A 74-year-old man presented with a 1-year history of an unexplained intermittent itch and stabbing pain on his upper back, medial to his left scapula. On an examination, scratching scars and hyperpigmentation were observed in the area (Picture), accompanied by hypoesthesia, without signs of inflammation. Notalgia paresthetica was diagnosed based on these findings. His symptoms resolved after treatment with capsaicin ointment. Notalgia paresthetica is an entrapment neuropathy caused by compression of the 2nd to 6th thoracic rami of the posterior root of the spinal nerve due to degeneration of the spine or intervertebral discs, extended bedridden periods, or muscular compression (1,2). Symptoms are itching, paresthesia and stinging/burning pain of the upper back. Pigmentation is present in one-third of patients (2). Treatments include gabapentin, capsaicin ointment and stretching exercises (1,2). Antihistamines and topical steroids are ineffective (1). The differential diagnosis includes postherpetic neuralgia and contact dermatitis. Appropriate treatment can improve the patient's quality of life.
Picture.
The authors state that they have no Conflict of Interest (COI).
References
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