Ann Dermatol.  2016 Feb;28(1):86-89. 10.5021/ad.2016.28.1.86.

Considerable Variability in the Efficacy of 8% Capsaicin Topical Patches in the Treatment of Chronic Pruritus in 3 Patients with Notalgia Paresthetica

• Andersen H
• Sand C
• Elberling

• KMID: 2429486
• DOI: http://doi.org/10.5021/ad.2016.28.1.86

Abstract

Notalgia paresthetica (NP) is a focal neuropathic itch condition manifesting in intense chronic or recurrent episodic itch in a hyperpigmented, macular, uni- or bilateral skin area located below and/or medially to the scapulae. Achieving satisfactory relieve in NP patients is challenging. In this case-series three female NP patients were treated with 8% capsaicin patches following a spatial quantification of their alloknetic area with a von Frey filament. The use of a von Frey filament in order to delimit the precise area of itch sensitization and thus patch application, proved clinically feasible. Although 8% topical capsaicin relieved itch in all three patients, the duration of the effectiveness varied greatly from only 3 days to >2 months. The treatment was well tolerated in the patients and there appear to be no significant hindrances to applying this treatment with NP as an indication, although it may only exhibit satisfactory effectiveness in certain patients. Placebo-controlled double-blinded trials are needed to confirm the effectiveness of the treatment and assess predictive parameters of the treatment outcome.

Keyword

Alloknesis; Capsaicin; Itch; Neuropathic itch; Notalgia paresthetica; Paresthesia

MeSH Terms

Capsaicin*
Female
Humans
Paresthesia
Pruritus*
Scapula
Skin
Treatment Outcome
Capsaicin

Figure

• 

  Fig. 1 Cases 1~3 before (A), during (B), and after (C) application of capsaicin. The blue marker signifies the predetermined area of alloknesis to von Frey pinprick. Notice that the area of alloknesis is larger than that of hyperpigmentation, particularly in case 1 and 3 and to a lesser extent in case 2. As evident in all 3 cases (B and C), the erythema extends beyond the area of application highlighting capsaicin-induced activation of C-mechano-insensitive-fibers.

• 

  Fig. 2 Case 1 at follow-up (and 2nd treatment), 3 months following the initial treatment. Notice the significantly retracted area of alloknesis indicated by the black demarcation (Fig. 1A, B for comparison). The patient also exhibited diminished hyperpigmentation.

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