Neuropathic itch of the back: a case of notalgia paresthetica.

Abstract

Notalgia paresthetica refers to an isolated mononeuropathy involving chronic

localized itch or paresthesia most often at the skin of the scapula or

surrounding regions. There are no specific skin manifestations except those

arising from chronic scratching and rubbing. The specific etiology remains

unknown; however, it has been theorized that the neuropathic itch is caused by

sensory nerve entrapment involving the posterior rami of the T2 to T6 nerve root.

The entrapment is due to degenerative changes in the vertebrae. We report here a

particular case of notalgia paresthetica in a 55-year-old woman. The patient

visited our hospital for tingling pain around the left inferior angle of the

scapula. Pruritus was first reported seven years ago with tingling pain

developing only four months ago. There were no specific skin lesions observed

except for excoriation and vague hyperpigmentation. A skin biopsy revealed only

epidermal thinning with pigmentary incontinence. The patient was treated with 600

mg of gabapentin daily as well as capsaicin cream. The response was deemed

unsatisfactory.