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

• Published in: British journal of dermatology (1951) Vol. 176; no. 1; pp. 209 - 211
• Main Authors: Hurliman, E., Groth, D., Wendelschafer‐Crabb, G., Kennedy, W., Kavand, S., Ericson, M., Hordinsky, M.
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.01.2017
• Subjects: Adult; Biopsy; Burning; Dermatomyositis; Dermatomyositis - complications; Dermatomyositis - diagnostic imaging; Female; Humans; Microscopy, Confocal; Muscle Weakness - etiology; Myositis; Neuropathy; Pain; Pruritus; Pruritus - etiology; Scalp; Scalp Dermatoses - complications; Scalp Dermatoses - diagnostic imaging; Skin; Small Fiber Neuropathy - diagnostic imaging; Small Fiber Neuropathy - etiology
• ISSN: 0007-0963; 1365-2133
• DOI: 10.1111/bjd.14678

Summary Dermatomyositis (DM) is commonly associated with scalp pruritus that can be severe. In addition, significant crawling and burning sensations have been reported in these cases. The aetiology of these scalp sensations in the context of DM is not fully understood. We report a 42‐year‐old female with treatment‐resistant DM and structural changes in scalp epidermal and dermal nerve fibres. The patient presented with characteristic skin manifestations (Gottron's papules and poikiloderma), severely pruritic scalp, intermittent muscle weakness on neurological exam with electrodiagnostically confirmed myositis, and joint pain. Structural changes in scalp epidermal and dermal nerve fibres were discovered in a skin biopsy, suggesting that small‐fibre neuropathy associated with scalp pruritus may be a manifestation of the DM syndrome. Further clinical experience combined with selective skin biopsy in patients with DM and symptomatic scalp will help determine the frequency of coexistent small nerve fibre involvement. Based on our limited findings, we suggest that pruritus in DM may be associated with abnormal epidermal and dermal nerve fibre structure. What's already known about this topic? It is known that pruritus is a complex and multifactorial phenomenon. Dermatomyositis is a condition that is commonly associated with recalcitrant treatment‐resistant pruritus. What does this study add? This study adds to the existing knowledge by demonstrating abnormal epidermal nerve fibre structure that may be related to the severe pruritus associated with dermatomyositis. Linked Comment: Bernhard. Br J Dermatol 2017; 176:16–17.