The applicability of the digit wrinkle scan to quantify sympathetic nerve function

Maurice Sopacua*, Carla M L Gorissen-Brouwers, Bianca T A de Greef, Isis B T Joosten, Catharina G Faber, Ingemar S J Merkies, Janneke G J Hoeijmakers

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Objective: Stimulated skin wrinkling test (SSW) has been launched as a non-invasive diagnostic procedure. However, no normative age dependent values have been reported that can be applied in clinical practice. The objectives of the study were to (1) collect age-dependent normative values according to the 5-point scale assessment for the SSW, to (2) determine reliability scores for the obtained norm values, and to (3) introduce a new digital method for SSW assessment, the Digit Wrinkle Scan© (DWS©) for detection of wrinkles in a more quantitative manner.

Methods: Firstly, 82 healthy participants were included, divided in 5 age groups. The participants underwent SSW using lidocaine and prilocaine topical cream. Secondly, 35 healthy participants were included to test whether the DWS© could be a novel manner to assess the grade of wrinkling quantitatively. We determined the inter-observer reliability of both methods. Also, the intra-observer reliability was calculated for the DWS©.

Results: We found a decrease in normative values over age. The inter-observer reliability of assessment by the 5-point scale method was moderate after SSW (Cohen's k: 0.53). Results of the DWS© indicate that total wrinkle length per mm2 showed moderate to good agreement for the 4th and 5th digits after SSW, and a low agreement for the other digits.

Conclusions: Age-dependent normative values were obtained according to the 5-point scale, but its clinical application is doubtful since we found a moderate inter-observer reliability. We introduced the DWS© as a possible new method in order to quantify the grade of wrinkling.

Significance: We found unsatisfactory reliability scores, which hampers its usefulness for clinical practice.

Original languageEnglish
Pages (from-to)115-119
Number of pages5
JournalClinical Neurophysiology Practice
Publication statusPublished - 2022


  • 5-point scale
  • Digit wrinkle scan
  • Small fiber neuropathy
  • Autonomic function
  • Digit vasoconstriction
  • Inter-observer reliability

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