Ann Dermatol.  2014 Jun;26(3):392-394.

Neuropathic Itch of the Back: A Case of Notalgia Paresthetica

• Shin J
• Kim YC

Abstract

Notalgia paresthetica refers to an isolated mononeuropathy involving chronic localized itch or paresthesia most often at the skin of the scapula or surrounding regions. There are no specific skin manifestations except those arising from chronic scratching and rubbing. The specific etiology remains unknown; however, it has been theorized that the neuropathic itch is caused by sensory nerve entrapment involving the posterior rami of the T2 to T6 nerve root. The entrapment is due to degenerative changes in the vertebrae. We report here a particular case of notalgia paresthetica in a 55-year-old woman. The patient visited our hospital for tingling pain around the left inferior angle of the scapula. Pruritus was first reported seven years ago with tingling pain developing only four months ago. There were no specific skin lesions observed except for excoriation and vague hyperpigmentation. A skin biopsy revealed only epidermal thinning with pigmentary incontinence. The patient was treated with 600 mg of gabapentin daily as well as capsaicin cream. The response was deemed unsatisfactory.

Keyword

Neuropathy; Pruritus

MeSH Terms

Biopsy
Capsaicin
Female
Humans
Hyperpigmentation
Middle Aged
Mononeuropathies
Nerve Compression Syndromes
Paresthesia
Pruritus
Scapula
Skin
Skin Manifestations
Spine
Capsaicin

Figure

• 

  Fig. 1 There was no specific skin lesion where the patient had complained of pruritus and tingling pain, except excoriation and vague hyperpigmentation (arrow indicating the symptomatic area).

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  Fig. 2 Routine histopathology demonstrated epidermal thinning with slight pigmentary incontinence (H&E; A: ×100, B: ×200).

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