Multilevel symmetric neuropathic pruritus (MSNP) presenting as recalcitrant "generalized" pruritus

Abstract

Background: Chronic itch is a disruptive and disabling condition that can lead to psychological stress and depression.

Objective: We sought to describe an entity of generalized, symmetric, neuropathic pruritus, which we term "multilevel symmetric neuropathic pruritus," and offer possible explanations accounting for its pathogenesis.

Methods: A case series of 14 patients was evaluated at academic institutions from 2011 to 2015.

Results: All patients exhibited detectable degenerative vertebral changes, as seen by spinal x-ray or magnetic resonance imaging. In 12 of 14 (85.7%) subjects, the radiographic imaging abnormalities directly correlated with the distribution of their cutaneous findings. Twelve of 14 (85.7%) patients had cutaneous findings along the C5 to C6 and/or C6 to C7 dermatomal distributions. Eleven of 14 (78.5%) patients were overweight or obese, and 14 of 14 (100%) patients had at least 4 risk factors for the development of atherosclerosis. Twelve of 14 (85.7%) patients noted complete or near complete resolution after treatment with gabapentin (300-1200 mg daily).

Limitations: No healthy age-matched control group without pruritus was investigated.

Conclusion: A combination of multilevel degenerative disc disease of the spine, spinal nerve root impingement, and/or nerve root traction may play a pivotal role in the cause of multilevel symmetric neuropathic pruritus.

Keywords: atherosclerosis; degenerative disc disease; dermatomal; gabapentin; neuropathic; pruritus; symmetric.