Truncal Pruritus of Unknown Origin May Be a Symptom of Diabetic Polyneuropathy

Abstract

OBJECTIVEOur goal was to ascertain the prevalence of pruritus in diabetic and nondiabetic subjects and the relevance of symptoms, signs, and nerve functions of diabetic polyneuropathy (DPN) of pruritus.RESEARCH DESIGN AND METHODSA large-scale survey of 2,656 diabetic outpatients and 499 nondiabetic subjects was performed. In diabetic subjects, the relationship between pruritus and age, sex, diabetic duration, A1C, Achilles tendon reflex (ATR), and abnormal sensation in legs was evaluated. In 105 diabetic subjects, nerve conduction studies, quantitative vibratory threshold (QVT), heart rate variability, and a fall of systolic blood pressure at a head-up tilt test (ΔBP) were performed, and the relationships between pruritus and nerve functions were evaluated.RESULTSAlthough the prevalence of truncal pruritus of unknown origin (TPUO) in diabetic subjects was significantly higher than that in age-matched nondiabetic subjects (11.3 vs. 2.9%, P = 0.0001), the prevalence of other pruritus was not different between the two groups. Multiple logistic regression analysis revealed that abnormal sensation and ATR areflexia were independent risk factors for TPUO in age, sex, duration of diabetes, and A1C. ΔBP in diabetic subjects with TPUO was significantly impaired compared with that in those without TPUO. Larger ΔBP was identified as a significant risk factor of TPUO independent of other nerve dysfunctions by multiple logistic regression analysis.CONCLUSIONSTPUO is significantly more frequent in diabetic than in nondiabetic individuals. TPUO is significantly associated with symptoms and signs of DPN, including impaired blood pressure response in a head-up tilt test. TPUO, therefore, might be a newly recognized symptom of DPN.

An Unusual Presenting Symptom in an Atypical Case of Acute Inflammatory Polyradiculopathy: Facial Pruritus

“…For those patients, they related itching to loss of sudomotor function or direct C fiber injury (12). However, this explanation does not account for the case of polyneuropathy involving large myelinated fibers like our patient.…”

HbA1c Is Related with Uremic Pruritus in Diabetic and Nondiabetic Hemodialysis Patients

“…The authors suggested that truncal pruritus of unknown origin was suspected of being a complication of diabetes, and diabetic polyneuropathy was suspected of being a possible origin of truncal pruritus of unknown origin. 20 To the best of our knowledge, in HD patients there is no study that compared the pruritus prevalence of diabetic and nondiabetic patients. As a novel finding, in this study we found that diabetic HD patients experienced more severe pruritus, as evaluated by VAS pruritus score, than nondiabetic HD patients and, interestingly, in both diabetic and nondiabetic patients, UP was independently related with HbA1c.…”

“…As the itching sensation is thought to be transmitted by small, unmyelinated sensory c-fibers, 27 pruritus may reflect some abnormality of the peripheral nerve. 20 Indeed, it was previously hypothesized that neuropathy seen in dialysis patients might reflect a dysfunction of the peripheral nervous system. 16,28 Additionally, as uremia progresses, peripheral nervous system becomes more affected, especially the sensory parts.…”

Kleinfaserneuropathie als mögliche Ursache für chronischen Pruritus

“…Entgegen der früheren Lehrmeinung ist Diabetes mellitus eine häufige metabolische Ursache, die zum generalisierten Pruritus führt. Typischerweise beginnt der "diabetogene Pruritus" an den Füßen/ Unterschenkeln oder am Rumpf [30]. Die Einstellung des postprandialen Glukosespiegels führt in der Regel zu einer Linderung des Pruritus [9].…”