Altered manifestations of skin disease at sites affected by neurological deficit

We reviewed the literature and identified 23 cases of alterations in the appearance or distribution of skin disorders in patients with acquired central or peripheral neural damage or dysfunction

E. Azimi; E.A. Lerner; S.B. Elmariah

2014

Scholarcy highlights

  • Peripheral nerve fibers are capable of releasing neuromediators including neuropeptides when activated
  • Neurogenic inflammation has been implicated in the pathogenesis of many skin disorders including psoriasis, atopic dermatitis and rosacea
  • We identified a total of 23 cases described in 19 case reports, including 9 cases of eczema, 8 cases of psoriasis, 2 cases of scleroderma, and 1 case each of rosacea, contact dermatitis, bullous pemphigoid and a relapsing vesicular dermatitis
  • While nerve injury was associated with improvement in cutaneous involvement in the majority of cases, worsening or new onset of skin lesions occurred in areas affected by neurologic deficit in 4 cases
  • Langerhans and mast cells are anatomically associated with neuropeptidergic fibers and previous studies have demonstrated that neuropeptides and adrenergic transmitters including epinephrine and norepinephrine can influence the function of these immune cell types, modulating antigen presentation, mast cell degranulation, and cytokine release
  • The cases highlighted in this review essentially represent in people what conditional genetic mutations have demonstrated in animal models, providing powerful clinical evidence for the importance of neural-mediated signaling in inflammatory skin disease

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