hyperesthesie

Hyperesthesia, also spelled hyperaesthesia in some languages, is an abnormal increase in sensitivity to sensory stimuli. It most commonly refers to tactile or nociceptive hyperesthesia but can involve other modalities such as temperature or proprioception. It may be localized to a region or generalized and can be transient or persistent.

Hyperesthesia can arise from peripheral nerve injury, neuropathies (such as diabetic or inflammatory neuropathies), nerve compression, postherpetic neuralgia, or inflammatory or infectious processes affecting the skin or nerves. Central nervous system lesions, including stroke, multiple sclerosis, spinal cord injury, or brain trauma, can produce central hyperesthesia through sensitization of dorsal horn neurons and altered cortical processing. Mechanisms include peripheral sensitization, central sensitization, and disinhibition of pain pathways.

Clinically, patients describe increased sensitivity to touch that would normally be non-painful or only mildly uncomfortable. This may include allodynia (pain from non-painful stimuli) or hyperalgesia (increased pain from painful stimuli). Distinguishing hyperesthesia from paresthesia (abnormal sensations such as tingling without stimulus) and dysesthesia (unpleasant abnormal sensations) is important. The distribution may be dermatomal or regional; symptoms may worsen with heat, pressure, or anxiety.

Diagnosis is primarily clinical, based on history and neurologic examination. Supporting tests can include nerve conduction studies, electromyography, quantitative sensory testing, MRI to identify CNS or structural causes, laboratory tests for metabolic or inflammatory conditions, and skin biopsy if small-fiber neuropathy is suspected.

Treatment targets the underlying cause and symptom relief. This can include disease-specific therapies, neuropathic pain medications (such as gabapentinoids like gabapentin or pregabalin, antidepressants such as duloxetine or amitriptyline), topical agents like lidocaine or capsaicin, physical therapy, and psychological interventions for chronic pain. Management is individualized and may require multidisciplinary care.

Prognosis varies by underlying cause; some cases improve with treatment, while others persist as a chronic sensory abnormality. See also allodynia, hyperalgesia, dysesthesia, paresthesia, neuropathy, and central sensitization.