What’s that itch?…Notalgia Paresthetica…..

Notalgia paresthetica is a condition that causes an area of the skin on the back to feel an intense itch but the skin shows no rash or change in most people. It affects usually only one side of the back and localizes to the shoulder blade area. Most patients complain of an intense itch or a weird sensation like a tingling or a creepy-crawly feeling at the location and there is no redness, rash, or change to the skin where the sensation/itch is occurring. The itch may be intermittent or continuous and is not usually relieved by scratching. Over time if there is repeated scratching or rubbing of that area the skin can actually become hyperpigmented (darker) and sometimes will thicken or become almost leather-like.

Notalgia paresthetica is not a skin issue despite it seeming as such. Nerves are the actual cause for this condition. The nerves that supply sensation to the skin of the upper back exit the spinal cord at the area of the lower neck/upper back. They can become trapped or compressed for a number of reasons at the level of the neck and this results in nerve irritation and symptoms.

Treatment can be frustrating and difficult for this condition again since the nerves, not the skin is the cause. Most treatments that we try are applied to the skin to seek relief. Cooling creams or lotions that contain camphor or menthol can be helpful. Topical steroids can be used to help treat the skin if it has become thick from repeated scratching. Other topical products containing capsaicin or lidocaine are sometimes helpful as well.

A visit with a neurologist or orthopedist is often recommended to assess the cause and come up with an effective treatment plan. X-rays or other studies may be ordered and physical therapy may be used in some cases. Notalgia paresthetica is luckily not harmful or dangerous but can be frustrating to effectively treat.