Just below the shoulder blade (scapula), a pigmented patch typical of notalgia paresthetica. A close-up of hyperpigmented patch of notalgia paresthetica. The brown, flat area underneath the right shoulder blade is caused by continual rubbing and scratching.
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Notalgia Paraesthetica  Information for adults

Picture of Notalgia Paraesthetica: Just below the shoulder blade (scapula), a pigmented patch typical of notalgia paresthetica. Divider line
Just below the shoulder blade (scapula), a pigmented patch typical of notalgia paresthetica.
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Overview
Notalgia paresthetica is a condition where the skin of the upper back becomes itchy, and there is often a darker patch of skin on the itchy area. Notalgia paresthetica may be caused by a problem with the nerve cells that provide feeling to the skin of the upper back (sensory neuropathy). Skin changes, if present, are due to chronic rubbing and scratching of the affected area.
Who's At Risk
Notalgia paresthetica can affect people of any age, of any race, and of either sex. However, it is thought to be most common in middle-aged to older adults. Women seem to develop notalgia paresthetica more frequently than men.

Though researchers are not certain what causes notalgia paresthetica, some studies have demonstrated spine disease in the spinal bone (vertebra) at the level of the affected skin. Scientists speculate that spine disease due to age or injury may press on a nerve providing feeling to that area of the skin, which leads to itching.
Signs and Symptoms
The most common location for notalgia paresthetica is the upper back, especially between the shoulder blades. The area may be confined to only one side of the upper back, or it may occur in the middle of the upper back, over the spinal bones.

Notalgia paresthetica often occurs without any obvious changes to the skin. If skin changes do occur, there may be a well-defined patch of darker skin (hyperpigmentation) over the affected area.

Although periodic itching is the main symptom associated with notalgia paresthetica, some people notice pain, tingling, or a change in feeling (sensation) in the affected skin.
Self-Care Guidelines
Dry skin is a common cause of itching, so it helps to apply a moisturizer to the itchy area at least twice a day.

If moisturizers are not helpful, try an over-the-counter cream containing an extract of hot peppers, called capsaicin, and follow the package directions carefully. You will probably not get immediate relief, and the capsaicin cream may take up to 6 weeks to have its full effect. If the capsaicin cream is effective, symptoms will likely come back after you stop using the cream.
When to Seek Medical Care
If moisturizers and capsaicin cream are not helpful, see your doctor for an evaluation.
Treatments Your Physician May Prescribe
Your doctor may be able to diagnose notalgia paresthetica by taking your history and examining your skin. In addition, your doctor might order an X-ray or another type of radiologic study, such as an MRI or a CT scan.

If you do have a diagnosis of notalgia paresthetica, your doctor may try the following:
  • Prescription-strength anesthetic cream
  • Prescription-strength corticosteroid (cortisone) cream
If the itching or pain becomes intolerable or interferes with your activities, your doctor may prescribe an oral anti-seizure (anti-epileptic or anti-convulsant) medication, such as:
  • Gabapentin
  • Topiramate
  • Oxcarbazepine
If these approaches are not effective, and if your symptoms are severe enough to justify it, more aggressive procedures may be performed to relieve pressure on the compressed nerve:
  • Injection of local anesthetic near the compressed nerves as they exit the spine (paravertebral block)
  • Spine surgery

References

Bolognia, Jean L., ed. Dermatology, pp.105. New York: Mosby, 2003.

Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed. pp.402. New York: McGraw-Hill, 2003.
Last Updated: 22 Dec 2008