Dysautonomia: "The finger wrinkling test can be used as a screening test before tilt table testing"

[Rufous McKinney]

Damn. I just looked again and the left hand (I'm right-handed) veins have crept up slightly above my wrist, and we know it won't stop there.

Yeah, when I did a 12 minute bath test....my pointing finger is mutant. Its the worst.

Can you direct me to: Neurology?

These symptoms are so bizarre. Oh well, at least they have some entertainment value.

 

[Rufous McKinney]

As usual @pattismith , stellar graphics and really interesting observations

Ditto Ditto..your posts are always very interesting and helpful!

 

[Rufous McKinney]

That's also the case for me too and I have idiopathic Autonomic Neuropathy. I don't have POTS and just had a delayed drop in bp during a TTT but interestingly, the TTT test also reproduced my gastroparesis symptoms similar to how it can in those with neuropathic POTS;
https://www.autonomicneuroscience.com/article/S1566-0702(18)30052-3/pdf
The gastrointestinal symptoms present in patients with postural tachycardia syndrome: A review of the literature and overview of treatment

It looks like I will be reading all of that! I had a bad gastro night the other day- blame food again..but its just not making sense...to blame the food. (like 3 pieces of romaine lettuce at lunch, blame)

So I developed gastro-p recently- it seems rather mild (luckily), and mostly disconcerting. It empties- eventually.(?)...more and more things feel neurological.

 

[kangaSue]

It looks like I will be reading all of that! I had a bad gastro night the other day- blame food again..but its just not making sense...to blame the food. (like 3 pieces of romaine lettuce at lunch, blame)

I always blame food - if I don't eat at all, all is well. I've had a bad gastro 20 years!

So I developed gastro-p recently- it seems rather mild (luckily), and mostly disconcerting. It empties- eventually.(?)...more and more things feel neurological.

Some more required reading then;
https://onlinelibrary.wiley.com/doi/full/10.1111/nmo.13810 Autonomic function in gastroparesis and chronic unexplained nausea and vomiting: Relationship with etiology, gastric emptying, and symptom severity

 

[Nemanja]

If fingertips wrinkles normaly,is that mean that small fibers nerves works normaly in feet and toes also? I have symptoms of SFN in my feet( mosty pain when walking or standing more then 2 min.) Also I got itchy sensation,but skin on fingertips wrinkles normaly in j
Thank you

 

[pattismith]

If fingertips wrinkles normaly,is that mean that small fibers nerves works normaly in feet and toes also? I have symptoms of SFN in my feet( mosty pain when walking or standing more then 2 min.) Also I got itchy sensation,but skin on fingertips wrinkles normaly in j
Thank you

It doesn't rule out totally SFN. (I suspect different kind of SFN do exist, with different kind of small nerve fibers damages)
My own SFN sensory symptoms in feet and hands are more pronounced when lying in my bed, but again I couldn't tell you if you have it or not.
Skin biopsy is the gold standard for SFN diagnosis, so any opportunity to do it should be taken.

 

[kangaSue]

If fingertips wrinkles normaly,is that mean that small fibers nerves works normaly in feet and toes also? I have symptoms of SFN in my feet( mosty pain when walking or standing more then 2 min.) Also I got itchy sensation,but skin on fingertips wrinkles normaly in j
Thank you

Not sure where I read it but if SFN is restricted to the lower extremities only, you can have a normal finger wrinkling test.

 

[Nemanja]

Not sure where I read it but if SFN is restricted to the lower extremities only, you can have a normal finger wrinkling test.

But I also have symptoms in my fingers, mostly durring night,some numbness and pins and needles,but fingertips skin wrinkle norlmal.

 

[kangaSue]

But I also have symptoms in my fingers, mostly durring night,some numbness and pins and needles,but fingertips skin wrinkle norlmal.

It's possible to have just a vascular blood flow issue, such as atherosclerosis or a connective tissue disorder.

 

[Nemanja]

It's possible to have just a vascular blood flow issue, such as atherosclerosis or a connective tissue disorder.

Yes,I think I have Ehler Danols syndrome

 

[kangaSue]

Yes,I think I have Ehler Danols syndrome

That could explain it then and Autonomic Neuropathy (or SFN) is very prevalent among those with EDS.

 

[Nemanja]

That could explain it then and Autonomic Neuropathy (or SFN) is very prevalent among those with EDS.

But what about skin wrinkle test,I think I have some autonomic dysfunction ( POTS,digestive problems etc.) And also some SFN symptoms ,but my skin wrinkles in hot water. I don't understand. Is that kind of test accurate or not?

 

[kangaSue]

But what about skin wrinkle test,I think I have some autonomic dysfunction ( POTS,digestive problems etc.) And also some SFN symptoms ,but my skin wrinkles in hot water. I don't understand. Is that kind of test accurate or not?

It possibly depends on the extent that SFN actually affects your hands. I know of a couple of other people diagnosed with Autonomic Neuropathy who also have normal finger wrinkling doing this test so I guess that as a simple measure of your autonomic function, it's not infallible and only a quick screening measure to pick up the classic text book cases.

 

[pattismith]

@ScottTriGuy


Early detection of peripheral neuropathy using stimulated skin wrinkling test in HIVinfected patients: A cross-sectional study.
Mawuntu AHP1,


Abstract
Peripheral neuropathy is a common condition of human immunodeficiency virus (HIV)-infected patients, which often remains undetected.

We assessed the performance of stimulated skin wrinkling-eutectic mixture of local anesthetic (SSW-EMLA) test compared with brief peripheral neuropathy screening (BPNS) to detect HIV neuropathy.

This is a cross-sectional study conducted in HIV-positive patients.

A modified skin wrinkling grading was used to assess SSW-EMLA effect.

BPNS-detectable neuropathy was assessed by a combination of neuropathy severity scoring scale (subjective) and objective method of sensory and tendon reflex examination. The SSW-EMLA test accuracy with reference to BPNS was assessed using sensitivity and specificity and predictive values.In a total of 99 HIV patients, 61.6% were males and the majority age group were between 30 and 40 years (52%).

The neuropathy detection was SSW-EMLA test 36.4% versus BPNS 15.2% (P = .04).

The sensitivity of SSW-EMLA test was 60.0% [95% confidence interval (95% CI) 34.5-81.7], specificity 67% (95% CI 63.3-3-71.7), and overall accuracy of 66.7% (95% CI 58.9-73.2).

The SSW-EMLA test detected many more peripheral neuropathy cases than BPNS in HIV patients and has potential as an alternative test for screening for HIV neuropathy in resource-constraint hospitals in Indonesia.

 

[pattismith]

I stopped taking very hot bathes or showers some weeks ago, because it triggers burning red feet soles, and yesterday, while I was having a short shower, I realized my fingers were wrinkled again!
What a mystery, I have to solve this!

TODAY after a 10 min shower:

7 september after a 30 mn hot bath

 

[sb4]

@pattismith I cant remember if I have mentioned this but I have had several occasions where my fingers shrivel up like that and feel quite unpleasant without being wet at all, like when I am just sitting around.

 

[pattismith]

@pattismith I cant remember if I have mentioned this but I have had several occasions where my fingers shrivel up like that and feel quite unpleasant without being wet at all, like when I am just sitting around.

I think I have read some ME patients have some wrinkling fingers without water. It may be a skin sympathetic overactivation. Do you remember if your fingers were sweating when it happened?

 

[Nemanja]

I am so confuse now,I hope that if our fingers wrinkle ,we don't have any kind of neuropathy.

 

[sb4]

I think I have read some ME patients have some wrinkling fingers without water. It may be a skin sympathetic overactivation. Do you remember if your fingers were sweating when it happened?

No sweating. It hasnt happened to mean in a long while but it regularly occured when I was worse a few years ago. I think it is most likey dysautonomia related and skin sympathetic activation makes sense.
If I am out in the sun and get too hot, I don't sweat and my skin gouse bumps like what happens when you are very cold. I feel awful during this. I persume the heat is causing vasodialation which is bad for my pots so my body ups the sympathetic to cause vasoconstriction.

 

[Booble]

Fascinating.
Can't wait to try it. I don't dare do the POTS test because I know I will be sick and dizzy. I have to be careful even sitting back up in the dentist chair when they have me laying way back.
I haven't thought about skin wrinkles in decades. I used to wrinkle up a lot as a kid but haven't seen them for such a long time.