Notalgia paresthetica (NP) causes intense itching, burning, or tingling between shoulder blade and spine.
Due to continuous rubbing and scratching, many patients develop a colored patch on their skin in this area. It may last for months to years.
Neurocutaneous disorders like spina paresthetica cause various spinal paresthesias. NP presents as tan or hyperpigmented patch in symptomatic area. Chronic with periodic remissions and exacerbations.
The condition is related to cervical musculoskeletal issues at C5-C6 position. NP was first described in 1934 by the Russian neurologist Michail Astwazaturow.
NP happens due to irritation or damage to certain nerves. This condition is not life-threatening or dangerous to health.
‘Notalgia’ meaning ‘pain in the back,’ while ‘paresthetica’ meaning “burning pain or itch.”
Epidemiology
Narcolepsy is common but undiagnosed leading to unknown true frequency and incidence rates.
It targets adults >50 years old with higher prevalence in women and individuals assigned female at birth.
NP affects both males and females with a female preference. NP seen in all races with no racial preference described.
No specific geographic records have been identified as cases are reported worldwide.
Anatomy
Pathophysiology
The cause of itch and discomfort is related to peripheral neuropathy. The brain and spinal cord modify sensory signals from the affected nerves that create a sensation of itching or pain disproportionate.
It may affect one or both upper extremities. Skin changes such as hyperpigmentation or atrophy may occur in affected area.
Dysregulation causes abnormal firing of itch nerves without physical stimulus.
Chronic scratching causes keratinocyte damage leading to amyloid formation in amyloidosis.
Etiology
The causes of NP are:
Nerve Injury or Irritation
Postherpetic neuralgia
Trauma
Underlying conditions
Genetics
Prognostic Factors
Symptoms can be controlled but condition may fluctuate naturally over time.
NP symptoms not deadly, but significantly decrease quality of life causing discomfort. The increased morbidity due to cervical and thoracic spine issues.
Chronic cases show improvement with proper treatment, but full recovery is not claim.
Sedentary jobs and poor posture can lead to more relapses and worse prognosis.
Clinical History
Collect details such as presenting symptoms, family and medical history to know clinical history of patient.
Physical Examination
Functional examination
Neurological examination
Skin examination
Itching assessment
Age group
Associated comorbidity
Notalgia paresthetica is often considered an idiopathic condition, meaning it is not linked to a specific underlying disease or comorbidity. However, certain factors or conditions may contribute to its development or exacerbation, such as:
Spinal Degenerative Changes: Osteoarthritis or degenerative disc disease may lead to bony growths or herniated discs, potentially compressing the nerves in the upper back and contributing to notalgia paresthetica.
Muscle Tension: Increased muscle tension or spasms in the back muscles can potentially compress the nerves and lead to symptoms.
Postural Habits: Poor posture, repetitive movements, or activities that put strain on the upper back may be associated with the condition.
Dermatological Factors: Some studies suggest underlying dermatological abnormalities, such as changes in skin innervation or nerve endings, may contribute to symptoms.
Associated activity
Acuity of presentation
Acute symptoms are:
Itching, paresthesia, local tenderness, pain
Differential Diagnoses
Post inflammatory Hyperpigmentation
Herpes Zoster
Prurigo Nodularis
Tinea Corporis
Brachioradial Pruritus
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Use camphor and menthol-based antipruritic compounds to provide limited relief.
Use topical treatments with steroids to provide partial relief in neurofibromatosis type 1 cases.
Cervical spine imaging is performed to diagnose degenerative spine issues without medical history.
Early spinal nerve impingement may contribute to skin symptoms in degenerative or traumatic cervicothoracic disease.
Use Botulinum toxin A in cervical degenerative disk disease and nerve impingement cases.
Notalgia paresthetica (NP) causes intense itching, burning, or tingling between shoulder blade and spine.
Due to continuous rubbing and scratching, many patients develop a colored patch on their skin in this area. It may last for months to years.
Neurocutaneous disorders like spina paresthetica cause various spinal paresthesias. NP presents as tan or hyperpigmented patch in symptomatic area. Chronic with periodic remissions and exacerbations.
The condition is related to cervical musculoskeletal issues at C5-C6 position. NP was first described in 1934 by the Russian neurologist Michail Astwazaturow.
NP happens due to irritation or damage to certain nerves. This condition is not life-threatening or dangerous to health.
‘Notalgia’ meaning ‘pain in the back,’ while ‘paresthetica’ meaning “burning pain or itch.”
Narcolepsy is common but undiagnosed leading to unknown true frequency and incidence rates.
It targets adults >50 years old with higher prevalence in women and individuals assigned female at birth.
NP affects both males and females with a female preference. NP seen in all races with no racial preference described.
No specific geographic records have been identified as cases are reported worldwide.
The cause of itch and discomfort is related to peripheral neuropathy. The brain and spinal cord modify sensory signals from the affected nerves that create a sensation of itching or pain disproportionate.
It may affect one or both upper extremities. Skin changes such as hyperpigmentation or atrophy may occur in affected area.
Dysregulation causes abnormal firing of itch nerves without physical stimulus.
Chronic scratching causes keratinocyte damage leading to amyloid formation in amyloidosis.
The causes of NP are:
Nerve Injury or Irritation
Postherpetic neuralgia
Trauma
Underlying conditions
Symptoms can be controlled but condition may fluctuate naturally over time.
NP symptoms not deadly, but significantly decrease quality of life causing discomfort. The increased morbidity due to cervical and thoracic spine issues.
Chronic cases show improvement with proper treatment, but full recovery is not claim.
Sedentary jobs and poor posture can lead to more relapses and worse prognosis.
Collect details such as presenting symptoms, family and medical history to know clinical history of patient.
Functional examination
Neurological examination
Skin examination
Itching assessment
Notalgia paresthetica is often considered an idiopathic condition, meaning it is not linked to a specific underlying disease or comorbidity. However, certain factors or conditions may contribute to its development or exacerbation, such as:
Spinal Degenerative Changes: Osteoarthritis or degenerative disc disease may lead to bony growths or herniated discs, potentially compressing the nerves in the upper back and contributing to notalgia paresthetica.
Muscle Tension: Increased muscle tension or spasms in the back muscles can potentially compress the nerves and lead to symptoms.
Postural Habits: Poor posture, repetitive movements, or activities that put strain on the upper back may be associated with the condition.
Dermatological Factors: Some studies suggest underlying dermatological abnormalities, such as changes in skin innervation or nerve endings, may contribute to symptoms.
Acute symptoms are:
Itching, paresthesia, local tenderness, pain
Post inflammatory Hyperpigmentation
Herpes Zoster
Prurigo Nodularis
Tinea Corporis
Brachioradial Pruritus
Use camphor and menthol-based antipruritic compounds to provide limited relief.
Use topical treatments with steroids to provide partial relief in neurofibromatosis type 1 cases.
Cervical spine imaging is performed to diagnose degenerative spine issues without medical history.
Early spinal nerve impingement may contribute to skin symptoms in degenerative or traumatic cervicothoracic disease.
Use Botulinum toxin A in cervical degenerative disk disease and nerve impingement cases.
Dermatology, General
Use ergonomic chairs and adjustable desks to improve posture of patient at work.
In every 30 to 60 minutes, one should remind for break and walk to reduce muscle tension.
Maintain comfortable temperature to avoid worsen symptoms of extreme temperatures.
Proper awareness about NP should be provided and its related causes with management strategies.
Appointments with a dermatologist and preventing recurrence of disorder is an ongoing life-long effort.
Dermatology, General
Clobetasol propionate:
It stabilizes lysosomal membranes to inhibit PMN and mast cell degranulation.
Fluocinonide:
It inhibits cell proliferation with antipruritic and vasoconstrictive properties.
Triamcinolone:
It suppresses the migration of PMNs to reverse capillary permeability.
Dermatology, General
Hydroxyzine hydrochloride:
It suppresses histamine activity in the subcortical region of CNS.
Dermatology, General
Capsaicin:
It deeply penetrates for temporary relief of minor muscle and joint pain.
Dermatology, General
Intervention of neck pain with cervical issues includes use of injections in severe cases.
Surgical options for cervical degenerative disease and nerve impingement include fusion, disk replacement, and injectable techniques.
Dermatology, General
In the initial treatment phase medical history, physical examination and sensory testing conducted to confirm diagnosis.
Pharmacologic therapy is effective in the treatment phase as it includes use of topical corticosteroid, antipruritic, and topical analgesic.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical intervention.
The regular follow-up visits with the dermatologist are scheduled to check the improvement of patients along with treatment response.
Notalgia paresthetica (NP) causes intense itching, burning, or tingling between shoulder blade and spine.
Due to continuous rubbing and scratching, many patients develop a colored patch on their skin in this area. It may last for months to years.
Neurocutaneous disorders like spina paresthetica cause various spinal paresthesias. NP presents as tan or hyperpigmented patch in symptomatic area. Chronic with periodic remissions and exacerbations.
The condition is related to cervical musculoskeletal issues at C5-C6 position. NP was first described in 1934 by the Russian neurologist Michail Astwazaturow.
NP happens due to irritation or damage to certain nerves. This condition is not life-threatening or dangerous to health.
‘Notalgia’ meaning ‘pain in the back,’ while ‘paresthetica’ meaning “burning pain or itch.”
Narcolepsy is common but undiagnosed leading to unknown true frequency and incidence rates.
It targets adults >50 years old with higher prevalence in women and individuals assigned female at birth.
NP affects both males and females with a female preference. NP seen in all races with no racial preference described.
No specific geographic records have been identified as cases are reported worldwide.
The cause of itch and discomfort is related to peripheral neuropathy. The brain and spinal cord modify sensory signals from the affected nerves that create a sensation of itching or pain disproportionate.
It may affect one or both upper extremities. Skin changes such as hyperpigmentation or atrophy may occur in affected area.
Dysregulation causes abnormal firing of itch nerves without physical stimulus.
Chronic scratching causes keratinocyte damage leading to amyloid formation in amyloidosis.
The causes of NP are:
Nerve Injury or Irritation
Postherpetic neuralgia
Trauma
Underlying conditions
Symptoms can be controlled but condition may fluctuate naturally over time.
NP symptoms not deadly, but significantly decrease quality of life causing discomfort. The increased morbidity due to cervical and thoracic spine issues.
Chronic cases show improvement with proper treatment, but full recovery is not claim.
Sedentary jobs and poor posture can lead to more relapses and worse prognosis.
Collect details such as presenting symptoms, family and medical history to know clinical history of patient.
Functional examination
Neurological examination
Skin examination
Itching assessment
Notalgia paresthetica is often considered an idiopathic condition, meaning it is not linked to a specific underlying disease or comorbidity. However, certain factors or conditions may contribute to its development or exacerbation, such as:
Spinal Degenerative Changes: Osteoarthritis or degenerative disc disease may lead to bony growths or herniated discs, potentially compressing the nerves in the upper back and contributing to notalgia paresthetica.
Muscle Tension: Increased muscle tension or spasms in the back muscles can potentially compress the nerves and lead to symptoms.
Postural Habits: Poor posture, repetitive movements, or activities that put strain on the upper back may be associated with the condition.
Dermatological Factors: Some studies suggest underlying dermatological abnormalities, such as changes in skin innervation or nerve endings, may contribute to symptoms.
Acute symptoms are:
Itching, paresthesia, local tenderness, pain
Post inflammatory Hyperpigmentation
Herpes Zoster
Prurigo Nodularis
Tinea Corporis
Brachioradial Pruritus
Use camphor and menthol-based antipruritic compounds to provide limited relief.
Use topical treatments with steroids to provide partial relief in neurofibromatosis type 1 cases.
Cervical spine imaging is performed to diagnose degenerative spine issues without medical history.
Early spinal nerve impingement may contribute to skin symptoms in degenerative or traumatic cervicothoracic disease.
Use Botulinum toxin A in cervical degenerative disk disease and nerve impingement cases.
Dermatology, General
Use ergonomic chairs and adjustable desks to improve posture of patient at work.
In every 30 to 60 minutes, one should remind for break and walk to reduce muscle tension.
Maintain comfortable temperature to avoid worsen symptoms of extreme temperatures.
Proper awareness about NP should be provided and its related causes with management strategies.
Appointments with a dermatologist and preventing recurrence of disorder is an ongoing life-long effort.
Dermatology, General
Clobetasol propionate:
It stabilizes lysosomal membranes to inhibit PMN and mast cell degranulation.
Fluocinonide:
It inhibits cell proliferation with antipruritic and vasoconstrictive properties.
Triamcinolone:
It suppresses the migration of PMNs to reverse capillary permeability.
Dermatology, General
Hydroxyzine hydrochloride:
It suppresses histamine activity in the subcortical region of CNS.
Dermatology, General
Capsaicin:
It deeply penetrates for temporary relief of minor muscle and joint pain.
Dermatology, General
Intervention of neck pain with cervical issues includes use of injections in severe cases.
Surgical options for cervical degenerative disease and nerve impingement include fusion, disk replacement, and injectable techniques.
Dermatology, General
In the initial treatment phase medical history, physical examination and sensory testing conducted to confirm diagnosis.
Pharmacologic therapy is effective in the treatment phase as it includes use of topical corticosteroid, antipruritic, and topical analgesic.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical intervention.
The regular follow-up visits with the dermatologist are scheduled to check the improvement of patients along with treatment response.
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