Notalgia paresthetica

Abstract

55-year-old woman states that she has itching to the right side of her mid-back for about the last 2 years. At fi rst, it did not bother her, but she has noticed it more in the past 6 months. The itch has worsened and is always in the same location. She reports that her husband didn't see anything on her back except a brownish "birth mark" that looked a lot like "a big freckle." You examine the patient and see a 5 cm fl at, irregularly shaped, slightly hyperpigmented patch with indistinct borders and no excoriations.