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Apesar da presen&#231;a de eicosanoides&#44; citocinas e proteases&#44; a histamina &#233; a principal citocina que afeta os receptores H1 &#40;85&#37;&#41; e H2 &#40;15&#37;&#41; na pele&#46; A liga&#231;&#227;o da histamina aos receptores H1 causa prurido &#40;estimula&#231;&#227;o das fibras C&#41;&#44; enquanto a liga&#231;&#227;o aos receptores nos capilares leva &#224; vasodilata&#231;&#227;o&#44; aumento da permeabilidade vascular e edema&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A dor neurop&#225;tica pode ser definida como dor anormal no sistema nervoso perif&#233;rico ou central ap&#243;s les&#227;o e resulta de disfun&#231;&#245;es no sistema nervoso perif&#233;rico ou central sem estimula&#231;&#227;o de nociceptores perif&#233;ricos&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">5</span></a> A dor neurop&#225;tica &#233; problema comum na pr&#225;tica cl&#237;nica e pode ser um desafio diagn&#243;stico em raz&#227;o das diferen&#231;as metodol&#243;gicas na defini&#231;&#227;o e avalia&#231;&#227;o&#44; embora sua preval&#234;ncia estimada seja de 7&#37; a 10&#37; na popula&#231;&#227;o em geral&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">6</span></a> Os mecanismos de indu&#231;&#227;o da dor s&#227;o altamente diversos e ainda n&#227;o foram totalmente esclarecidos&#46; Estudos recentes relataram que os mast&#243;citos se acumulam ao redor das bainhas nervosas e desempenham papel na fisiopatologia da dor neurop&#225;tica ao secretar ampla variedade de citocinas&#44; incluindo a histamina&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A histamina aparece na patog&#234;nese tanto da UCE quanto das doen&#231;as do espectro da dor neurop&#225;tica&#46; O presente estudo investiga os sintomas de dor neurop&#225;tica em pacientes com UCE utilizando escalas&#44; como o m&#233;todo mais simples e f&#225;cil&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todo</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Amostra do estudo</span><p id="par0020" class="elsevierStylePara elsevierViewall">Este estudo transversal e de caso&#8208;controle&#44; com base em question&#225;rios&#44; foi aprovado pelo Comit&#234; de &#201;tica local &#40;Decreto n&#176; 2017&#8208;KAEK&#8208;189&#95;2019&#46;07&#46;10&#95;04&#41; e foi conduzido de acordo com os princ&#237;pios da Declara&#231;&#227;o de Helsinque&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Ap&#243;s obter o consentimento informado&#44; 51 pacientes com UCE e 47 controles saud&#225;veis pareados por sexo e idade foram inclu&#237;dos no estudo&#46; Todos os participantes tinham idade superior a 18 anos&#46; Foram exclu&#237;dos do estudo os participantes com gravidez&#44; em lacta&#231;&#227;o&#44; relatando consumo de &#225;lcool&#44; presen&#231;a de doen&#231;a importante do sistema nervoso central&#44; comprometimento cognitivo e comorbidade psiqui&#225;trica&#46; Apenas pacientes com UCE foram inclu&#237;dos no estudo&#46; Pacientes com urtic&#225;ria cr&#244;nica induz&#237;vel e urtic&#225;ria aguda foram exclu&#237;dos&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">As medidas de peso corporal e estatura foram obtidas para o c&#225;lculo do &#237;ndice de massa corporal &#40;IMC&#41;&#44; bem como dados sociodemogr&#225;ficos&#44; tempo de doen&#231;a&#44; comorbidades&#44; uso de medicamentos&#44; presen&#231;a de angioedema e resultados de exames cl&#237;nicos de pacientes com UCE atendidos em ambulat&#243;rios de Dermatologia&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Medidas</span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Escore de atividade de urtic&#225;ria por sete dias consecutivos &#40;UAS7&#44; <span class="elsevierStyleItalic">Urticaria Activity Score for 7 consecutive days</span>&#41;</span><p id="par0040" class="elsevierStylePara elsevierViewall">Essa &#233; uma ferramenta de desfecho relatado pelo paciente estabelecida e amplamente aceita para a medida prospectiva da atividade da UCE&#46; Escores UAS7 &#8804; 6 indicam urtic&#225;ria bem controlada&#44; 7&#8208;15 leve&#44; 16&#8208;27 moderada e 28&#8208;42 indicam urtic&#225;ria grave&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">8</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Short&#8208;form McGill Pain Questionnaire &#40;SF&#8208;MPQ&#41;</span><p id="par0045" class="elsevierStylePara elsevierViewall">O componente principal do SF&#8208;MPQ compreende 15 descritores &#40;11 sensoriais&#59; 4 afetivos&#41; classificados em uma escala de intensidade de 0<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>nenhum&#44; 1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>leve&#44; 2<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>moderada ou 3<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>intensa&#44; e tr&#234;s escores de dor s&#227;o derivados do soma dos valores do gradua&#231;&#227;o da intensidade das palavras escolhidas para os descritores sensorial&#44; afetivo e total&#46; O SF&#8208;MPQ tamb&#233;m inclui o &#237;ndice de intensidade da dor atual do MPQ padr&#227;o e uma escala visual anal&#243;gica &#40;EVA&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">9</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Question&#225;rio Self&#8208;Administered Leeds Assessment of Neuropathic Symptoms and Signs &#40;S&#8208;LANSS&#41;</span><p id="par0050" class="elsevierStylePara elsevierViewall">Objetiva identificar a dor de origem predominantemente neurop&#225;tica&#44; distinta da dor nociceptiva&#44; sem a necessidade de exame cl&#237;nico&#46; O S&#8208;LANSS &#233; um question&#225;rio de cinco itens relacionado a sintomas de dor e com dois itens relacionados a sinais cl&#237;nicos envolvendo testes sensoriais autoadministrados para a presen&#231;a de alodinia e diminui&#231;&#227;o da sensa&#231;&#227;o de picada de alfinete&#46; Os escores variam de 0 a 24&#59; um escore de 12 ou mais sugere dor neurop&#225;tica&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">10</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">A validade e a confiabilidade da vers&#227;o em turco dessas escalas foram verificadas&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">An&#225;lise de dados</span><p id="par0060" class="elsevierStylePara elsevierViewall">Todas as an&#225;lises estat&#237;sticas foram realizadas utilizando o pacote estat&#237;stico IBM SPSS Statistics &#40;Vers&#227;o 20&#46;0&#46; Armonk&#44; NY&#58; IBM Corp&#46;&#41;&#46; As vari&#225;veis cont&#237;nuas foram expressas como m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&#44; e os testes <span class="elsevierStyleItalic">t</span> de Student foram usados para comparar as m&#233;dias entre dois grupos&#46; Para vari&#225;veis categ&#243;ricas&#44; teste Qui&#8208;quadrado foi usado para testar as diferen&#231;as entre os grupos&#46; A an&#225;lise de correla&#231;&#227;o de Spearman foi utilizada para a correla&#231;&#227;o entre os testes de neuropatia e as caracter&#237;sticas da doen&#231;a&#46; Salvo indica&#231;&#227;o ao contr&#225;rio&#44; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 foi considerado significante&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="par0065" class="elsevierStylePara elsevierViewall">O estudo incluiu 51 pacientes &#40;36 mulheres&#44; 15 homens&#41; e 47 controles &#40;27 mulheres&#44; 20 homens&#41;&#59; ambos os grupos tinham caracter&#237;sticas sociodemogr&#225;ficas semelhantes &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; No grupo de pacientes&#44; 18 estavam em uso de omalizumabe e 18 em uso de anti&#8208;histam&#237;nicos&#44; enquanto os demais n&#227;o estavam recebendo tratamento no momento da admiss&#227;o no estudo &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Uma avalia&#231;&#227;o dos resultados do <span class="elsevierStyleItalic">short&#8208;form McGill Pain Questionnaire</span> revelou que os escores nos dom&#237;nios sensorial e afetivo&#44; escores EVA e &#237;ndices de dor eram significantemente maiores no grupo de pacientes &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 para todos os casos&#41;&#44; enquanto a avalia&#231;&#227;o geral da dor e avalia&#231;&#227;o sensorial com base na escala de dor S&#8208;LANSS tamb&#233;m foram significantemente maiores no grupo de pacientes&#46; Com base na suposi&#231;&#227;o de que escores<span class="elsevierStyleHsp" style=""></span>&#62; 12 indicavam neuropatia&#44; 27 &#40;53&#37;&#41; indiv&#237;duos do grupo de pacientes e 8 &#40;17&#37;&#41; do grupo controle apresentavam neuropatia &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Uma an&#225;lise dos resultados do question&#225;rio revelou que a mediana do escore total de neuropatia no grupo de pacientes foi de 14&#44; o que foi estatisticamente compat&#237;vel com os achados de neuropatia &#40;intervalo&#58; 0&#8208;33&#59; <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Uma an&#225;lise das correla&#231;&#245;es entre os achados de ativa&#231;&#227;o da doen&#231;a &#40;dura&#231;&#227;o da doen&#231;a&#44; frequ&#234;ncia dos ataques&#44; escore de atividade de urtic&#225;ria e presen&#231;a de angioedema&#41; e neuropatia revelou correla&#231;&#227;o positiva estatisticamente forte&#44; especialmente com o escore de atividade da urtic&#225;ria &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#59; varia&#231;&#227;o de rho&#58; 0&#44;524&#8208;0&#44;969&#59; <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> apresenta um gr&#225;fico de barras dos sintomas do grupo de pacientes e do grupo controle de acordo com os itens do Question&#225;rio McGill&#46; Como pode ser visto&#44; os descritores estatisticamente fortemente significantes foram dolorida&#44; dor pesada&#44; dolorosa&#44; corrosiva e dor em queima&#231;&#227;o &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001 para todos&#41;&#46; Quanto ao dom&#237;nio afetivo&#44; os descritores significantes mais fortes foram cansativa&#8208;exaustiva &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; nauseante e amedrontadora &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; enquanto outros eram latejante &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;195&#41;&#44; s&#250;bita &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;591&#41;&#44; penetrante &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;041&#41;&#44; aguda &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;042&#41;&#44; c&#227;ibras &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;591&#41;&#44; excruciante &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;090&#41; e punitiva&#8208;cruel &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;018&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discuss&#227;o</span><p id="par0085" class="elsevierStylePara elsevierViewall">No presente estudo&#44; os escores significantemente mais altos foram identificados nos dom&#237;nios sensorial e afetivo do <span class="elsevierStyleItalic">short&#8208;form McGill Pain Questionnaire</span>&#44; bem como nos escores EVA e &#237;ndices de dor no grupo de pacientes&#46; As avalia&#231;&#245;es gerais de dor e as avalia&#231;&#245;es sensoriais identificadas na escala de dor S&#8208;LANSS tamb&#233;m foram significantemente maiores no grupo de pacientes&#46; Neuropatia foi detectada em 27 indiv&#237;duos do grupo de pacientes e 8 dos controles&#44; respectivamente&#46; Houve correla&#231;&#227;o positiva estatisticamente forte entre o escore de atividade de urtic&#225;ria e os escores do teste de neuropatia&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">A dor neurop&#225;tica &#233; um problema comum na pr&#225;tica cl&#237;nica&#44; que afeta muitos aspectos da vida di&#225;ria e est&#225; associada a problemas de sa&#250;de geral&#44; redu&#231;&#227;o da qualidade de vida&#44; sono ruim e n&#237;veis mais altos de ansiedade e depress&#227;o&#46; As medidas de qualidade de vida de indiv&#237;duos com dor neurop&#225;tica cr&#244;nica foram t&#227;o baixas quanto daqueles com depress&#227;o&#44; doen&#231;a arterial coronariana&#44; infarto do mioc&#225;rdio recente ou diabetes <span class="elsevierStyleItalic">mellitus</span> n&#227;o controlado&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">11</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Os mast&#243;citos s&#227;o c&#233;lulas imunol&#243;gicas que se distribuem por diferentes partes do corpo&#44; com relatos de influ&#234;ncia em diversas condi&#231;&#245;es patol&#243;gicas&#44; como hipersensibilidade&#44; aterosclerose&#44; hipertens&#227;o pulmonar e infertilidade&#46; Tamb&#233;m h&#225; estudos relatando importante influ&#234;ncia na patog&#234;nese da dor neurop&#225;tica de v&#225;rias etiologias&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">7</span></a> Olsson<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">12</span></a> relatou pela primeira vez o papel dos mast&#243;citos na dor neurop&#225;tica e demonstrou a degranula&#231;&#227;o dos mast&#243;citos no epineuro&#44; perineuro e tecido conjuntivo endoneural em resposta ao trauma&#46; Estudos posteriores revelaram o papel do aumento dos mast&#243;citos nas regi&#245;es ao redor dos nervos e seus mediadores &#40;principalmente histamina e 5&#8208;HT&#41; na etiologia da dor neurop&#225;tica&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">13&#8211;15</span></a> Considerando a patog&#234;nese da UCE&#44; parece prov&#225;vel que seja principalmente uma doen&#231;a por a&#231;&#227;o dos mast&#243;citos&#46; Citocinas como histamina e fator ativador de plaquetas&#44; triptase e leucotrienos liberados pelos mast&#243;citos causam ativa&#231;&#227;o do nervo sensorial&#44; vasodilata&#231;&#227;o e extravasamento de plasma&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">16</span></a> Assim sendo&#44; os mast&#243;citos aparecem na etiopatogenia de doen&#231;as como a UCE e a dor neurop&#225;tica&#46; Foi hipotetizado no presente estudo que os sintomas relacionados &#224; dor neurop&#225;tica podem ser mais comuns em pacientes com UCE&#46; Que seja de conhecimento dos autores&#44; entretanto&#44; n&#227;o h&#225; nenhum estudo abordando esse assunto na literatura at&#233; o momento&#46; Consequentemente&#44; o presente estudo &#233; o primeiro a avaliar a rela&#231;&#227;o entre UCE e sintomas de neuropatia&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">J&#225; foi bem estabelecido que os mast&#243;citos sensibilizados podem causar alergias e anafilaxia&#44; e que tamb&#233;m s&#227;o conhecidos por contribuir para v&#225;rios processos biol&#243;gicos e patol&#243;gicos&#44; como fisiologia vascular&#44; dor&#44; prurido e c&#226;ncer&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">17&#8211;19</span></a> Entre os estudos anteriores na literatura avaliando a rela&#231;&#227;o entre doen&#231;as dermatol&#243;gicas e sintomas de neuropatia&#44; Di Carlo et al&#46; examinaram 118 pacientes com artrite psori&#225;sica e aplicaram question&#225;rios por meio dos quais detectaram sintomas de neuropatia em 25&#44;4&#37; dos pacientes&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">20</span></a> Garcovich et al&#46; avaliaram sintomas de dor neurop&#225;tica em 110 pacientes com hidradenite supurativa utilizando question&#225;rios e classificaram 33 &#40;30&#37;&#41; dos 110 pacientes como tendo &#8220;prov&#225;vel dor neurop&#225;tica&#8221;&#44; 32 &#40;29&#44;1&#37;&#41; com &#8220;poss&#237;vel dor neurop&#225;tica&#8221; e 45 &#40;40&#44;9&#37;&#41; com &#8220;dor neurop&#225;tica improv&#225;vel&#8221;&#46; Os escores de dor e prurido foram correlacionados&#44; e os pacientes relataram que suas atividades di&#225;rias foram significantemente prejudicadas em decorr&#234;ncia da dor&#46; Os autores enfatizaram os fatores complexos e multifatoriais que determinam o fen&#243;tipo da dor na hidradenite supurativa&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">21</span></a> Inflama&#231;&#227;o perineural eosinof&#237;lica e inerva&#231;&#227;o anormal de mast&#243;citos foram demonstradas na histopatologia da pele lesional e perilesional de pacientes com hidradenite supurativa&#44; sugerindo potencial correlato anat&#244;mico de dor &#8220;neurop&#225;tica&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">22</span></a> Mediadores inflamat&#243;rios derivados da lipo&#8208;oxigenase&#44; eicosanoides e leucotrieno B4 est&#227;o aumentados na pele lesionada e s&#227;o conhecidos por serem indutores de inflama&#231;&#227;o perif&#233;rica e hiperalgesia&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">23</span></a> &#192; luz dessas informa&#231;&#245;es&#44; n&#227;o &#233; surpresa que os pacientes com hidradenite supurativa tendam a apresentar sintomas concomitantes de dor neurop&#225;tica&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">A dermatite at&#243;pica apresenta prurido intenso&#44; semelhante &#224; UCE&#44; e estudos recentes relataram sintomas de dor concomitantes&#44; al&#233;m de prurido em pacientes com dermatite at&#243;pica&#44; identificando a necessidade de questionar os pacientes a esse respeito&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">24&#8211;26</span></a> A dor era comumente descrita como &#8220;em queima&#231;&#227;o&#8221; e &#8220;em fisgadas&#8221; por pacientes com dermatite at&#243;pica<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">26</span></a> que descreveram sua experi&#234;ncia de prurido como dolorosa&#44; latejante&#44; cortante&#44; em fisgada&#44; em queima&#231;&#227;o&#44; aguda&#44; com formigamento&#44; tipo alfinetada e&#47;ou associada a sensa&#231;&#245;es de rastejamento sob a pele&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">24&#44;25</span></a> Todas essas caracter&#237;sticas cl&#237;nicas apoiam parcialmente &#40;mas n&#227;o totalmente&#41; o componente neurop&#225;tico do prurido&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Wallis et al&#46; examinaram 35 pacientes com paquion&#237;quia cong&#234;nita &#8211; rara doen&#231;a autoss&#244;mica dominante &#8211; e avaliaram a gravidade e o tipo de dor&#44; como principal sintoma desses pacientes&#44; por meio de question&#225;rios e testes sensoriais quantitativos&#46; Os autores relataram que 62&#37; dos pacientes apresentavam dor neurop&#225;tica e o restante apresentava sintomas de dor nociceptiva&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">27</span></a> Da mesma maneira&#44; Brill et al&#46; fizeram um estudo recente sobre a origem da dor em pacientes com paquion&#237;quia cong&#234;nita&#44; no qual foram aplicados os question&#225;rios McGill e Douleur Neuropathique&#8208;4 em 62 pacientes e 45 controles que foram tamb&#233;m submetidos a testes sensoriais&#46; Os autores descobriram que a dor pode ser de origem neurop&#225;tica e sugeriram que os pacientes poderiam se beneficiar de tratamentos orientados para a neuropatia&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">28</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">O presente estudo apresenta algumas limita&#231;&#245;es&#44; principalmente seu desenho transversal&#44; a pequena amostra de pacientes e o uso de escalas autorreferidas&#46; Comorbidades como diabetes tipo 2 poderiam estar associadas &#224; dor neurop&#225;tica&#44; mas estavam presentes em apenas uma pequena propor&#231;&#227;o da amostra e n&#227;o houve diferen&#231;a nas comorbidades dos dois grupos&#46; Al&#233;m disso&#44; outra limita&#231;&#227;o foi a n&#227;o realiza&#231;&#227;o de testes de avalia&#231;&#227;o eletrofisiol&#243;gica&#46; Os question&#225;rios aplicados podem ser considerados v&#225;lidos e confi&#225;veis para uso em testes de avalia&#231;&#227;o e&#44; em alguns casos&#44; podem auxiliar na identifica&#231;&#227;o de doen&#231;as que n&#227;o podem ser detectadas pela eletrofisiologia&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclus&#227;o</span><p id="par0120" class="elsevierStylePara elsevierViewall">Al&#233;m do prurido&#44; os pacientes com UCE devem estar cientes da possibilidade de dor neurop&#225;tica concomitante&#46; Nessa doen&#231;a cr&#244;nica que sabidamente afeta a qualidade de vida&#44; a abordagem integrada dos pacientes e a identifica&#231;&#227;o dos problemas associados s&#227;o t&#227;o importantes quanto o tratamento da doen&#231;a dermatol&#243;gica&#46; Estudos prospectivos sobre esse assunto s&#227;o necess&#225;rios&#44; nos quais m&#233;todos descritivos e metodol&#243;gicos sejam aplicados juntos em grandes s&#233;ries de pacientes para apoiar os achados do presente estudo&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Suporte financeiro</span><p id="par0125" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Contribui&#231;&#227;o dos autores</span><p id="par0130" class="elsevierStylePara elsevierViewall">GG&#46;&#44; H&#46;S foram respons&#225;veis pelo desenho do estudo&#46; G&#46;G recrutou os participantes&#46; G&#46;G e H&#46;S participaram da obten&#231;&#227;o de dados&#46; H&#46;S fez a an&#225;lise estat&#237;stica&#46; G&#46;G e H&#46;S interpretaram os dados&#46; GG redigiu a primeira vers&#227;o do manuscrito e todos os autores revisaram criticamente o artigo&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflito de interesses</span><p id="par0135" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&#47;rho&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&#47;rho&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&#47;rho&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&#47;rho&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t">Frequ&#234;ncia de ataques</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t">0&#44;596&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;300&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;300&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;842&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;468&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;095&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;077&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;029&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;105&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Escore da atividade de urtic&#225;ria</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;000</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;000</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;000</span>&nbsp;\t\t\t\t\t\t\n
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Artigo original
Urticária crônica espontânea pode produzir sintomas de dor neuropática?
Gülhan Gürela,
Autor para correspondência
gulhanozturkgurel@hotmail.com

Autor para correspondência.
, Hikmet Saçmacıb
a Departamento de Dermatologia, Faculdade de Medicina, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turquia
b Departamento de Neurologia, Faculdade de Medicina, Bozok University, Yozgat, Turquia
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Apesar da presen&#231;a de eicosanoides&#44; citocinas e proteases&#44; a histamina &#233; a principal citocina que afeta os receptores H1 &#40;85&#37;&#41; e H2 &#40;15&#37;&#41; na pele&#46; A liga&#231;&#227;o da histamina aos receptores H1 causa prurido &#40;estimula&#231;&#227;o das fibras C&#41;&#44; enquanto a liga&#231;&#227;o aos receptores nos capilares leva &#224; vasodilata&#231;&#227;o&#44; aumento da permeabilidade vascular e edema&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A dor neurop&#225;tica pode ser definida como dor anormal no sistema nervoso perif&#233;rico ou central ap&#243;s les&#227;o e resulta de disfun&#231;&#245;es no sistema nervoso perif&#233;rico ou central sem estimula&#231;&#227;o de nociceptores perif&#233;ricos&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">5</span></a> A dor neurop&#225;tica &#233; problema comum na pr&#225;tica cl&#237;nica e pode ser um desafio diagn&#243;stico em raz&#227;o das diferen&#231;as metodol&#243;gicas na defini&#231;&#227;o e avalia&#231;&#227;o&#44; embora sua preval&#234;ncia estimada seja de 7&#37; a 10&#37; na popula&#231;&#227;o em geral&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">6</span></a> Os mecanismos de indu&#231;&#227;o da dor s&#227;o altamente diversos e ainda n&#227;o foram totalmente esclarecidos&#46; Estudos recentes relataram que os mast&#243;citos se acumulam ao redor das bainhas nervosas e desempenham papel na fisiopatologia da dor neurop&#225;tica ao secretar ampla variedade de citocinas&#44; incluindo a histamina&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A histamina aparece na patog&#234;nese tanto da UCE quanto das doen&#231;as do espectro da dor neurop&#225;tica&#46; O presente estudo investiga os sintomas de dor neurop&#225;tica em pacientes com UCE utilizando escalas&#44; como o m&#233;todo mais simples e f&#225;cil&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todo</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Amostra do estudo</span><p id="par0020" class="elsevierStylePara elsevierViewall">Este estudo transversal e de caso&#8208;controle&#44; 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bem como dados sociodemogr&#225;ficos&#44; tempo de doen&#231;a&#44; comorbidades&#44; uso de medicamentos&#44; presen&#231;a de angioedema e resultados de exames cl&#237;nicos de pacientes com UCE atendidos em ambulat&#243;rios de Dermatologia&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Medidas</span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Escore de atividade de urtic&#225;ria por sete dias consecutivos &#40;UAS7&#44; <span class="elsevierStyleItalic">Urticaria Activity Score for 7 consecutive days</span>&#41;</span><p id="par0040" class="elsevierStylePara elsevierViewall">Essa &#233; uma ferramenta de desfecho relatado pelo paciente estabelecida e amplamente aceita para a medida prospectiva da atividade da UCE&#46; Escores UAS7 &#8804; 6 indicam urtic&#225;ria bem controlada&#44; 7&#8208;15 leve&#44; 16&#8208;27 moderada e 28&#8208;42 indicam urtic&#225;ria grave&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">8</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Short&#8208;form McGill Pain Questionnaire &#40;SF&#8208;MPQ&#41;</span><p id="par0045" class="elsevierStylePara elsevierViewall">O componente principal do SF&#8208;MPQ compreende 15 descritores &#40;11 sensoriais&#59; 4 afetivos&#41; classificados em uma escala de intensidade de 0<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>nenhum&#44; 1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>leve&#44; 2<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>moderada ou 3<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>intensa&#44; e tr&#234;s escores de dor s&#227;o derivados do soma dos valores do gradua&#231;&#227;o da intensidade das palavras escolhidas para os descritores sensorial&#44; afetivo e total&#46; O SF&#8208;MPQ tamb&#233;m inclui o &#237;ndice de intensidade da dor atual do MPQ padr&#227;o e uma escala visual anal&#243;gica &#40;EVA&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">9</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Question&#225;rio Self&#8208;Administered Leeds Assessment of Neuropathic Symptoms and Signs &#40;S&#8208;LANSS&#41;</span><p id="par0050" class="elsevierStylePara elsevierViewall">Objetiva identificar a dor de origem predominantemente neurop&#225;tica&#44; distinta da dor nociceptiva&#44; sem a necessidade de exame cl&#237;nico&#46; O S&#8208;LANSS &#233; um question&#225;rio de cinco itens relacionado a sintomas de dor e com dois itens relacionados a sinais cl&#237;nicos envolvendo testes sensoriais autoadministrados para a presen&#231;a de alodinia e diminui&#231;&#227;o da sensa&#231;&#227;o de picada de alfinete&#46; Os escores variam de 0 a 24&#59; um escore de 12 ou mais sugere dor neurop&#225;tica&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">10</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">A validade e a confiabilidade da vers&#227;o em turco dessas escalas foram verificadas&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">An&#225;lise de dados</span><p id="par0060" class="elsevierStylePara elsevierViewall">Todas as an&#225;lises estat&#237;sticas foram realizadas utilizando o pacote estat&#237;stico IBM SPSS Statistics &#40;Vers&#227;o 20&#46;0&#46; Armonk&#44; NY&#58; IBM Corp&#46;&#41;&#46; As vari&#225;veis cont&#237;nuas foram expressas como m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DP&#44; e os testes <span class="elsevierStyleItalic">t</span> de Student foram usados para comparar as m&#233;dias entre dois grupos&#46; Para vari&#225;veis categ&#243;ricas&#44; teste Qui&#8208;quadrado foi usado para testar as diferen&#231;as entre os grupos&#46; A an&#225;lise de correla&#231;&#227;o de Spearman foi utilizada para a correla&#231;&#227;o entre os testes de neuropatia e as caracter&#237;sticas da doen&#231;a&#46; Salvo indica&#231;&#227;o ao contr&#225;rio&#44; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 foi considerado significante&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="par0065" class="elsevierStylePara elsevierViewall">O estudo incluiu 51 pacientes &#40;36 mulheres&#44; 15 homens&#41; e 47 controles &#40;27 mulheres&#44; 20 homens&#41;&#59; ambos os grupos tinham caracter&#237;sticas sociodemogr&#225;ficas semelhantes &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; No grupo de pacientes&#44; 18 estavam em uso de omalizumabe e 18 em uso de anti&#8208;histam&#237;nicos&#44; enquanto os demais n&#227;o estavam recebendo tratamento no momento da admiss&#227;o no estudo &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Uma avalia&#231;&#227;o dos resultados do <span class="elsevierStyleItalic">short&#8208;form McGill Pain Questionnaire</span> revelou que os escores nos dom&#237;nios sensorial e afetivo&#44; escores EVA e &#237;ndices de dor eram significantemente maiores no grupo de pacientes &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 para todos os casos&#41;&#44; enquanto a avalia&#231;&#227;o geral da dor e avalia&#231;&#227;o sensorial com base na escala de dor S&#8208;LANSS tamb&#233;m foram significantemente maiores no grupo de pacientes&#46; Com base na suposi&#231;&#227;o de que escores<span class="elsevierStyleHsp" style=""></span>&#62; 12 indicavam neuropatia&#44; 27 &#40;53&#37;&#41; indiv&#237;duos do grupo de pacientes e 8 &#40;17&#37;&#41; do grupo controle apresentavam neuropatia &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Uma an&#225;lise dos resultados do question&#225;rio revelou que a mediana do escore total de neuropatia no grupo de pacientes foi de 14&#44; o que foi estatisticamente compat&#237;vel com os achados de neuropatia &#40;intervalo&#58; 0&#8208;33&#59; <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Uma an&#225;lise das correla&#231;&#245;es entre os achados de ativa&#231;&#227;o da doen&#231;a &#40;dura&#231;&#227;o da doen&#231;a&#44; frequ&#234;ncia dos ataques&#44; escore de atividade de urtic&#225;ria e presen&#231;a de angioedema&#41; e neuropatia revelou correla&#231;&#227;o positiva estatisticamente forte&#44; especialmente com o escore de atividade da urtic&#225;ria &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#59; varia&#231;&#227;o de rho&#58; 0&#44;524&#8208;0&#44;969&#59; <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> apresenta um gr&#225;fico de barras dos sintomas do grupo de pacientes e do grupo controle de acordo com os itens do Question&#225;rio McGill&#46; Como pode ser visto&#44; os descritores estatisticamente fortemente significantes foram dolorida&#44; dor pesada&#44; dolorosa&#44; corrosiva e dor em queima&#231;&#227;o &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001 para todos&#41;&#46; Quanto ao dom&#237;nio afetivo&#44; os descritores significantes mais fortes foram cansativa&#8208;exaustiva &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; nauseante e amedrontadora &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; enquanto outros eram latejante &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;195&#41;&#44; s&#250;bita &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;591&#41;&#44; penetrante &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;041&#41;&#44; aguda &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;042&#41;&#44; c&#227;ibras &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;591&#41;&#44; excruciante &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;090&#41; e punitiva&#8208;cruel &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;018&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discuss&#227;o</span><p id="par0085" class="elsevierStylePara elsevierViewall">No presente estudo&#44; os escores significantemente mais altos foram identificados nos dom&#237;nios sensorial e afetivo do <span class="elsevierStyleItalic">short&#8208;form McGill Pain Questionnaire</span>&#44; bem como nos escores EVA e &#237;ndices de dor no grupo de pacientes&#46; As avalia&#231;&#245;es gerais de dor e as avalia&#231;&#245;es sensoriais identificadas na escala de dor S&#8208;LANSS tamb&#233;m foram significantemente maiores no grupo de pacientes&#46; Neuropatia foi detectada em 27 indiv&#237;duos do grupo de pacientes e 8 dos controles&#44; respectivamente&#46; Houve correla&#231;&#227;o positiva estatisticamente forte entre o escore de atividade de urtic&#225;ria e os escores do teste de neuropatia&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">A dor neurop&#225;tica &#233; um problema comum na pr&#225;tica cl&#237;nica&#44; que afeta muitos aspectos da vida di&#225;ria e est&#225; associada a problemas de sa&#250;de geral&#44; redu&#231;&#227;o da qualidade de vida&#44; sono ruim e n&#237;veis mais altos de ansiedade e depress&#227;o&#46; As medidas de qualidade de vida de indiv&#237;duos com dor neurop&#225;tica cr&#244;nica foram t&#227;o baixas quanto daqueles com depress&#227;o&#44; doen&#231;a arterial coronariana&#44; infarto do mioc&#225;rdio recente ou diabetes <span class="elsevierStyleItalic">mellitus</span> n&#227;o controlado&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">11</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Os mast&#243;citos s&#227;o c&#233;lulas imunol&#243;gicas que se distribuem por diferentes partes do corpo&#44; com relatos de influ&#234;ncia em diversas condi&#231;&#245;es patol&#243;gicas&#44; como hipersensibilidade&#44; aterosclerose&#44; hipertens&#227;o pulmonar e infertilidade&#46; Tamb&#233;m h&#225; estudos relatando importante influ&#234;ncia na patog&#234;nese da dor neurop&#225;tica de v&#225;rias etiologias&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">7</span></a> Olsson<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">12</span></a> relatou pela primeira vez o papel dos mast&#243;citos na dor neurop&#225;tica e demonstrou a degranula&#231;&#227;o dos mast&#243;citos no epineuro&#44; perineuro e tecido conjuntivo endoneural em resposta ao trauma&#46; Estudos posteriores revelaram o papel do aumento dos mast&#243;citos nas regi&#245;es ao redor dos nervos e seus mediadores &#40;principalmente histamina e 5&#8208;HT&#41; na etiologia da dor neurop&#225;tica&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">13&#8211;15</span></a> Considerando a patog&#234;nese da UCE&#44; parece prov&#225;vel que seja principalmente uma doen&#231;a por a&#231;&#227;o dos mast&#243;citos&#46; Citocinas como histamina e fator ativador de plaquetas&#44; triptase e leucotrienos liberados pelos mast&#243;citos causam ativa&#231;&#227;o do nervo sensorial&#44; vasodilata&#231;&#227;o e extravasamento de plasma&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">16</span></a> Assim sendo&#44; os mast&#243;citos aparecem na etiopatogenia de doen&#231;as como a UCE e a dor neurop&#225;tica&#46; Foi hipotetizado no presente estudo que os sintomas relacionados &#224; dor neurop&#225;tica podem ser mais comuns em pacientes com UCE&#46; Que seja de conhecimento dos autores&#44; entretanto&#44; n&#227;o h&#225; nenhum estudo abordando esse assunto na literatura at&#233; o momento&#46; Consequentemente&#44; o presente estudo &#233; o primeiro a avaliar a rela&#231;&#227;o entre UCE e sintomas de neuropatia&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">J&#225; foi bem estabelecido que os mast&#243;citos sensibilizados podem causar alergias e anafilaxia&#44; e que tamb&#233;m s&#227;o conhecidos por contribuir para v&#225;rios processos biol&#243;gicos e patol&#243;gicos&#44; como fisiologia vascular&#44; dor&#44; prurido e c&#226;ncer&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">17&#8211;19</span></a> Entre os estudos anteriores na literatura avaliando a rela&#231;&#227;o entre doen&#231;as dermatol&#243;gicas e sintomas de neuropatia&#44; Di Carlo et al&#46; examinaram 118 pacientes com artrite psori&#225;sica e aplicaram question&#225;rios por meio dos quais detectaram sintomas de neuropatia em 25&#44;4&#37; dos pacientes&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">20</span></a> Garcovich et al&#46; avaliaram sintomas de dor neurop&#225;tica em 110 pacientes com hidradenite supurativa utilizando question&#225;rios e classificaram 33 &#40;30&#37;&#41; dos 110 pacientes como tendo &#8220;prov&#225;vel dor neurop&#225;tica&#8221;&#44; 32 &#40;29&#44;1&#37;&#41; com &#8220;poss&#237;vel dor neurop&#225;tica&#8221; e 45 &#40;40&#44;9&#37;&#41; com &#8220;dor neurop&#225;tica improv&#225;vel&#8221;&#46; Os escores de dor e prurido foram correlacionados&#44; e os pacientes relataram que suas atividades di&#225;rias foram significantemente prejudicadas em decorr&#234;ncia da dor&#46; Os autores enfatizaram os fatores complexos e multifatoriais que determinam o fen&#243;tipo da dor na hidradenite supurativa&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">21</span></a> Inflama&#231;&#227;o perineural eosinof&#237;lica e inerva&#231;&#227;o anormal de mast&#243;citos foram demonstradas na histopatologia da pele lesional e perilesional de pacientes com hidradenite supurativa&#44; sugerindo potencial correlato anat&#244;mico de dor &#8220;neurop&#225;tica&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">22</span></a> Mediadores inflamat&#243;rios derivados da lipo&#8208;oxigenase&#44; eicosanoides e leucotrieno B4 est&#227;o aumentados na pele lesionada e s&#227;o conhecidos por serem indutores de inflama&#231;&#227;o perif&#233;rica e hiperalgesia&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">23</span></a> &#192; luz dessas informa&#231;&#245;es&#44; n&#227;o &#233; surpresa que os pacientes com hidradenite supurativa tendam a apresentar sintomas concomitantes de dor neurop&#225;tica&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">A dermatite at&#243;pica apresenta prurido intenso&#44; semelhante &#224; UCE&#44; e estudos recentes relataram sintomas de dor concomitantes&#44; al&#233;m de prurido em pacientes com dermatite at&#243;pica&#44; identificando a necessidade de questionar os pacientes a esse respeito&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">24&#8211;26</span></a> A dor era comumente descrita como &#8220;em queima&#231;&#227;o&#8221; e &#8220;em fisgadas&#8221; por pacientes com dermatite at&#243;pica<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">26</span></a> que descreveram sua experi&#234;ncia de prurido como dolorosa&#44; latejante&#44; cortante&#44; em fisgada&#44; em queima&#231;&#227;o&#44; aguda&#44; com formigamento&#44; tipo alfinetada e&#47;ou associada a sensa&#231;&#245;es de rastejamento sob a pele&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">24&#44;25</span></a> Todas essas caracter&#237;sticas cl&#237;nicas apoiam parcialmente &#40;mas n&#227;o totalmente&#41; o componente neurop&#225;tico do prurido&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Wallis et al&#46; examinaram 35 pacientes com paquion&#237;quia cong&#234;nita &#8211; rara doen&#231;a autoss&#244;mica dominante &#8211; e avaliaram a gravidade e o tipo de dor&#44; como principal sintoma desses pacientes&#44; por meio de question&#225;rios e testes sensoriais quantitativos&#46; Os autores relataram que 62&#37; dos pacientes apresentavam dor neurop&#225;tica e o restante apresentava sintomas de dor nociceptiva&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">27</span></a> Da mesma maneira&#44; Brill et al&#46; fizeram um estudo recente sobre a origem da dor em pacientes com paquion&#237;quia cong&#234;nita&#44; no qual foram aplicados os question&#225;rios McGill e Douleur Neuropathique&#8208;4 em 62 pacientes e 45 controles que foram tamb&#233;m submetidos a testes sensoriais&#46; Os autores descobriram que a dor pode ser de origem neurop&#225;tica e sugeriram que os pacientes poderiam se beneficiar de tratamentos orientados para a neuropatia&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">28</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">O presente estudo apresenta algumas limita&#231;&#245;es&#44; principalmente seu desenho transversal&#44; a pequena amostra de pacientes e o uso de escalas autorreferidas&#46; Comorbidades como diabetes tipo 2 poderiam estar associadas &#224; dor neurop&#225;tica&#44; mas estavam presentes em apenas uma pequena propor&#231;&#227;o da amostra e n&#227;o houve diferen&#231;a nas comorbidades dos dois grupos&#46; Al&#233;m disso&#44; outra limita&#231;&#227;o foi a n&#227;o realiza&#231;&#227;o de testes de avalia&#231;&#227;o eletrofisiol&#243;gica&#46; Os question&#225;rios aplicados podem ser considerados v&#225;lidos e confi&#225;veis para uso em testes de avalia&#231;&#227;o e&#44; em alguns casos&#44; podem auxiliar na identifica&#231;&#227;o de doen&#231;as que n&#227;o podem ser detectadas pela eletrofisiologia&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclus&#227;o</span><p id="par0120" class="elsevierStylePara elsevierViewall">Al&#233;m do prurido&#44; os pacientes com UCE devem estar cientes da possibilidade de dor neurop&#225;tica concomitante&#46; Nessa doen&#231;a cr&#244;nica que sabidamente afeta a qualidade de vida&#44; a abordagem integrada dos pacientes e a identifica&#231;&#227;o dos problemas associados s&#227;o t&#227;o importantes quanto o tratamento da doen&#231;a dermatol&#243;gica&#46; Estudos prospectivos sobre esse assunto s&#227;o necess&#225;rios&#44; nos quais m&#233;todos descritivos e metodol&#243;gicos sejam aplicados juntos em grandes s&#233;ries de pacientes para apoiar os achados do presente estudo&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Suporte financeiro</span><p id="par0125" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Contribui&#231;&#227;o dos autores</span><p id="par0130" class="elsevierStylePara elsevierViewall">GG&#46;&#44; H&#46;S foram respons&#225;veis pelo desenho do estudo&#46; G&#46;G recrutou os participantes&#46; G&#46;G e H&#46;S participaram da obten&#231;&#227;o de dados&#46; H&#46;S fez a an&#225;lise estat&#237;stica&#46; G&#46;G e H&#46;S interpretaram os dados&#46; GG redigiu a primeira vers&#227;o do manuscrito e todos os autores revisaram criticamente o artigo&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflito de interesses</span><p id="par0135" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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                  \t\t\t\t">8 &#40;17&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;000&nbsp;\t\t\t\t\t\t\n
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                  """
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&#47;rho&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&#47;rho&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&#47;rho&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&#47;rho&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&#47;rho&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;656&#8208;0&#44;065&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;464&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;656&#8208;0&#44;065&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;139&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;195&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;105&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t">Frequ&#234;ncia de ataques</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;510&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;596&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;300&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;990&#8208;0&#44;002&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;300&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;842&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;468&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;095&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;077&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;029&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;105&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Escore da atividade de urtic&#225;ria</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;000</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;000</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;000</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;000</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;000</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;572&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;524&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;969&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;533&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;969&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;894&nbsp;\t\t\t\t\t\t\n
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