Hyperesthesia refers to an abnormally increased or altered sensitivity of the skin to tactile, thermal, or painful stimuli. Patients may perceive normal touch, temperature, or pain sensations as exaggerated, unpleasant, or painful. Hyperesthesia can be localized or generalized and may result from neurological, dermatologic, or systemic conditions.

Pathophysiology

• Peripheral mechanisms:

  • Sensitization of nociceptors or cutaneous sensory nerve endings increases responsiveness to stimuli.

  • Peripheral neuropathies, nerve compression, or inflammation can enhance sensory input.

• Central mechanisms:

  • Spinal cord or brain lesions can amplify sensory perception.

  • Central sensitization in conditions such as post-stroke, spinal cord injury, or neuropathic pain syndromes.

• Examples of causes:

  • Diabetic neuropathy

  • Herpes zoster infection

  • Spinal cord injury

  • Fibromyalgia and other chronic pain syndromes

  • Medication-induced or toxic neuropathies

Examination Technique

1. Patient positioning: Ensure the patient is seated or lying comfortably.

2. Instruction: Explain that the exam will involve gentle touching, temperature exposure, or pressure.

3. Tactile testing: Lightly stroke the skin with a cotton wisp or soft brush.

4. Pain testing: Gently apply pressure with a blunt object or pinprick.

5. Temperature testing: Use warm and cool objects to assess thermal sensitivity.

6. Observation: Watch for exaggerated responses, withdrawal, flinching, or verbal complaints.

7. Documentation: Map areas of altered sensation and note whether the hyperesthesia is focal, segmental, or generalized.

Clinical Features

Differential Diagnosis

Pediatric considerations

• Children may report itching, pain, or “funny feeling” instead of describing hyperesthesia.

• Behavioral observation is crucial for nonverbal or young children.

Geriatric considerations

• Age-related neuropathies or metabolic disorders may cause focal or generalized hyperesthesia.

• May coexist with decreased protective sensation, increasing risk of injury.

Limitations

• Subjective symptom; requires patient cooperation.

• Differentiation from allodynia, paresthesia, or hyperalgesia may require careful clinical evaluation and electrophysiologic studies.

Patient counseling

• Explain that hyperesthesia is due to increased nerve sensitivity rather than structural skin disease.

• Advise protection of affected areas to avoid injury.

• Discuss underlying cause and potential treatments, including medications for neuropathic pain, desensitization therapy, and physical therapy.

Conclusion

Hyperesthesia is an increased or altered sensitivity to tactile, thermal, or painful stimuli. Proper assessment can help localize neurological or systemic disorders, guide management, and prevent complications such as injury or chronic pain.

References

1. McCance KL, Huether SE, Brashers VL, Rote NS. Pathophysiology: The Biologic Basis for Disease in Adults and Children. 7th ed. Missouri: Mosby Elsevier; 2010.

2. Campbell JN, Meyer RA. Mechanisms of neuropathic pain. Neuron. 2006;52(1):77–92.

3. Oaklander AL, Fields HL. Cutaneous hyperesthesia: clinical assessment and mechanisms. Curr Opin Neurol. 2009;22(5):560–567.

4. National Institute of Neurological Disorders and Stroke (NINDS). Peripheral Neuropathy Information Page. 2021.