Advertisement

Pruritus pp 219-224 | Cite as

Notalgia Paresthetica

  • Ekin ŞavkEmail author
Chapter

Abstract

Notalgia paresthetica is a chronic pruritic condition typically localized to scapular area of the back which may be accompanied with other paresthetic sensations. It is considered to be a localized neuropathy and the dermatological findings consisting of a hyperpigmented patch with indefinite borders and mild lichenification in some cases are secondary to chronic scratching. Notalgia paresthetica is mainly a disease of the middle aged and a majority of cases are women. Among various hypotheses, including one with a hereditary component, nerve entrapment due to various musculoskeletal factors appears to be the the most likely candidate responsible for pathogenesis. Current list of therapeutic alternatives which offer transitory relief includes capsaicin, gabapentin and various modes of physical therapy. Phototherapy and acupuncture might be other options to explore. A collaborative multispecialty effort with orthopaedic surgeons and neurologists should be encouraged to better evaluate and devise a treatment plan encompassing nondermatological treatment modalities.

Keywords

Notalgia paresthetica Neuropathic pruritus Neuropathy Back Hyperpigmentation Amyloidosis Spine 

References

  1. 1.
    Astwazaturow M. Über parästhetische Neuralgien und eine besondere Form derselben-Notalgia paraesthetica. Dtsch Z Nervenh. 1934;133:188–96.CrossRefGoogle Scholar
  2. 2.
    Pérez-Pérez LC. General features and treatment of notalgia paresthetica. Skinmed. 2011;9:353–8.PubMedGoogle Scholar
  3. 3.
    Marcusson JA, Lundh B, Sidén A, Persson A. Notalgia paresthetica—puzzling posterior pigmented pruritic patch. Report on two cases. Acta Derm Venereol. 1990;70(5):452–4.PubMedGoogle Scholar
  4. 4.
    Huesmann T, Cunha PR, Osada N, Huesmann M, Zanelato TP, Phan NQ, Gontijo GM, Marziniak M, Ständer S. Notalgia paraesthetica: a descriptive two-cohort study of 65 patients from Brazil and Germany. Acta Derm Venereol. 2012;92:535–40.CrossRefPubMedGoogle Scholar
  5. 5.
    Bernhard JD. Notalgia paresthetica, macular posterior pigmentary incontinence, macular amyloidosis and pruritus. Acta Derm Venereol. 1997;77(2):164.PubMedGoogle Scholar
  6. 6.
    Bernhard JD. Macular amyloidosis, notalgia paresthetica and pruritus: three sides of the same coin? Dermatologica. 1991;183(1):53–4.CrossRefPubMedGoogle Scholar
  7. 7.
    Westermark P, Ridderström E, Vahlquist A. Macular posterior pigmentary incontinence: its relation to macular amyloidosis and notalgia paresthetica. Acta Derm Venereol. 1996;76(4):302–4.PubMedGoogle Scholar
  8. 8.
    Savk O, Savk E. Investigation of spinal pathology in notalgia paresthetica. J Am Acad Dermatol. 2005;52:1085–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Maciel AA, Cunha PR, Laraia IO, Trevisan F. Efficacy of gabapentin in the improvement of pruritus and quality of life of patients with notalgia paresthetica. An Bras Dermatol. 2014;89(4):570–5.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Raison-Peyron N, Meunier L, Acevedo M, Meynadier J. Notalgia paresthetica: clinical, physiopathological and therapeutic aspects. A study of 12 cases. J Eur Acad Dermatol Venereol. 1999;12(3):215–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Weber PJ, Poulos EG. Notalgia paresthetica. Case reports and histologic appraisal. J Am Acad Dermatol. 1988;18(1 Pt 1):25–30.CrossRefPubMedGoogle Scholar
  12. 12.
    Savk E, Savk O, Bolukbasi O, Culhaci N, Dikicioğlu E, Karaman G, Sendur N. Notalgia paresthetica: a study on pathogenesis. Int J Dermatol. 2000;39(10):754–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Savk E, Dikicioğlu E, Culhaci N, Karaman G, Sendur N. Immunohistochemical findings in notalgia paresthetica. Dermatology. 2002;204(2):88–93.CrossRefPubMedGoogle Scholar
  14. 14.
    Fantini F, Zorzi F, Rizzitelli G, Benassi L, Pincelli C. Notalgia paresthetica: clinical, pathological and immunohistochemical observations in 12 cases. Eur J Dermatol. 1994;4:649–53.Google Scholar
  15. 15.
    Cerroni L, Kopera D, Soyer HP, Kerl H. Notalgia paresthetica, “posterior pigmented pruritic patch” and macular amyloidosis. Three stages of a disease. Hautarzt. 1993;44(12):777–80.PubMedGoogle Scholar
  16. 16.
    Goulden V, Highet AS, Shamy HK. Notalgia paraesthetica—report of an association with macular amyloidosis. Clin Exp Dermatol. 1994;19(4):346–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Springall DR, Karanth SS, Kirkham N, Darley CR, Polak JM. Symptoms of notalgia paresthetica may be explained by increased dermal innervation. J Invest Dermatol. 1991;97(3):555–61.CrossRefPubMedGoogle Scholar
  18. 18.
    Inaloz HS, Kirtak N, Erguven HG, Karakok M, Inaloz SS. Notalgia paresthetica with a significant increase in the number of intradermal nerves. J Dermatol. 2002;29(11):739–43.CrossRefPubMedGoogle Scholar
  19. 19.
    Massey EW, Pleet AB. Notalgia paresthetica. JAMA. 1979;241(14):1464.PubMedGoogle Scholar
  20. 20.
    Comings ED, Comings NS. Hereditary localized pruritus. Arch Dermatol. 1965;92:236–7.CrossRefGoogle Scholar
  21. 21.
    Chabre O, Labat F, Pinel N, Berthod F, Tarel V, Bachelot I. Cutaneous lesion associated with multiple endocrine neoplasia type 2A: lichen amyloidosis or notalgia paresthetica? Henry Ford Hosp Med J. 1992;40(3–4):245–8.PubMedGoogle Scholar
  22. 22.
    Massey EW, Pleet AB. Localized pruritus-notalgia paresthetica. Arch Dermatol. 1979;115(8):982–3.CrossRefPubMedGoogle Scholar
  23. 23.
    Massey EW, Pleet AB. Electromyographic evaluation of notalgia paresthetica. Neurology. 1981;31:642.CrossRefPubMedGoogle Scholar
  24. 24.
    Streib EW, Sun SF. Notalgia paresthetica owing to compression neuropathy: case presentation including electrodiagnostic studies. Eur Neurol. 1981;20(1):64–7.CrossRefPubMedGoogle Scholar
  25. 25.
    Eisenberg E, Barmeir E, Bergman R. Notalgia paresthetica associated with nerve root impingement. J Am Acad Dermatol. 1997;37:998–1000.CrossRefPubMedGoogle Scholar
  26. 26.
    Alai NN, Skinner HB, Nabili ST, Jeffes E, Shahrokni S, Saemi AM. Notalgia paresthetica associated with cervical spinal stenosis and cervicothoracic disk disease at C4 through C7. Cutis. 2010;85(2):77–81.PubMedGoogle Scholar
  27. 27.
    Savk E, Savk O, Sendur F. Transcutaneous electrical nerve stimulation offers partial relief in notalgia paresthetica patients with a relevant spinal pathology. J Dermatol. 2007;34(5):315–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Fleischer AB, Meade TJ, Fleischer AB. Notalgia paresthetica: successful treatment with exercises. Acta Derm Venereol. 2011;91(3):356–7.CrossRefPubMedGoogle Scholar
  29. 29.
    Williams EH, Rosson GD, Elsamanoudi I, Dellon AL. Surgical decompression for notalgia paresthetica: a case report. Microsurgery. 2010;30(1):70–2.PubMedGoogle Scholar
  30. 30.
    Goulden V, Toomey PJ, Highet AS. Successful treatment of notalgia paresthetica with a paravertebral local anesthetic block. J Am Acad Dermatol. 1998;38(1):114–6.CrossRefPubMedGoogle Scholar
  31. 31.
    Goodkin R, Wingard E, Bernhard JD. Brachioradial pruritus:cervical spine disease and neurogenic/neuropathic pruritus. J Am Acad Dermatol. 2003;48:521–4.CrossRefPubMedGoogle Scholar
  32. 32.
    Thornsberry LA, English JC. Scalp dysesthesia related to cervical spine disease. JAMA Dermatol. 2013;149(2):200–3.CrossRefPubMedGoogle Scholar
  33. 33.
    Wallengren J, Klinker M. Successful treatment of notalgia paresthetica with topical capsaicin: vehicle-controlled, double-blind, crossover study. J Am Acad Dermatol. 1995;32(2 Pt 1):287–9.CrossRefPubMedGoogle Scholar
  34. 34.
    Metz M, Krause K, Maurer M, Magerl M. Treatment of notalgia paraesthetica with an 8% capsaicin patch. Br J Dermatol. 2011;165(6):1359–61.CrossRefPubMedGoogle Scholar
  35. 35.
    Misery L, Erfan N, Castela E, et al. Successful treatment of refractory neuropathic pruritus with capsaicin 8% patch: a bicentric retrospective study with long-term follow-up. Acta Derm Venereol. 2015;95(7):864–5.PubMedGoogle Scholar
  36. 36.
    Layton AM, Cotterill JA. Notalgia paraesthetica—report of three cases and their treatment. Clin Exp Dermatol. 1991;16(3):197–8.CrossRefPubMedGoogle Scholar
  37. 37.
    Maari C, Marchessault P, Bissonnette R. Treatment of notalgia paresthetica with botulinum toxin A: a double-blind randomized controlled trial. J Am Acad Dermatol. 2014;70(6):1139–41.CrossRefPubMedGoogle Scholar
  38. 38.
    Ochi H, Tan LX, Tey HL. Notalgia paresthetica: treatment with topical tacrolimus. J Eur Acad Dermatol Venereol. 2014. doi: 10.1111/jdv.12830.PubMedGoogle Scholar
  39. 39.
    Savk E, Bolukbasi O, Akyol A, Karaman G. Open pilot study on oxcarbazepine for the treatment of notalgia paresthetica. J Am Acad Dermatol. 2001;45(4):630–2.CrossRefPubMedGoogle Scholar
  40. 40.
    Yeo B, Tey HL. Effective treatment of notalgia paresthetica with amitriptyline. J Dermatol. 2013;40(6):505–6.CrossRefPubMedGoogle Scholar
  41. 41.
    Wang CK, Gowda A, Barad M, Mackey SC, Carroll IR. Serratus muscle stimulation effectively treats notalgia paresthetica caused by long thoracic nerve dysfunction: a case series. J Brachial Plexus Peripher Nerve Inj. 2009;4:17.Google Scholar
  42. 42.
    Ricciardo B, Kumar S, O'Callaghan J, Boyce Z. Peripheral nerve field stimulation for pruritus relief in a patient with notalgia paraesthetica. Australas J Dermatol. 2010;51(1):56–9.CrossRefPubMedGoogle Scholar
  43. 43.
    Stellon A. Neurogenic pruritus: an unrecognised problem? A retrospective case series of treatment by acupuncture. Acupunct Med. 2002;20(4):186–90.CrossRefPubMedGoogle Scholar
  44. 44.
    Richardson BS, Way BV, Speece 3rd AJ. Osteopathic manipulative treatment in the management of notalgia paresthetica. J Am Osteopath Assoc. 2009;109(11):605–8.PubMedGoogle Scholar
  45. 45.
    Pérez-Pérez L, Allegue F, Fabeiro JM, Caeiro JL, Zulaica A. Notalgia paresthesica successfully treated with narrow-band UVB: report of five cases. J Eur Acad Dermatol Venereol. 2010;24(6):730–2.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag London 2016

Authors and Affiliations

  1. 1.Department of DermatologyAdnan Menderes University HospitalAydinTurkey

Personalised recommendations