Relief of post-herpetic neuralgia by surgical removal of painful skin.
We present a case of longstanding PHN treated by skin excision of the area of greatest pain (11.3 x 26.0 cm(2)). The operation reduced pain, eliminated tactile allodynia, and facilitated greatly reduced medication use over a 1-year follow-up period. Fourteen punch biopsies and 10 strips of skin (each 10 mm long) from the excised painful PHN skin were qualitatively assessed by double-label immunofluorescence using antibodies against protein-gene-product 9.5 (PGP9.5), 200 kDa neurofilament protein (NF), calcitonin gene-related peptide (CGRP) and vanilloid receptor-1 (VR-1). Compared with a punch biopsy from mirror image skin, the pattern of cutaneous innervation in PHN skin was consistently and substantially different. The results may explain the anatomical basis of the capsaicin-response test and have implications for our understanding of clinical mechanisms underlying PHN pain.
Petersen
Karin L
KL
Department of Neurology, UCSF Pain Clinical Research Center, University of California-San Francisco, 1701 Divisadero Street, Suite 480, San Francisco, CA 94115, USA. klp@itsa.ucsf.edu
Rice
Frank L
FL
Suess
Fred
F
Berro
Marlene
M
Rowbotham
Michael C
MC
D000368:Aged; D001706:Biopsy; D015740:Calcitonin Gene-Related Peptide / Q000378:metabolism; D062109:Dermatologic Surgical Procedures; D006562:Herpes Zoster / Q000150:complications*; D006801:Humans; D006941:Hyperesthesia / Q000209:etiology / Q000503:physiopathology; D008297:Male; D009437:Neuralgia / Q000150:complications / Q000503:physiopathology / Q000601:surgery* / Q000821:virology*; D016900:Neurofilament Proteins / Q000378:metabolism; D010146:Pain / Q000503:physiopathology; D010166:Palliative Care; D011955:Receptors, Drug / Q000378:metabolism; D012867:Skin / Q000473:pathology / Q000503:physiopathology*; D013869:Thiolester Hydrolases / Q000378:metabolism; D014110:Touch; D043222:Ubiquitin Thiolesterase
D016900:Neurofilament Proteins; D011955:Receptors, Drug; D013869:Thiolester Hydrolases; D043222:Ubiquitin Thiolesterase; D015740:Calcitonin Gene-Related Peptide