Notalgia paresthetica is an itchy skin condition of upper back. Itching occurs typically in one half between the two shoulder blades. Thus it is also called interscapular itching. Although common, the condition is not well recognized. The exact cause of notalgia paresthetica is not known, but it is believed to develop as a result of cutaneous nerve damage resulting from injury to neck and spine.
Classical clinical feature of notalgia paresthetica is itching with occasional pain. Moderate to severe itching can lead to repeated scratching and thickening of skin in the affected area.Antihistamines and topical steroids which normally alleviate itching are not useful in this condition.
Treatment tried in notalgia paresthetica is somewhat different. It includes use of topical capsaicin ointment, local nerve block and various anti seizure medicines. With appropriate treatment, prognosis is satisfactory.
What Causes Notalgia Paresthetica?
Notalgia paresthetica was first described as a clinical entity in 1934 by a Russian neurologist. ‘Notos’ means back and ‘algia’ refers to pain in Greek. The exact cause of notalgia paresthetica is not clearly understood. There are several etiologies postulated, but in general it is believed to be a sensory neuropathy caused due to entrapment or damage to the cutaneous branch of nerve originating from cervical and thoracic region of spine.
Degenerative changes in cervical spine and spasm in the back muscles are supposed to the common risk factors. Trauma in neck region or whiplash injury from vehicular accidents or excessive weight lifting can lead to spasm and injury to the spine.
People of middle age are typically affected by notalgia paresthetica. Men and women both are affected, but the condition is more prevalent in middle aged women.
Signs And Symptoms Of Notalgia Paresthetica
The signs and symptoms of notalgia paresthetica may be mild or severe. Following are the classical clinical features of this condition.
- Skin symptoms developing in either right or left side of the upper back between two scapulas (shoulder blade).
- Unilateral itching and pain in the upper back. As compared to pain, itching is more severe.
- Pins and needle sensation or burning sensation in the affected area.
- Repeated scratching causes hyperpigmentation (darkening) and thick skin.
- Rash may or may not be present. Rash when present occurs due to repeated scratching.
- Due to pain and itching patient often feels depressed and stressed.
Treatment Options For Notalgia Paresthetica
The diagnosis of notalgia paresthetica is made clinically after detailed analysis of symptoms and skin biopsy. Biopsy helps to rule out other possible causes that can cause severe itching such as tinea versicolor, contact dermatitis, psoriasis etc.
Notalgia paresthetica is a chronic skin condition. The disease may last for many years leading to intense frustration and depression in the patient because of regular discomfort. Treatment of notalgia paresthetica is somewhat different as the neurological itch is not relieved with regular use of anti histamines and topical corticosteroid creams and ointment. There are multiple treatment options.
- Use of topical capsaicin.
- Local nerve block.
- Botulinum toxin injection.
- Acupuncture has been found to be effective.
- Osteopathic manipulative treatment.
- Massage therapy to stimulate nerve.
- Physiotherapy exercise.
- Use of anti seizure medicines.
- Reassurance to the patient.