Notalgia paresthetica: a study on pathogenesis

Şavk, Ekin; Şavk, Şevki Öner; Bölükbaşı, Okan; Ccedilulhaci, Nil; Dikicioğlu, Emel; Karaman, Göksun; Şendur, Neslihan

doi:10.1046/j.1365-4362.2000.00080.x

Cited by 84 publications

(64 citation statements)

References 21 publications

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“…Factors implicated include a hereditary component, increased dermal innervation, neurotoxicity of certain chemicals and spinal nerve injury due to trauma or entrapment [4, 9, 11, 12, 13, 14]. …”

Section: Discussionmentioning

confidence: 99%

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Immunohistochemical Findings in Notalgia paresthetica

et al. 2002

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Background: Notalgia paresthetica (NP) is a sensory neuropathy the pathogenesis of which is not yet completely elucidated. Objective: The aim of this study was to investigate the histopathological changes in NP with special emphasis on cutaneous innervation. Methods: Along with site-matched biopsies from 5 healthy individuals, lesional skin biopsies from 14 cases of NP and biopsies from contralateral nonlesional skin in 9 of these cases were stained with hematoxylin-eosin and Congo red. For immunohistochemical analysis, all samples were stained with two general neural markers (S-100 protein and protein gene product 9.5) and two neuropeptides (vasoactive intestinal polypeptide and substance P). Results: Light microscopy was compatible with postinflammatory hyperpigmentation. Immunohistochemistry did not reveal a significant difference in the staining pattern of lesional skin and control tissue (p > 0.05). Although not reaching statistical significance, the percentage of cases which showed no staining was higher in the group of patients with more chronic NP. Conclusion: The finding of less immunohistochemical staining in cases with more chronicity could be of clinical importance and is worth investigating further.

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Section: Discussionmentioning

confidence: 99%

“…The dermatological finding which consists of a well-circumscribed hyperpigmented patch is thought to be secondary to the chronic rubbing and scratching due to the pruritus [4, 5, 6]. The pathogenesis of NP is not yet completely elucidated, and investigational studies about this entity are rare [4, 7, 8, 9, 10]. …”

Section: Introductionmentioning

confidence: 99%

Immunohistochemical Findings in Notalgia paresthetica

et al. 2002

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“…6 Another study suggested that nerve root impingement may be causative because several patients had degenerative changes of the vertebrae corresponding with the affected dermatome. 7 A genetic basis has been suggested. 3 Treatment options to date have been unsatisfactory.…”

Section: Commentmentioning

confidence: 99%

Successful Treatment of Notalgia Paresthetica With Botulinum Toxin Type A

Weinfeld

2007

Arch Dermatol

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“…Studies have shown that over 60% of patients with notalgia paresthetica have degenerative vertebral changes or herniated discs that correspond with the dermatomal distribution of their symptoms. 1 Savk et al 3 reported a striking correlation of localization of notalgia paresthetica with degenerative changes in the spines of 10 patients, suggesting that spinal nerve impingement may be important to its pathogenesis. Notalgia paresthetica has also been reported with radiologic evidence of low cervical spinal compression.…”

Section: Discussionmentioning

confidence: 99%

“…Notalgia paresthetica is not believed to be rare, although it is not frequently reported or studied. 3 A number of physical and pharmacologic therapies have been described, with variable results. Herein, we report a case of notalgia paresthetica that responded to cervical traction with permanent resolution of symptoms.…”

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Notalgia Paresthetica Relieved by Cervical Traction

Low

Swanson

2017

J Am Board Fam Med

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Notalgia paresthetica is a syndrome of unilateral, chronic pruritis that is associated with burning pain, paresthesia, numbness, and hyperesthesia localized to the medial and inferior scapula. The condition does not respond to anti-inflammatory drugs or traditional antipruritic agents and has variable responses to numerous other reported pharmacologic and nonpharmacologic therapies. Although the etiology is thought to be nerve impingement, neurologic and musculoskeletal causes are often not considered in the differential diagnosis. We present a report of a woman with a 2-year history of refractory notalgia paresthetica. Notalgia paresthetica, first described in 1934, is a unilateral pruritus located medial or inferior to the scapula.1 Burning pain, paresthesia, numbness, and hyperesthesia may accompany the itch. 2 The condition is more prevalent in middle-aged women and is often chronic, lasting for years. 1 The condition is similar to other forms of neuropathic itch or neurocutaneous dysesthesias, such as meralgia paresthetica and brachioradialis syndrome. Notalgia paresthetica is not believed to be rare, although it is not frequently reported or studied. 3 A number of physical and pharmacologic therapies have been described, with variable results. Herein, we report a case of notalgia paresthetica that responded to cervical traction with permanent resolution of symptoms. Case ReportA 49-year-old woman presented with a 2-year history of increasing pruritus and skin sensitivity. She had a history of atopy and initially attributed the cause of the condition to a clothing allergy. The pruritus was localized to the left midscapular region, extending to the posterior and medial upper arm and axilla. The itch was present most of the day, occasionally wakening her from sleep at night, and was aggravated by hot weather and hot showers. Topical corticosteroid, ketamine, lidocaine, and menthol therapies provided only temporary relief. On examination, there was slight hyperesthesia of the involved skin and a few excoriations but no evidence of dermatitis, induration, warmth, or swelling. A punch biopsy of the involved skin showed no pathologic findings. A computed tomographic scan of the patient's cervical spine revealed a small C5-C6 central disk herniation, not impacting the thecal sac. At the C7-T1 level, there was a mild to moderate, left-sided bony neuroforaminal stenosis with a possible C8 root compromise.The patient was prescribed a 6-week course of cervical mechanical traction of the C4 -C7 vertebrae and exercises to release the left upper trapezius and posterior shoulder capsule and to strengthen the lower trapezius, as well as posture education.

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Notalgia paresthetica: a study on pathogenesis

Abstract: The striking correlation of notalgia paresthetica localization with degenerative changes in the spine suggests that spinal nerve impingement may contribute to the pathogenesis of this entity.

Cited by 84 publications

References 21 publications

Immunohistochemical Findings in Notalgia paresthetica

Immunohistochemical Findings in Notalgia paresthetica

Successful Treatment of Notalgia Paresthetica With Botulinum Toxin Type A

Notalgia Paresthetica Relieved by Cervical Traction

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