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- Carlsson, Christer, et al.
(författare)
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Cutaneous innervation before and after one treatment period of acupuncture.
- 2006
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Ingår i: British Journal of Dermatology. - : Oxford University Press (OUP). - 1365-2133 .- 0007-0963. ; 155:5, s. 970-976
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The effect of acupuncture on nociceptive pain is well documented, but effects on nociceptive itch have been contradictory. OBJECTIVES: To evaluate possible effects of acupuncture on the occurrence, distribution and function of sensory nerve fibres in human skin. METHODS: Ten subjects were treated by inserting 10 acupuncture needles subcutaneously at the upper lateral aspect of one buttock. The subjects were recruited from an acupuncture clinic and were undergoing specific acupuncture treatment for their disorders. The needles were stimulated (rotated to and fro) twice during the twice-weekly 25-min sessions over 5 weeks. Skin biopsies, diameter 3 mm, were taken before and 3-6 days after local acupuncture. Antibodies to the pan-neuronal marker protein gene product 9.5 (PGP 9.5), calcitonin gene-related peptide (CGRP), vanilloid receptor 1 (VR1) and mu- and delta-opioid receptors were employed to study sensory unmyelinated nerve fibres that transmit nociceptive pain and itch. A histamine prick test using planimetry was used to record experimental itch after acupuncture on the treated area and on the corresponding control skin, and a visual analogue scale was used to evaluate itch. RESULTS: The mean +/- SEM number of CGRP-immunoreactive nerve fibres per biopsy section was reduced from 36.0 +/- 3.3 to 21.3 +/- 4.0 (P = 0.05) after the treatment. PGP 9.5-immunoreactive nerve fibres were found both in the epidermis and in the subpapillary dermis. The mean +/- SEM total number of PGP 9.5-immunoreactive nerve fibres decreased from 249.8 +/- 16.7 to 211.8 +/- 12.0 (P = 0.03). The PGP 9.5-immunoreactive nerve fibres occurring in the dermis appeared more fragmented after the acupuncture compared with pretreatment. VR1 immunoreactivity was found both in the free nerve fibres and in kite-like formations, possibly mast cells, throughout the dermis, sometimes occurring around hair follicles. The mean +/- SEM number of VR1-immunoreactive elements was not significantly influenced by acupuncture, at 33.5 +/- 4.6 vs. 43.0 +/- 4.4 (P = 0.09). No immunoreactivity was found in the skin against mu- and delta-opioid receptors with the antibodies used in this study. Neither histamine-induced itch nor cutaneous responses were influenced by acupuncture. CONCLUSIONS: The present data indicate an effect of acupuncture on neuropathic itch but not histamine-mediated itch. Our findings support the opinion that the pain-relieving effects of acupuncture partly depend on its effect on the peripheral innervation.
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| 2. |
- Wallengren, Joanna, et al.
(författare)
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Brachioradial pruritus is associated with a reduction in cutaneous innervation that normalizes during the symptom-free remissions.
- 2005
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Ingår i: Journal of American Academy of Dermatology. - : Elsevier BV. - 0190-9622. ; 52:1, s. 142-145
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Tidskriftsartikel (refereegranskat)abstract
- Background: There has been a controversy regarding the cause of brachioradial pruritus: is it caused by a nerve compression in the cervical spine or is it caused by a prolonged exposure to sunlight? Objective: The purpose was to study clinical features of patients with brachioradial pruritus and to compare the cutaneous innervation in punch biopsies from the itchy skin of patients with the age-matched controls. Methods: Skin biopsy specimens from itchy skin of 16 patients with brachioradial pruritus were collected during the early autumn and were compared with corresponding skin specimens from 11 age-matched controls in the early spring, four of the patients being their own controls. The cutaneous innervation was visualized by antibodies against protein gene product 9.5 (general neuronal marker), by antibodies against calcitonin gene-related peptide (marker for thin sensory nerve fibers), and by antibodies against VR1-receptor (marker for capsaicin-sensitive nerve fibers). Results: In all but two of the patients, itching of the arms or shoulders was seasonal. Some patients reported neck pain. in the skin of the lower arm, the number of protein gene product 9.5 immunoreactive nerve fibers was reduced 23% as compared with controls (P = .03), the number of intraepithelial nerve fibers being reduced by 27% (P = .03). The number of calcitonin gene-related peptide immunoreactive nerve fibers in the dermis was reduced by 34% (P = .02) and the number of capsaicin-sensitive nerve fibers by 43% (P = .008). The innervation of the four patients who were their own controls became normalized during the symptom-free period. Conclusions: The temporal course of the brachioradial pruritus and the histological changes in the skin similar to those caused by ultraviolet light, indicate that sunlight is an eliciting factor and that cervical spine disease can be a predisposing factor.
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| 3. |
- Wallengren, Joanna, et al.
(författare)
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Cutaneous field stimulation in the treatment of severe itch
- 2001
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Ingår i: Archives of Dermatology. - 0003-987X. ; 137:10, s. 1323-1325
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate the efficacy of cutaneous field stimulation of C fibers for the treatment of itchy skin and its effect on peripheral nerve fibers as shown in skin biopsy specimens. DESIGN: We conducted an open-label uncontrolled study of 19 patients with itching. Each patient applied a flexible plate containing electrodes to the itchy area for 20 minutes at a time once daily for 5 weeks to stimulate nerve fibers with a constant current (0.8 mA). Skin biopsy specimens were collected before treatment and at the end of treatment and were immunostained for calcitonin gene-related peptide and protein gene product 9.5. SETTING: University hospital in Lund, Sweden. PATIENTS: Sixteen patients with nostalgia paresthetica or brachioradial pruritus and 3 with generalized itch. INTERVENTIONS: Cutaneous field stimulation and punch biopsies of the itchy skin. MAIN OUTCOME MEASURES: Visual analog scale for assessment of itching and counting the immunoreactive nerve fibers in 3-mm biopsy specimens. RESULTS: Patients with localized itching experienced a reduction in mean values on the visual analog scale (from 78% before treatment to 42% by the end of the fifth week). The number of protein gene product 9.5- immunoreactive nerve fibers in the epidermis was reduced by 40% by the end of treatment compared with baseline values. CONCLUSIONS: Cutaneous field stimulation is an effective alternative for the treatment of localized itching. The reduction in itching is accompanied by degeneration of the epidermal nerve fibers, as evidenced by the loss of protein gene product 9.5 immunoreactivity.
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| 4. |
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| 5. |
- Wallengren, Joanna, et al.
(författare)
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Cutaneous sensory nerve fibers are decreased in number after peripheral and central nerve damage.
- 2002
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Ingår i: Journal of American Academy of Dermatology. - : Elsevier BV. - 0190-9622. ; 46:2, s. 215-217
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Tidskriftsartikel (refereegranskat)abstract
- Two dermatologic patients displaying peripheral and central nerve damage, respectively, are described. Cutaneous nerve fibers in both patients were studied in skin biopsy specimens taken from neuropathic areas and from the contralateral side, immunocytochemistry being applied to a pan-neuronal marker, a protein gene-product (PGP 9.5). One of the patients, suffering from compression of the ulnar nerve, had dyshidrotic eczema of the hands that was absent on areas of skin that were neuropathic. The cutaneous innervation (most of which was sensory) was reduced by 50% in the neuropathic area as compared with the contralateral side. The other patient had unilateral pruritus on the parethic side after a stroke. The cutaneous innervation of that side was reduced by 80% as compared with the other side. It seems that peripheral sensory innervation is a prerequisite for inflammation, whereas spontaneous itching may emanate from a central nervous system disorder such as a stroke and continue on in partly denervated skin.
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| 7. |
- Wallengren, Joanna, et al.
(författare)
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Innervation of the skin of the forearm in diabetic patients: relation to nerve function
- 1995
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Ingår i: Acta Dermato-Venereologica. - 1651-2057. ; 75:1, s. 37-42
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Tidskriftsartikel (refereegranskat)abstract
- Complications of diabetes include sensory and autonomic neuropathy. The aim of the present paper was to study the degree of sensory and autonomic neuropathy and correlate these findings with the distribution and density of neuropeptidergic nerve fibers in the skin of the forearm of diabetic patients and healthy controls. We investigated 30 diabetics (24 type 1 and 6 type 2) and compared them with 13 healthy controls. There were no differences between the groups with respect to density and distribution of nerve fibers displaying immunoreactivity to the pan-neuronal marker PGP 9.5 and sensory and parasympathetic neuropeptides (substance P, calcitonin gene-related peptide and vasoactive intestinal peptide). By contrast, nerve fibers containing neuropeptide Y, a marker of sympathetic neurons, were reduced in number in the diabetic patients. C-fiber function (measured as the axon-reflex-evoked flare response) became impaired with increasing age in all subjects. The diabetic patients, however, showed a reduced flare compared to age-matched healthy controls. The reduction was particularly prominent in the younger patients (20-50 years). There was a greater reduction of the flare in neuropathic patients than in non-neuropathic patients, but there was no correlation between the degree of functional impairment and the duration of the disease.
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