Abstract
Background
Topical capsaicin shows efficacy in the treatment of brachioradial pruritus, however its mechanisms of action remain unclear.
Objective
The effect of capsaicin on the epidermis (i.e. peripheral expression of non-neuronal sensory receptors on keratinocytes, morphological changes in innervation) is still unknown. We aimed to investigate the effect of topical capsaicin on keratinocyte expression of TRP channels and on the intraepidermal nerve fibre density (IENFD) in patients with brachioradial pruritus.
Methods
Thirty-one patients with brachioradial pruritus received an 8% capsaicin patch. Biopsies in lesional and non-lesional skin were taken to assess epidermal morphology, keratinocyte expression of TRP channels and IENFD before and 3 weeks after treatment.
Results
Treatment with the capsaicin patch led to a significant decrease in itch and paresthetic symptoms (p<0.05). Keratinocyte morphology is unaltered after capsaicin therapy. Reduced keratinocyte expression of TRPV1 in lesional skin (p=0.009; n=9) normalized three weeks after treatment (p=0.016; n=10), but not the IENFD, which remained reduced in lesional epidermis.
Conclusion
The normalization of the decreased TRPV1 expression may account for the effectiveness of topical capsaicin, which does not reconstitute the reduced IENFD, arguing for a role of epidermal TRPV1 in the maintenance of brachioradial pruritus.
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