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SynopsisNotalgia paresthetica is a condition of the skin of the upper back with extreme pruritus in a localized area just below or medial to the scapula. Notalgia paresthetica is felt to be secondary to spinal nerve impingement, causing a sensory neuropathy and persistent itch. Pain, paresthesias, and hyperesthesias may coincide with the itch. Hyperpigmented or lichenified skin changes, if present, are due to chronic rubbing and scratching of the affected area.
Notalgia paresthetica is relatively common but perhaps underdiagnosed. It can affect people of any age, any race, and either sex. However, it is thought to be most common in middle-aged to older adults. Women seem to develop notalgia paresthetica more frequently than men. A higher body mass index has been associated with longer disease duration.
A related entity is macular amyloidosis, which can also be caused by chronic rubbing. Both notalgia paresthetica and macular amyloidosis can be cutaneous markers of multiple endocrine neoplasia type 2, or Sipple syndrome, especially if onset is during childhood or adolescence.
Although the etiology of notalgia paresthetica is not entirely certain, some studies have demonstrated, radiographically, degenerative changes of the spine corresponding to the level of the nerve root affecting the pruritic skin, typically T2-T6. The posterior rami of T2-T6 have a perpendicular anatomical course through the multifidus spinae muscle, which may predispose them to entrapment and injury.
R20.2 – Paresthesia of skin
277802001 – Notalgia paresthetica
Differential Diagnosis & Pitfalls
Patient Information for Notalgia paresthetica
OverviewNotalgia paresthetica is a condition where the skin of the middle of the upper back becomes itchy. Notalgia paresthetica may be caused by a problem with the nerve cells that provide feeling to the skin of the upper back (sensory neuropathy). There is often a darker patch (a flat, smooth area of skin larger than a thumbnail) where the skin is itchy. This is due to chronic rubbing and scratching of the affected area.
Who’s At RiskNotalgia paresthetica can affect people of any age, race / ethnicity, and sex. However, it is thought to be most common in middle-aged to older adults. Women seem to develop notalgia paresthetica more frequently than men.
Although researchers are not certain what causes notalgia paresthetica, some speculate that spine disease due to age or injury may press on a nerve providing feeling to that area of the skin, which leads to itching.
Signs & SymptomsThe most common location for notalgia paresthetica is the upper back, especially between the shoulder blades. The area may be confined to one side of the upper back, or it may occur in the middle of the upper back, over the spinal bones.
Notalgia paresthetica often occurs without any obvious changes to the skin. If skin changes do occur, there may be a well-defined patch of darker skin over the affected area.
Although periodic itching is the main symptom associated with notalgia paresthetica, some people notice pain, tingling, or a change in feeling (sensation) in the affected skin.
Self-Care GuidelinesDry skin is a common cause of itching, so applying a thick moisturizer (eg, CeraVe Moisturizing Cream) to the itchy area at least twice a day can help.
If moisturizers are not helpful, try over-the-counter creams or lotions containing menthol, such as Sarna anti-itch lotion. Keep it in the fridge, as cool temperatures can also help to improve itch. Capsaicin cream (eg, Zostrix) is an extract of hot chili peppers that helps to improve itch, but the itch may get worse before it gets better, and it may take up to 6 weeks to reach its full effect. If the capsaicin cream is effective, symptoms will likely come back after you stop using the cream.
When to Seek Medical CareIf moisturizers and over-the counter anti-itch creams or lotions are not helpful, see a medical professional for evaluation.
TreatmentsA medical professional can typically diagnose notalgia paresthetica by taking your history and examining your skin.
If diagnosed with notalgia paresthetica, you may be prescribed:
- Prescription-strength anesthetic (EMLA, Oraqix) cream.
- Prescription-strength corticosteroid (eg, Aristacort, Lidex) cream.
If these approaches are not effective and if your symptoms are severe enough to justify it, injection of local anesthetic near the compressed nerves as they exit the spine (paravertebral block) may be performed.