Notalgia paresthetica


Also known as Hereditary localized pruritus.

A chronic sensory neuropathy.

A common localized itch, affecting mainly the interscapular area, especially the T2–T6 dermatomes.

Occasionally is more widespread distribution, involving the shoulders, back, and upper chest.

The characteristic symptom is pruritus on the back, usually on the left hand side below the shoulder blade.

Characterized by recurrent, usually localized unilateral itching in the interscapular and paravertebral regions.

Pruritus is occasionally accompanied by pain, paresthesias such as pins and needles, or increased sensitivity of the skin to sensory stimuli, such as pain, heat, cold, or touch, which results in a well circumscribed hyperpigmentation of a skin patch in the affected area.

The causes are not yet been completely defined.

Patients are usually older persons.

Notalgia paraesthetica localization corresponds degenerative changes in the spine suggesting spinal nerve impingement may be a contributing cause.

The posterior rami of spinal nerves arising in T2 through T6 pursue a right-angle course through the multifidus spinae muscle, and this particular circumstance may predispose them to harm from otherwise innocuous insults of a varied nature.

Speculated that it is caused by damage to the cutaneous branches of the dorsal rami of the thoracic spinal nerves.

Patients may have other conditions that predispose them to peripheral neuropathies.

Excessive scratching often leads to pigmentary changes or lichenification of the area.

Therapy is directed at controlling symptoms.

No cure exists.

It is resistant to numerous treatments and traditional antipruritic therapies, such as anti-histamines and topical glucocorticoids have been ineffective.

Treatments include local anesthetics, topical capsaicin, topical gabapentinoids, corticosteroids, hydroxyzine, oxcarbazepine, gabapentin, and nerve block and botulinum toxin injections may also be helpful.

Difelikeafalin, a selective kappa opioid, receptor agonist, and has been shown to have efficacy and safety in the treatment of moderate to severe pruritus is associated with notalgia paresthetica.

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