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Notalgia paresthetica
Other Resources UpToDate PubMed

Notalgia paresthetica

Contributors: Sruthi Renati MD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Notalgia paresthetica is a condition of the skin of the upper back with extreme pruritus in a localized area just below or medial to the scapula. Notalgia paresthetica is felt to be secondary to spinal nerve impingement, causing a sensory neuropathy and persistent itch. Pain, paresthesias, and hyperesthesias may coincide with the itch. Hyperpigmented or lichenified skin changes, if present, are due to chronic rubbing and scratching of the affected area.

Notalgia paresthetica is relatively common but perhaps underdiagnosed. It can affect people of any age, any race, and either sex. However, it is thought to be most common in middle-aged to older adults. Women seem to develop notalgia paresthetica more frequently than men. A higher body mass index has been associated with longer disease duration.

A related entity is macular amyloidosis, which can also be caused by chronic rubbing. Both notalgia paresthetica and macular amyloidosis can be cutaneous markers of multiple endocrine neoplasia type 2, or Sipple syndrome, especially if onset is during childhood or adolescence.

Although the etiology of notalgia paresthetica is not entirely certain, some studies have demonstrated, radiographically, degenerative changes of the spine corresponding to the level of the nerve root affecting the pruritic skin, typically T2-T6. The posterior rami of T2-T6 have a perpendicular anatomical course through the multifidus spinae muscle, which may predispose them to entrapment and injury.

Codes

ICD10CM:
R20.2 – Paresthesia of skin

SNOMEDCT:
277802001 – Notalgia paresthetica

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Postinflammatory hyperpigmentation
  • Macular amyloidosis
  • Nummular dermatitis
  • Fixed drug eruption
  • Drug-induced pigmentation
  • Lichen simplex chronicus
  • Neurodermatitis

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:08/05/2018
Last Updated:08/05/2018
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Patient Information for Notalgia paresthetica
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Notalgia paresthetica
A medical illustration showing key findings of Notalgia paresthetica : Hyperpigmented patch, Shoulder, Unilateral distribution, Upper back, Pruritus
Clinical image of Notalgia paresthetica - imageId=322995. Click to open in gallery.  caption: 'A hyperpigmented patch with an overlying scaly papule at the inferior angle of the scapula.'
A hyperpigmented patch with an overlying scaly papule at the inferior angle of the scapula.
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