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    • We found at least one cutaneous symptom such

    2018-11-12

    We found at least one cutaneous symptom such as pruritus, increased sweating, numbness, and tingling in 92.4% of the FMS patients in our study. Pathologic investigations of skin from FMS patients in other studies have revealed changes such as increased mast cells, mitochondrial dysfunction, coenzyme Q10 deficiency, increased oxidative stress, increased why not of δ and κ opiate receptors, increased interleukin (IL)-1β, IL-6, and tumor necrosis factor-α, microcirculation abnormalities at tender points, vasoconstriction, hypoxia and hypothermia, intradermal immunoglobulin G deposits, and increased Type 3 collagen reactivity. Mitochondrial dysfunction, increased oxidative stress, and inflammation interdependently cause peripheral nerve damage and this is associated with the pain and allodynia seen in FMS. Evaluation of the serum cytokine levels of the patients has revealed increased IL-6, IL-8, and IL-1 receptor antagonist and decreased T helper 2 cytokines. There is a complicated relationship between pain and pruritus. We found pruritus as a symptom in 69.5% of the FMS patients in our study. There are various similar mechanisms to explain the relationship between chronic pain and chronic pruritus such as peripheral and central sensitization, loss of inhibition in the spinal cord, and neuroimmune and neuroglial interactions. In the physiological conditions, itch and pain are encoded by labeled lines. But in pathological conditions, the crosstalk of the pain and itch labeled lines are disrupted. Pruritus and pain have both an antagonistic relationship and similar sensitization processes. The high rate of pruritus in our study may support the presence of this common mechanism and common pathways. Laniosz et al retrospectively evaluated 845 FMS patients in their study on cutaneous symptoms and dermatologic disorders in FMS patients. They found hyperhidrosis (32%), skin and mucosal burning sensation (3.4%), various unusual cutaneous sensations (1.7%), pruritus of unknown origin (3.3%), neurotic excoriation, prurigo nodularis, lichen simplex chronicus (1.9%), and eczema other than lichen simplex chronicus (9.1%). They stated that FMS-related cutaneous problems can be present in FMS patients but there was no markedly increased dermatologic diagnosis other than a subjective increase in sweating. When accompanied dermatologic disorders are considered, psychocutaneous diseases concept should not be ignored. Psychiatric and dermatologic disorders are closely related and are evaluated within the dermatology practice as psychocutaneous disorders. The skin and brain originate from the ectoderm and are affected by the same hormones and neurotransmitters. The neuropeptides secreted from skin cells regulate the local neuroimmune reactions in the skin as a response to the stress. Neurogenic inflammation develops as a result of associated events and intercellular interactions. Doğramacı and Yalcinkaya found the incidence of xerosis and neurotic excoriation in FMS patients to be significantly higher than in the control group and concluded that some stress-induced dermatologic problems could be seen commonly in FMS patients. We also found incidences of 15.2% and 6.6%, respectively, for lichen simplex chronicus and neurotic excoriation, both psychocutaneous disorders. Any stressor can trigger skin findings while also causing FMS. Another possibility is that this relationship may not just be due to stress and that a certain type of personality predisposed to FMS, lichen simplex chronicus or neurotic excoriation may provide a suitable background for all three disorders. However, this is only speculation for now as there is no study supporting it. The third most common disorder in FMS patients was acne with an incidence of 10.4% while the control group had an incidence of 6%. Although, the number of patients with acne in the test group was more than in the control, the statistical difference between the two groups was not significant. Therefore, it may not indicate a meaningful coexistence of the two disorders, acne and FMS. By contrast, stress induces the hypothalamic-pituitary-adrenal axis and substance P, which also plays a role in FMS pathogenesis and is secreted from peripheral nerves, has recently been shown to stimulate sebaceous gland proliferation and increase lipid synthesis in the sebaceous cells. A stress-related indirect relationship between FMS and acne is likely, but this needs to be clarified with other studies.