Abstract
The human skin is a highly specialized organ for receiving sensory information but also to preserve the body's homeostasis. These functions are mediated by cutaneous small nerve fibers which display a complex anatomical architecture and are commonly classified into cutaneous A-beta, A-delta and C-fibers based on their diameter, myelinization, and velocity of conduction of action potentials. Knowledge on structure and function of these nerve fibers is relevant as they are selectively targeted by various autonomic neuropathies such as diabetic neuropathy or Parkinson's disease. Functional integrity of autonomic skin nerve fibers can be assessed by quantitative analysis of cutaneous responses to local pharmacological induction of axon reflex responses which result in dilation of cutaneous vessels, sweating, or piloerection depending on the agent used to stimulate this neurogenic response. Sensory fibers can be assessed using quantitative sensory test. Complementing these functional assessments, immunohistochemical staining of superficial skin biopsies allow analysis of structural integrity of cutaneous nerve fibers, a technique which has gained attention due to its capacity of detecting pathogenic depositions of alpha-synuclein in patients with Parkinson's disease. Here, we reviewed the current literature on the anatomy and functional pathways of the cutaneous autonomic nervous system as well as diagnostic techniques to assess its functional and structural integrity.
Highlights
Small fiber neuropathy is a condition which leads to impaired functional integrity of unmyelinated autonomic or somatic small nerve fibers
We aimed to provide an update on the architecture and diagnostic assessments of the autonomic cutaneous nervous system
The Consensus Panel on Diabetic Neuropathy reported a prevalence of diabetes related cardiovascular autonomic neuropathy of 20% up to 60% with increasing age and diabetes duration in patients suffering from type 1 and 2 diabetes [67, 68]
Summary
Small fiber neuropathy is a condition which leads to impaired functional integrity of unmyelinated autonomic or somatic small nerve fibers. This condition affects approximately 53 per 100.000 people and the most common etiologies are diabetes, neurodegenerative diseases, and complex regional pain syndrome due to trauma and paraneoplastic syndromes [1]. Autonomic small fiber neuropathy has been associated with increased morbidity and mortality in patients with diabetes or cardiovascular disease [1,2,3]. A few diagnostic techniques are available to assess peripheral small fiber neuropathy. Assessment of functional integrity of these nerve fibers can be performed using Laser doppler flowmetry (LDF), two-dimensional Laser doppler imaging (LDI) as well as axon-reflex based
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.