Clin Exp Dermatol. 2026 Feb 28:llag107. doi: 10.1093/ced/llag107. Online ahead of print.
ABSTRACT
Cutaneous sensory syndromes (CSS) are a heterogeneous group of disorders characterized by itch, burning, pain, or other dysesthesias on normal or minimally altered skin. They share convergent biology that includes aberrant small-fiber input, spinal and supraspinal sensitization, and neuroimmune crosstalk that perpetuates the itch-scratch cycle. This narrative review synthesizes current concepts and practical management across seven types of CSS encountered in adult practice: scalp dysesthesia, vulvodynia, scrotodynia, brachioradial pruritus, notalgia paresthetica, burning mouth syndrome, and psychogenic itch. We first outline a clinically focused pathophysiology from peripheral pruriceptors through dorsal horn circuits to cortical networks and descending control, and we integrate the brain-skin axis and autonomic influences. We then present a pragmatic evaluation framework that emphasizes targeted history, symptom mapping, red flags, a minimal laboratory panel, selective imaging or biopsy, and patch testing when product exposure suggests contact allergy. Management is organized around education and trigger modification, topical neuromodulators for focal disease, class-level systemic neuromodulators when symptoms are frequent or widespread, and psychoderm integration that addresses attention, mood, sleep, and behavioral loops. Disorder specific sections highlight distinctive clinical clues and low risk first steps, with adjuncts for refractory cases. This narrative review provides a concise, mechanism-informed roadmap to improve diagnosis, counseling, and outcomes in CSS.
PMID:41762688 | DOI:10.1093/ced/llag107
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