title: Multilevel symmetric neuropathic pruritus (MSNP) presenting as recalcitrant "generalized" pruritus.
abstract: BACKGROUND
  Chronic itch is a disruptive and disabling condition that can lead to psychological stress and depression.
  
  
  OBJECTIVE
  We sought to describe an entity of generalized, symmetric, neuropathic pruritus, which we term "multilevel symmetric neuropathic pruritus," and offer possible explanations accounting for its pathogenesis.
  
  
  METHODS
  A case series of 14 patients was evaluated at academic institutions from 2011 to 2015.
  
  
  RESULTS
  All patients exhibited detectable degenerative vertebral changes, as seen by spinal x-ray or magnetic resonance imaging. In 12 of 14 (85.7%) subjects, the radiographic imaging abnormalities directly correlated with the distribution of their cutaneous findings. Twelve of 14 (85.7%) patients had cutaneous findings along the C5 to C6 and/or C6 to C7 dermatomal distributions. Eleven of 14 (78.5%) patients were overweight or obese, and 14 of 14 (100%) patients had at least 4 risk factors for the development of atherosclerosis. Twelve of 14 (85.7%) patients noted complete or near complete resolution after treatment with gabapentin (300-1200 mg daily).
  
  
  CONCLUSIONS
  No healthy age-matched control group without pruritus was investigated.
  
  
  CONCLUSIONS
  A combination of multilevel degenerative disc disease of the spine, spinal nerve root impingement, and/or nerve root traction may play a pivotal role in the cause of multilevel symmetric neuropathic pruritus.
authors.affiliation: Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana. Electronic address: wardr@iupui.edu.
authors.forename: Rachel Elizabeth
authors.initials: RE
authors.lastname: Ward
authors.affiliation: Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Vindhya Lakshmi
authors.initials: VL
authors.lastname: Veerula
authors.affiliation: Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Navid
authors.initials: N
authors.lastname: Ezra
authors.affiliation: Department of Pharmacology and Toxicology, Wright State University, Dayton, Ohio; Department of Dermatology, Wright State University, Dayton, Ohio.
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Travers
authors.affiliation: Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Nico
authors.initials: N
authors.lastname: Mousdicas
mesh_terms: D017677:Age Distribution; D000368:Aged; D000588:Amines / Q000627:therapeutic use; D002908:Chronic Disease; D015331:Cohort Studies; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D018450:Disease Progression; D005260:Female; D000077206:Gabapentin; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases / Q000150:complications*; D011379:Prognosis; D011537:Pruritus / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology* / Q000523:psychology; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
chemical_list: D000588:Amines; D003509:Cyclohexanecarboxylic Acids; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin
keywords: atherosclerosis; degenerative disc disease; dermatomal; gabapentin; neuropathic; pruritus; symmetric