Stimulated skin wrinkling for predicting intraepidermal nerve fibre density

Wilder-Smith, Einar; Guo, Yaling; Chow, Adeline

doi:10.1016/j.clinph.2009.03.011

Cited by 27 publications

(39 citation statements)

References 13 publications

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“…We have previously demonstrated a high inter- and intra-rater correlation for the SSW assessment with EMLA (5). In this current study, 2 trained examiners blinded to the patient’s clinical status, graded the skin wrinkling scores in 46 of these patients, both on the same day of testing, under identical conditions.…”

Section: Resultsmentioning

confidence: 99%

“…It has been shown to predict abnormal IENFD in patients with sensory neuropathy (4, 5), an accepted end-point for clinical trials for early stages of diabetic neuropathy (27). Based on this knowledge, our study sought to determine the use of SSW as a cost-effective, simple diagnostic tool for distal diabetic neuropathy.…”

Section: Discussionmentioning

confidence: 99%

“…We had previously found that this can be circumvented by comparing the area of stimulated wrinkling with that of the adjacent control skin in order to counter over-scoring (5). Our study validates this as a reasonable method of grading skin wrinkling, given we found that the elderly were more likely to have abnormal wrinkling scores, correlating with the finding of age as an independent predictor of IENFD in healthy individuals (38).…”

Section: Discussionmentioning

confidence: 99%

“…Skin wrinkling occurs as a result of vasoconstriction in the glabrous skin, mediated by post-ganglionic sympathetic fibers (2). As a test, it can be a simple method of determining small nerve fiber function (1, 3), and has been shown to correlate with intraepidermal nerve fiber density (IENFD) in patients with a sensory neuropathy (4, 5). …”

Section: Introductionmentioning

confidence: 99%

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EMLA-Induced Skin Wrinkling for the Detection of Diabetic Neuropathy

Ong

Nyein

et al. 2013

Front. Neurol.

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Objective: To determine the usefulness of Eutectic Mixture of Local Anesthetic (EMLA)-induced stimulated skin wrinkling (SSW) to detect diabetic sensorimotor polyneuropathy (DSPN).Research Design and Methods: Two hundred and ten diabetics were prospectively recruited (mean age 58.5 ± 12.7 years) from a large tertiary center from 2009 to 2011. EMLA was applied to the tips of digits 2, 3, and 4 and the degree of wrinkling graded. Diabetic Neuropathy Symptom (DNS) score, nerve conduction studies (NCS), Semmes–Weinstein monofilament (SWMF) tests, and vibratory perception thresholds (VPTs) testing were chosen as comparative clinical standards to diagnose length-dependent DSPN.Results: Inter-rater agreement for two examiners of SSW was high, with Cohen’s weighted κ of 0.912 for the right hand, and 0.823 for the left. K measure of agreement of SSW with the NCS, DNS scores, SWMF testing, and VPT testing was 0.486, 0.243, 0.289, and 0.395 respectively. SSW was able to distinguish between normal and abnormal NCS and DNS results, with median scores of 3.333 vs. 1.667 (p < 0.0005); and 3.167 vs. 2.000 (p < 0.0005) respectively. Following receiver operating characteristic-analysis, at a cut-off point of <3 for an abnormal SSW test, sensitivity of SSW test for diagnosing DSPN using NCS as a reference standard was 81.3%, and specificity was 67.0%, on par with other testing methods.Conclusion: SSW shows comparable sensitivity to other methods for detecting DSPN. Given its low cost and easy administration, SSW can be considered a useful alternative screening method for diagnosing diabetic neuropathy.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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EMLA-Induced Skin Wrinkling for the Detection of Diabetic Neuropathy

Ong

Nyein

et al. 2013

Front. Neurol.

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“…It is tested by immersing glabrous skin (smooth skin without hair, as on the palms or soles of the feet) in water or exposing it to EMLA (eutectic mixture of local anesthetic) 195196. It has been shown to correlate with IENFD in patients with sensory polyneuropathy,195197 and it has shown comparable sensitivity to other testing methods for diabetic neuropathy 196…”

Section: Diagnostic Approachmentioning

confidence: 99%

Diagnosis and management of sensory polyneuropathy

Gwathmey

Pearson

2019

BMJ

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Sensory polyneuropathies, which are caused by dysfunction of peripheral sensory nerve fibers, are a heterogeneous group of disorders that range from the common diabetic neuropathy to the rare sensory neuronopathies. The presenting symptoms, acuity, time course, severity, and subsequent morbidity vary and depend on the type of fiber that is affected and the underlying cause. Damage to small thinly myelinated and unmyelinated nerve fibers results in neuropathic pain, whereas damage to large myelinated sensory afferents results in proprioceptive deficits and ataxia. The causes of these disorders are diverse and include metabolic, toxic, infectious, inflammatory, autoimmune, and genetic conditions. Idiopathic sensory polyneuropathies are common although they should be considered a diagnosis of exclusion. The diagnostic evaluation involves electrophysiologic testing including nerve conduction studies, histopathologic analysis of nerve tissue, serum studies, and sometimes autonomic testing and cerebrospinal fluid analysis. The treatment of these diseases depends on the underlying cause and may include immunotherapy, mitigation of risk factors, symptomatic treatment, and gene therapy, such as the recently developed RNA interference and antisense oligonucleotide therapies for transthyretin familial amyloid polyneuropathy. Many of these disorders have no directed treatment, in which case management remains symptomatic and supportive. More research is needed into the underlying pathophysiology of nerve damage in these polyneuropathies to guide advances in treatment.

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Small fiber neuropathy: Getting bigger!

2016

Self Cite

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Etiological and clinical heterogeneity of small fiber neuropathy (SFN) precludes a unifying approach and necessitates reliance on recognizable clinical syndromes. Symptoms of SFN arise from dysfunction in nociception, temperature, and autonomic modalities. This review focuses on SFN involving nociception and temperature, examining epidemiology, etiology, clinical presentation, diagnosis, pathophysiology, and management. Prevalence of SFN is 52.95 per 100,000 population, and diabetes and idiopathic are the most common etiologies. Dysesthesia, allodynia, pain, burning, and coldness sensations frequently present in a length-dependent pattern. Additional autonomic features in gastrointestinal, urinary, or cardiovascular systems are frequent but poorly objectified. SFN is diagnosed by intraepidermal nerve fiber density and quantitative sensory and autonomic tests in combination with normal nerve conduction. Pathophysiological understanding centers on sodium channel dysfunction, and genetic forms are beginning to be understood. Treatment is directed at the underlying etiology supported by symptomatic treatment using antidepressants and anticonvulsants. Little is known about long-term outcomes, and systematic cohort studies are needed.

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Stimulated skin wrinkling for predicting intraepidermal nerve fibre density

Cited by 27 publications

References 13 publications

EMLA-Induced Skin Wrinkling for the Detection of Diabetic Neuropathy

EMLA-Induced Skin Wrinkling for the Detection of Diabetic Neuropathy

Diagnosis and management of sensory polyneuropathy

Small fiber neuropathy: Getting bigger!

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