Notalgia paresthetica (NP) is a common skin condition that causes itching, burning, or tingling, usually on the upper back, especially around the shoulder blades and spine. It can lead to a dark patch of skin from scratching or rubbing the area. The exact cause of NP is not fully understood, but it’s most often linked to nerve problems in adults, like nerve root compression. In rare cases, NP in children might be connected to genetic conditions, such as Multiple Endocrine Neoplasia Type 2A (MEN 2A).
Clinical Features and Etiology
NP causes intense itching, burning, or tingling in the upper back, usually around the inner shoulder blades. Early on, there’s often no pain or visible skin changes, but over time, scratching or rubbing the area can lead to a dark patch of skin. This patch can vary in size depending on how long the condition has been present.
NP is most common in adults, and the main cause is usually nerve compression in the upper back, often from issues like herniated discs or spinal changes (such as bone growth or narrowing of the spine). This compression affects the nerves that send sensations to the skin near the shoulder blades. In rare cases, especially in younger patients, NP can be linked to a genetic condition called Multiple Endocrine Neoplasia Type 2A (MEN 2A), which affects the thyroid and other glands.
Diagnosis
Doctors usually diagnose notalgia paresthetica based on your symptoms and by ruling out other possible causes of itching. If there’s a concern about nerve problems, an MRI might be done, especially if there are signs of spinal issues. A thorough neurological exam is important to check for any nerve involvement or other related conditions.
Treatment Options
Treating NP can be challenging and may require a mix of treatments. The goal is to relieve symptoms like itching and discomfort and to address any underlying causes. Here are some common treatments:
Topical Treatments
Capsaicin: This cream can help reduce itching by affecting nerves involved in pain and itching. It’s applied up to five times a day for a week, then less frequently for a few weeks. It may cause a burning feeling at first, but this usually gets better over time. There is also a patch with a stronger dose (8%) that may be easier and less irritating for some patients. However, relief is often temporary, and symptoms may return when treatment stops.
Topical Steroids: Creams like hydrocortisone or clobetasol can reduce inflammation and itching. They’re helpful when irritation is a factor but shouldn’t be used for long periods because they can thin the skin and become less effective over time.
Pramoxine and Lidocaine/Prilocaine Mixture: These are numbing creams that can help reduce itching and discomfort quickly. They’re usually used along with other treatments for short-term relief.
Oral Medications
Gabapentin: This medication, often used for nerve pain, can help with the itching and burning caused by NP. The dose starts low and can be gradually increased depending on how well it’s tolerated. It works by calming down overactive nerves.
Amitriptyline: A medication usually used for depression, amitriptyline can also help reduce the nerve-related symptoms of NP. It works by affecting certain chemicals in the brain that help manage pain and itching.
Physical Therapies and Non-Pharmacological Approaches
Acupuncture: Some people find relief from acupuncture, which stimulates certain points on the body to help ease nerve pain and itching.
Narrowband UVB Phototherapy: This type of light therapy can help reduce itching and dark patches of skin caused by NP. It’s usually for people who don’t respond to creams or medications.
Transcutaneous Electrical Nerve Stimulation (TENS): TENS uses mild electrical currents to reduce pain and itching. It works by stimulating nerves to block pain signals.
Spinal Nerve Block: For severe cases, a spinal nerve block may be considered. This involves injecting medicine around the nerves to reduce inflammation and pain.
Exercise and Osteopathic Manipulation
Strengthening and stretching exercises for the back can sometimes help by reducing pressure on the nerves causing the symptoms. Osteopathic manipulation has also shown benefits in restoring normal spinal function and reducing pain associated with NP.
Conclusion
Notalgia paresthetica can be a difficult condition to treat, but there are different options to help relieve symptoms and address the causes. Treatments like capsaicin cream, gabapentin, and acupuncture have worked well for some people, but the results can vary. It’s important to find a treatment plan that works for you. Ongoing research into new therapies, such as laser treatments and spinal procedures, may offer better and longer-lasting solutions in the future.
References
Bertolini, M., Fabbri, P., & Lodi, L. (2021). Efficacy of topical capsaicin in the treatment of notalgia paresthetica: A review of the literature. Journal of Dermatological Treatment, 32(2), 221-229. https://doi.org/10.1080/09546634.2020.1799821
Choi, T. Y., Lee, M. S., Lee, H., & Shin, B. C. (2020). Acupuncture for pruritus: A systematic review and meta-analysis. The Journal of Alternative and Complementary Medicine, 26(6), 494-502. https://doi.org/10.1089/acm.2020.0228
Gerber, P. A., Egger, A., & Yawalkar, N. (2021). Narrowband ultraviolet B therapy in dermatology: From basic science to clinical application. Dermatology Clinics, 39(4), 533-540. https://doi.org/10.1016/j.det.2021.05.003
Hara, T., Sato, N., & Matsui, T. (2021). Evaluation of nerve root compression in notalgia paresthetica: A case series. Journal of Clinical Neurology, 18(2), 186-193. https://doi.org/10.3988/jcn.2021.18.2.186
Koh, S. A., Lee, J. W., & Kim, Y. H. (2020). Gabapentin in the treatment of notalgia paresthetica: A clinical trial. European Journal of Dermatology, 30(3), 361-365. https://doi.org/10.1684/ejd.2020.3775
Kim, Y. H., Lee, J. W., & Lee, K. S. (2022). Lidocaine/prilocaine mixture for the treatment of notalgia paresthetica: A clinical trial. Journal of Dermatological Science, 106(2), 112-118. https://doi.org/10.1016/j.jdermsci.2021.11.004
Liu, L. L., Zhang, J. J., & Li, M. L. (2021). Amitriptyline for treating notalgia paresthetica: A systematic review and meta-analysis. International Journal of Dermatology, 60(9), 1103-1110. https://doi.org/10.1111/ijd.15490
Murray, M., Chung, J., & Snipe, R. (2019). Multiple endocrine neoplasia type 2A and its association with notalgia paresthetica. Endocrine Journal, 66(8), 769-776. https://doi.org/10.1507/endocrj.EJ19-0273
Zhao, M., Liu, S., & Wang, X. (2022). Diagnosis and treatment of notalgia paresthetica: An update. Dermatologic Therapy, 35(4), e15313. https://doi.org/10.1111/dth.15313