Notalgia Paresthetica

Overview

Notalgia paresthetica is a sensory neuropathy of the upper back characterized by localized itching, tingling, burning, or pain, typically in the area between the shoulder blades (infrascapular region). It is caused by nerve entrapment or irritation of the dorsal spinal nerves (T2-T6), often related to degenerative changes in the thoracic spine. A hyperpigmented patch may develop in the affected area from chronic rubbing and scratching.

Key Symptoms

Localized, often intense itching on the upper-to-mid back, usually unilateral
Tingling, burning, numbness, or prickling sensation in the affected area
Hyperpigmented patch from chronic scratching (may be the presenting sign)
Symptoms typically in the infrascapular region between the shoulder blades
Itching may be intermittent or constant and is often refractory to topical treatments
Symptoms may worsen with certain postures or spinal movements

Affected Areas

Infrascapular region (between shoulder blades), Upper back, Mid-back (T2-T6 dermatome)

Care Instructions

See a dermatologist for evaluation and to rule out other causes of localized itching.
Topical capsaicin cream (0.025-0.1%) applied 3-5 times daily can desensitize nerve fibers over time.
Oral medications such as gabapentin or pregabalin may provide relief by targeting nerve-related itch.
Topical anesthetics (lidocaine patches) can provide temporary symptomatic relief.
Physical therapy and exercises to improve thoracic spine posture may help address the underlying cause.
Botulinum toxin injections have shown benefit in refractory cases.

Medical Disclaimer: This information is for educational purposes only and does not replace professional medical advice. Always consult a qualified dermatologist for diagnosis and treatment.

Prevalence: Common but underdiagnosed; frequently seen in middle-aged and older adults