Continuing medical education
Neurocutaneous disease: Neurocutaneous dysesthesias

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Dysesthesia is a generic term for a cutaneous symptom—such as pruritus, burning, tingling, stinging, anesthesia, hypoesthesia, tickling, crawling, cold sensation, or even pain—without a primary cutaneous condition in a well-defined location that is often caused by nerve trauma, impingement, or irritation. There are multiple types of dysesthesias depending on the body location and the nerves involved. While location, exact symptoms, and etiologies might vary, the underlying theme is that these conditions are of neurologic origin and have dermatologic consequences. For many of these conditions, the symptoms are localized to the skin, and patients frequently present to the dermatologist; it is important for dermatologists to be knowledgeable about these symptoms and their underlying causes. In part II of this continuing medical education review, the primary diagnoses associated with underlying cutaneous dysesthesias will be explored, including scalp dysesthesia, trigeminal trophic syndrome, meralgia paresthetica, notalgia paresthetica, and brachioradial pruritus. The typical demographics in terms of symptoms, location, and patient populations will be discussed in addition to the specific etiologies, workups, and possible treatment options.

Section snippets

Scalp dysesthesia

Key point

  1. •

    Thought to be caused by either psychiatric conditions or nerve trauma either indirectly through muscle tension or directly through surgical trauma

Trigeminal trophic syndrome

Key points

  1. •

    Trigeminal trophic syndrome most commonly affects the V2 branch of the trigeminal nerve, resulting in ulceration of the nasal ala

  2. •

    The most common cause of trigeminal trophic syndrome is trigeminal nerve ablation for trigeminal neuralgia and cerebral vascular accidents

  3. •

    Treatment includes physical barriers, pharmacologic interventions, and surgical repairs

Meralgia paresthetica

Key points

  1. •

    Meralgia paresthetica affects the anterolateral thigh

  2. •

    Meralgia paresthetica is caused by both iatrogenic and spontaneous causes, including weight gain, pregnancy, and constrictive clothing

Notalgia paresthetica

Key points

  1. •

    Notalgia paresthetica symptoms are frequently located between the scapula and vertebral column

  2. •

    Notalgia paresthetica is often associated with hyperpigmented patches/plaques

  3. •

    Notalgia paresthetica can be associated with multiple endocrine neoplasia type 2A

Brachioradial pruritus

Key points

  1. •

    Brachioradial pruritus is usually located on the dorsolateral aspect of the arm, around the elbow

  2. •

    Brachioradial pruritus is often exacerbated by sun exposure

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    Funding sources: None.

    Conflicts of interest: None declared.

    Date of release: February 2016

    Expiration date: February 2019

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