CRPS & Neuropathic Itch: CRPS & Itchy, Blistering Skin: Understanding Skin Changes in Complex Regional Pain Syndrome
Complex Regional Pain Syndrome (CRPS) is a neurological condition that affects the Central, Autonomic, Sympathetic, and Enteric Nervous Systems, leading to severe pain. It can develop in anyone at any time after an injury. During the acute phase, CRPS causes circulation changes and vasoconstriction, along with constant firing of the inflammatory response. These factors contribute to various skin changes, ranging from minor texture and thinning alterations to more severe issues like bruising, blisters, and painful ulcers.
Skin Discoloration and Itching in CRPS:
CRPS can cause skin issues, discoloration, and itching. Some individuals suffering from CRPS may experience frightening blisters, open sores, and wounds. The condition affects circulation, leading to decreased oxygen supply to the affected limb and inadequate nutrient delivery to the skin and tissue, resulting in changes in skin texture, appearing shiny and thin.
Brittle skin may also develop, leading to tissue atrophy, tightness, and increased susceptibility to bruising, similar to eczema. Doctors and dermatologists may recommend lotions or creams to address skin concerns.
CRPS Skin Ulcers:
In rare cases, the skin may deteriorate further, leading to slow-healing ulcers that are challenging to treat, with new ulcers forming near old ones. To prevent or reduce new ulcers, doctors may employ vasodilator drugs like Verapamil and Ketanserin or use well-vented, padded splints to protect the skin.
Management of skin issues may involve prescribed drugs like Topamax, Gabapentin, and Lyrica, along with moisturizing the skin using fragrance-free and chemical-free lotions. Natural therapies, such as bathing in Magnesium, oats, olive oil, or baking soda-enriched baths, can also be helpful.
Neuropathic Itch:
CRPS can cause chronic itch due to dysfunctions in itch-sensing neurons, leading to sensory hallucinations of pruritogenic stimuli. Patients may experience a neuropathic itch, and scratching can trigger reflex responses, offering only fleeting relief and potentially worsening the itching. Patients might unknowingly cause severe painless self-injury by scratching deeply. To minimize scratching, using a protective barrier may be considered.
Formication:
CRPS can lead to a sensation known as “formication,” a tactile hallucination in which a person feels like insects are crawling over their skin. Formication is caused by sensory-paresthesia changes associated with CRPS. The sensation may be described as “spiders crawling on my skin.” While the sensation is unsettling, it is a tactile hallucination without a physical cause.
Treating CRPS & Neuropathic Itch:
Addressing the itch can be challenging, as many over-the-counter treatments and pain medications are often ineffective. Consultation with a doctor is essential to explore current treatment recommendations, including local or systemic administration of neuronal excitability inhibitors, such as local anesthetics. However, despite advances in understanding itch mechanisms in the typical nervous system, neuropathic itch in CRPS remains poorly understood.
