusionPruritus occurs frequently in patients with SFN and could be recognized as a possible presenting symptom, especially if there are other sensory or autonomic symptoms.